Predictors of treatment outcome in depression in later life: A systematic review and meta-analysis

Tunvirachaisakul, Chavit; Gould, Rebecca L.; Coulson, Mark; Ward, Emma V.; Reynolds, Gemma; Gathercole, Rebecca; Grocott, Hannah; Supasitthumrong, Thitiporn; Tunvirachaisakul, Athicha; Kimona, Kate; Howard, Robert

doi:10.1016/j.jad.2017.10.008

Cited by 75 publications

(61 citation statements)

References 140 publications

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“…There is an abundance of evidence assessing the effectiveness of treatments for late-life depression. However, frailer older adults represent an understudied subgroup of this population, and there is evidence that physical illness, older age, and impaired executive functioning can negatively impact pharmacological and non-pharmacological treatment outcomes (Tunvirachaisakul et al, 2017). Antidepressants only appear to be effective when studied as a class, rather than individual drug types, and when reviews use an "older adult" threshold of 55 + years rather than 65 + (Jonsson et al, 2016;Kok et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Non-pharmacological interventions for depression/anxiety in older adults with physical comorbidities affecting functioning: systematic review and meta-analysis

Frost

Bauernfreund

Walters

2018

Int. Psychogeriatr.

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Objective:To review the effectiveness of non-pharmacological interventions in older adults with depression or anxiety and comorbidities affecting functioning.Design:Systematic review and meta-analysis of randomized controlled trials, including searches of 10 databases (inception-Jul 2017).Setting:Home/community.Participants:People aged 60 and over experiencing functional difficulties from physical or cognitive comorbidities and have symptoms or a diagnosis of depression and/or anxiety.Interventions:Non-pharmacological interventions targeted at depression/anxiety.Measurements:We extracted outcome data on depressive symptoms, quality of life, functioning, and service use. We used random effects meta-analysis to pool study data where possible. Two authors assessed the risk of bias using the Cochrane Risk of Bias tool.Results:We identified 14 eligible trials including 2099 randomized participants and two subgroup analyses. Problem-solving therapy (PST) reduced short-term clinician-rated depressive symptoms (n = 5 trials, mean difference in Hamilton Depression Rating Scale score −4.94 [95% CI −7.90 to −1.98]) but not remission, with limited evidence for effects on functioning and quality of life. There was limited high-quality evidence for other intervention types. Collaborative care did not appear to affect depressive symptoms, functioning, or quality of life; and had mixed evidence for effects upon remission. No intervention consistently affected service use, but trials were limited by small sample sizes and short follow-up periods. No anxiety interventions were identified.Conclusion:PST may reduce depressive symptoms post-intervention in older people with depression and functional impairments. Collaborative care appears to have few effects in this population. Future research needs to assess cost-effectiveness, long-term outcomes, and anxiety interventions for this population.

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Section: Introductionmentioning

confidence: 99%

Non-pharmacological interventions for depression/anxiety in older adults with physical comorbidities affecting functioning: systematic review and meta-analysis

Frost

Bauernfreund

Walters

2018

Int. Psychogeriatr.

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“…In addition, depression and anxiety may worsen during the “off periods” that PD patients frequently experience during dopaminergic treatment . This complex presentation has been associated with nonresponse to depression treatment and with high rates of disability and depressive relapse . Given that 56% of PWP in this trial had a comorbid anxiety disorder and the average length of the current depressive episode was 2 years, the current findings reflect the suitability of PD‐informed CBT to addressing dPD's heterogeneity and psychiatric complexity.…”

Section: Discussionmentioning

confidence: 81%

Cognitive behavioral therapy improves diverse profiles of depressive symptoms in Parkinson's disease

