Residual symptoms and recurrence during maintenance treatment of late-life depression

Dombrovski, Alexandre Y.; Mulsant, Benoit H.; Houck, Patricia R.; Mazumdar, Sati; Lenze, Eric J.; Andreescu, Carmen; Cyranowski, Jill M.; Reynolds, Charles F.

doi:10.1016/j.jad.2007.01.020

Cited by 138 publications

(112 citation statements)

References 41 publications

(35 reference statements)

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“…The relatively low recurrence rate in our sample (26% percent in 99 remitters with IPT monotherapy and 50% in 32 remitters with sequential treatment) presumably reflect the protective effect of ongoing treatment; this may have limited our power to detect differences in time to recurrence between patients. Our use of HRSD-17 subscales to assess residual symptoms can be seen as another limitation, because of their relative lack of unidimensionality, characteristic of the HRSD-17 in general (Bagby et al 2004;Dombrovski et al 2007). To address this issue, we used clinically determined cutoffs to define significant levels of residual symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Are certain symptoms more ominous than others and should be targeted preferentially? In older patients with depression, persistent anxiety rather than the core depressive symptoms of low mood, guilt, suicidal thoughts, and anergia/anhedonia herald poorer long-term outcomes (Dombrovski et al 2007). Persistently poor sleep quality, assessed both objectively (Buysse et al 1996;Kupfer et al 1990) and subjectively (Buysse et al 1996;Reynolds et al 1997), also appears to be a marker of unfavorable long-term course.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Which symptoms predict recurrence of depression in women treated with maintenance interpersonal psychotherapy?

Dombrovski¹,

Cyranowski²,

Mulsant³

et al. 2008

Depress. Anxiety

Self Cite

103

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Background-Even low levels of residual symptoms are known to increase the risk of relapse and early recurrence of major depression. It is not known if ongoing psychotherapy lessens this risk. We therefore examined the impact of persistent symptoms, including mood, insomnia, and anxiety symptoms, on time to recurrence in women receiving maintenance interpersonal psychotherapy (IPT-M) for recurrent depression.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Which symptoms predict recurrence of depression in women treated with maintenance interpersonal psychotherapy?

Dombrovski¹,

Cyranowski²,

Mulsant³

et al. 2008

Depress. Anxiety

Self Cite

103

View full text Add to dashboard Cite

show abstract

“…Individuals with LLD experience greater functional disability 14 and cognitive decline 15 than those without. Further, they are at increased risk of morbidity and mortality from medical illness, 16 a phenomenon most likely attributable to a combination of both maladaptive health risk behaviors as well as physiologic effects of LLD.…”

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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“…Among the residual symptoms, disturbed sleep is also the most prevalent (15). The association between insomnia and major depressive relapse or recurrence has also been reported in more recent studies (32,33,34). Armitage stated that persistent sleep problems, insomnia specifically, elevate the risk of relapse and recurrence, as well as the need for augmenting medications (32).…”

Section: The Importance Of Sleep Disturbance As a Residual Symptommentioning

confidence: 71%

“…So, chronic insomnia can be a residual symptom of a previous mood disorder and put these subjects to a higher risk of relapse. Subjective sleep problems, including insomnia, were also found to be predictors of early recurrence in a study of "remitted" patients maintained on an SSRI and psychotherapy (34). …”

Section: The Importance Of Sleep Disturbance As a Residual Symptommentioning

confidence: 99%

The relationship between insomnia and major depressive disorder: a chicken and egg situation?

Güleç¹,

Özcan²,

Oral³

et al. 2017

JMOOD

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ÖZET:Uykusuzluk ve majör depresif bozukluk arasında-ki bağlantı: Bir tavuk ve yumurta durumu mudur?Majör depresif bozukluk (MDB) çok yaygın, şiddetle güç-süz düşürücü ve sıklıkla da yineleyicidir. MDB'li bireylerin önemli bir kısmı uyku düzensizliklerinden yakınırlar. MDB aynı zamanda çeşitli uyku bozukluklu kitleler arasında fazla miktarda temsil edilmektedir. Uyku düzensizlikleri MDB'nin tipik özelliklerinden olsa da, böyle belirtiler bazen bir MDB döneminden önce ortaya çıkarlar. Uyku düzensizliği, özellikle de uykusuzluk ile MDB arasındaki çift yönlü ilişki-ler, aralarındaki neden-sonuç bağlantılarının kurulmasını güçleştirmektedir. Uzunlamasına çalışmalar uykusuzluğu sürekli olarak yeni başlangıçlı ya da yineleyici bir MDB gelişimi için bir risk etmeni olarak tanımlamışlar ve bu ilişki genç, orta yaşlı ve hatta yaşlı erişkinlerde gösterilmiştir. Araştırmalar uykusuzluk ve depresyon birlikteliğinin aynı zamanda dönem şiddeti ve süresi yanında alevlenme oranlarını da artırarak MDB'nin seyrini etkilediğini göz-lemlemişlerdir. Ancak yakın tarihli çalışmalar uykusuzluk için gerek ilaçla gerekse de ilaç dışındaki müdahalelerin MDB'yi uygun bir şekilde azaltabileceği ve belki de önle-yebileceğini göstermişlerdir. Bu bulguların tümü birden uyku ile ilişkili belirtilerin ister bir MDB dönemi öncesinde, isterse de sırasında ve/veya sonrasında olsunlar, düzelme halinin sağlanması ve sürdürülmesinde önemli bir rol oynayabilecek büyük olasılıkla da değiştirilebilir etmenler olduklarını ileri sürülmüştür. The relationship between insomnia and major depressive disorder: a chicken and egg situation?Major Depressive Disorder (MDD) is highly prevalent, severely debilitating, and often recurrent. The majority of individuals with MDD experience sleep disturbances. MDD is also over-represented in populations with a variety of sleep disorders. Although sleep disturbances are typical features of MDD, such symptoms sometimes appear prior to an episode of MDD. The bidirectional association between sleep disturbance, especially insomnia and MDD, increases the difficulty of differentiating cause-and-effect relationship between them. Longitudinal studies have consistently identified insomnia as a risk factor for the development of a new-onset or recurrent MDD, and this association has been identified in young, middle-aged, and even older adults. Researches have also observed that the combination of insomnia and depression influences the trajectory of MDD, increasing episode severity and duration, as well as relapse rates. Fortunately, recent studies have demonstrated that both pharmacological and non-pharmacological interventions for insomnia may favourably reduce and possibly prevent MDD. Together, these findings suggest that sleep-related symptoms that are present before, during, and/or after a major depressive episode are potentially modifiable factors that may play an important role in achieving and maintaining remission of depression. Reviews / Derlemeler DOI: 10.5455/jmood.20120208025502 Major Depressive DisorderMajor depres...

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Residual symptoms and recurrence during maintenance treatment of late-life depression

Abstract: Background-Many older patients who recover from an episode of major depression continue to suffer from depressed mood, anxiety, and sleep problems. Our study assesses the impact of these residual symptoms on the risk of recurrence during maintenance treatment of late-life depression.

Cited by 138 publications

References 41 publications

Which symptoms predict recurrence of depression in women treated with maintenance interpersonal psychotherapy?

Which symptoms predict recurrence of depression in women treated with maintenance interpersonal psychotherapy?

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

The relationship between insomnia and major depressive disorder: a chicken and egg situation?

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