Reducing Suicidal Ideation and Depressive Symptoms in Depressed Older Primary Care Patients

Bruce, Martha L.; Have, Thomas R. Ten; Reynolds, Charles F.; Katz, Ira I.; Schulberg, Herbert C.; Mulsant, Benoit H.; Brown, Gregory K.; McAvay, Gail; Pearson, Jane L.; Alexopoulos, George S.

doi:10.1001/jama.291.9.1081

Cited by 902 publications

(852 citation statements)

References 67 publications

(24 reference statements)

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“…8,40 A few of these trials utilized empirically based psychotherapy as a treatment option for treatment resistant depression. 47,49 Unfortunately, psychotherapy in these trials was delivered as part of a package of collaborative care and its unique contribution to improved outcomes cannot be assessed. Nevertheless, evidence suggests that training nonmental health professionals to deliver brief psychotherapy may improve outcomes in primary care patients without excessively burdening limited resources.…”

Section: Discussionmentioning

confidence: 99%

Examination of the Utility of Psychotherapy for Patients with Treatment Resistant Depression: A Systematic Review

2010

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Section: Discussionmentioning

confidence: 99%

Examination of the Utility of Psychotherapy for Patients with Treatment Resistant Depression: A Systematic Review

2010

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“…For example, only 40-50% of older adults respond to the first prescribed antidepressant medication. 24-25 In those that do respond, response is often slow, sometimes taking up to 4 months 26 and once response is achieved, relapse and recurrence are common. Approximately 60% of community-dwelling older adults with MDD who initially responded to antidepressant treatment became depressed again within 2 years unless they were maintained on antidepressant pharmacotherapy.…”

Section: Late-life Depression: Definition Extent Burden and Hopementioning

confidence: 99%

The Age-by-Disease Interaction Hypothesis of Late-Life Depression

McKinney

Sibille

2013

The American Journal of Geriatric Psychiatry

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The phenomenological diagnosis of depression is successful in increasing diagnostic reliability, but it is a classification scheme without biological bases. One subtype of depression for which evidence suggests a unique biological basis is late-life depression (LLD), with first onset of symptoms after the age of 65. LLD is common and poses a significant burden on affected individuals, caretakers, and society. The pathophysiology of LLD includes disruptions of the neural network underlying mood, which can be conceptualized as the result of dysfunction in multiple underlying biological processes. Here, we briefly review current LLD hypotheses and then describe the characteristics of molecular brain aging and their overlap with disease processes. Further, we propose a new hypothesis for LLD, the Age-by-Disease Interaction hypothesis, which posits that the clinical presentation of LLD is the integrated output of specific biological processes that are pushed in LLD-promoting directions by changes in gene expression naturally occurring during brain aging, hence leading the brain to a physiological state that is more susceptible to LLD, since additional pushes by genetic, environmental and biochemical factors may now be sufficient to generate dysfunctional states that produce depressive symptoms. We put our propositions together into a decanalization model to aid in illustrating how age-related biological changes of the brain can shift the repertoire of available functional states in a pro-depression direction, and how additional factors can readily lead the system into distinct and stable maladaptive phenotypes, including LLD. This model brings together basic research on neuropsychiatric and neurodegenerative diseases more closely with the investigation of normal aging. Specifically, identifying biological processes affected during normal aging may inform the development of new interventions for the prevention and treatment of LLD.

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“…The PROSPECT treatment algorithm and implementation including the types and proportions of treatment received over time by persons in practices randomized to the Intervention Condition or to Usual Care has been described in detail elsewhere (Bruce et al, 2004). Briefly, the intervention consisted of trained depression care managers offering guideline concordant recommendations to the primary care physicians and helping patients with adherence to treatment.…”

Section: Description Of Intervention Condition and Usual Carementioning

confidence: 99%

The effects of memory, attention, and executive dysfunction on outcomes of depression in a primary care intervention trial: the PROSPECT study

Bogner

Bruce

Reynolds

et al. 2007

Int J Geriat Psychiatry

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OBJECTIVE-To describe the influence of domains of cognition on remission and response of depression in an intervention trial among older primary care patients.METHODS-Twenty primary care practices were randomly assigned to Usual Care or to an Intervention consisting of a depression care manager offering algorithm-based care for depression. In all, 599 adults 60 years and older with a depression diagnosis were included in these analyses. Depression severity and remission of depression were assessed by the 24-item Hamilton Depression Rating Scale. The Mini-Mental State Examination (MMSE) was our global measure of cognitive function. Verbal memory was assessed with the memory subscale of the Dementia Rating Scale. Attention was measured with the digit span from the Weschler Adult Intelligence Test. Response inhibition, one of the executive functions, was assessed with the Stroop Color-Word test. RESULTS-The intervention was associated with improved remission and response rates regardless of cognitive impairment. Response inhibition as measured by the Stroop Color-Word test appeared to significantly modify the intervention versus usual care difference in remission and response at 4 months. Patients in the poorest performance quartile at baseline on the Stroop ColorWord test in the Intervention Condition were more likely to achieve remission of depression at 4 months than comparable patients in Usual Care (odds ratio (OR) = 17.76, 95% confidence interval (CI) [3.06, 103.1]).CONCLUSIONS-Depressed older adults in primary care with executive dysfunction have low remission and response rates when receiving usual care but benefit from depression care management.

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Reducing Suicidal Ideation and Depressive Symptoms in Depressed Older Primary Care Patients

Cited by 902 publications

References 67 publications

Examination of the Utility of Psychotherapy for Patients with Treatment Resistant Depression: A Systematic Review

Examination of the Utility of Psychotherapy for Patients with Treatment Resistant Depression: A Systematic Review

The Age-by-Disease Interaction Hypothesis of Late-Life Depression

The effects of memory, attention, and executive dysfunction on outcomes of depression in a primary care intervention trial: the PROSPECT study

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