Dobkin

Mann

Interian

et al. 2019

Int J Geriat Psychiatry

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Objective Depression is among the most common and debilitating nonmotor complaints in Parkinson's disease (PD), yet there is a paucity of controlled research to guide treatment. Little research has focused on the extent to which specific depressive symptom profiles may dictate unique clinical recommendations to ultimately improve treatment outcomes. The current study examined the impact of cognitive behavioral therapy (CBT) on different types of depressive symptoms in PD. It was hypothesized that the cognitive (eg, guilt, rumination, and negative attitudes towards self) and behavioral (eg, avoidance and procrastination) symptoms targeted most intensively by the treatment protocol would show the most robust response. The extent to which stabilized antidepressant use moderated specific symptom change was examined on an exploratory basis. Method Eighty depressed people with PD participated in a randomized controlled trial of CBT plus clinical management, versus clinical management only. Hamilton Depression Rating Scale (HAMD) and Beck Depression Inventory (BDI) subscale scores, reflecting depressive symptom heterogeneity in PD, were the focus of this investigation. Results CBT response was associated with significant improvements in mood, sleep, anxiety, and somatic symptoms (HAMD), and negative attitudes toward self, performance impairment, and somatic symptoms (BDI). As hypothesized, the largest effect sizes were observed for cognitive and behavioral (vs somatic) symptoms of depression. Stabilized antidepressant use moderated the effect of CBT on somatic complaints (HAMD and BDI). Conclusions CBT may improve a diverse array of depressive symptoms in PD. Cognitive and behavioral (vs somatic) symptoms showed the greatest change. Combining CBT with antidepressants may help optimize the management of somatic complaints in depression in PD (dPD).

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“…In addition, case-control studies have revealed a positive correlation between depression and subsequent onset of Alzheimer's disease in patients with LOD [8]. A recent meta-analysis revealed that baseline depression severity, co-morbid anxiety, executive dysfunction, current episode duration, early improvement, physical illnesses and age were statistically significant predictors of treatment outcomes of patients with LOD [9].…”

Section: Introductionmentioning

confidence: 99%

Aspirin and Risk of Dementia in Patients with Late-Onset Depression: A Population-Based Cohort Study

Yang

Chiu

Teng³

et al. 2020

BioMed Research International

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Background. Late onset depression (LOD) often occurs in the context of vascular disease and may be associated with risk of dementia. Aspirin is widely used to reduce the risk of cardiovascular disease and stroke. However, its role in patients with LOD and risk of dementia remains inconclusive. Materials and Methods. A population-based study was conducted using data from National Health Insurance of Taiwan during 1996–2009. Patients fulfil diagnostic criteria for LOD with or without subsequent dementia (incident dementia) and among whom users of aspirin (75 mg daily for at least 6 months) were identified. The time-dependent Cox proportional hazards model was applied for multivariate analyses. Propensity scores with the one-to-one nearest-neighbor matching model were used to select matching patients. Cumulative incidence of incident dementia after diagnosis of LOD was calculated by Kaplan–Meier Method. Results. A total of 6028 (13.4%) and 40,411 (86.6%) patients were defined as, with and without diagnosis of LOD, among whom 2,424 (41.9%) were aspirin users. Patients with LOD had more comorbidities such as cardiovascular diseases, diabetes, and hypertension comparing to those without LOD. Among patients with LOD, aspirin users had lower incidence of subsequent incident dementia than non-users (Hazard Ratio = 0.734, 95% CI 0.641–0.841, p<0.001). After matching aspirin users with non-users by propensity scores-matching method, the cumulative incidence of incident dementia was significantly lower in aspirin users of LOD patients (p=0.022). Conclusions. Aspirin may be associated with a lower risk of incident dementia in patients with LOD. This beneficial effect of aspirin in LOD patients needs validation in prospective clinical trials and our results should be interpreted with caution.

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Predictors of treatment outcome in depression in later life: A systematic review and meta-analysis

Cited by 75 publications

References 140 publications

Non-pharmacological interventions for depression/anxiety in older adults with physical comorbidities affecting functioning: systematic review and meta-analysis

Non-pharmacological interventions for depression/anxiety in older adults with physical comorbidities affecting functioning: systematic review and meta-analysis

Cognitive behavioral therapy improves diverse profiles of depressive symptoms in Parkinson's disease

Aspirin and Risk of Dementia in Patients with Late-Onset Depression: A Population-Based Cohort Study

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