Treatment-resistant Late-life Depression: Challenges and Perspectives

Abstract

Abstract:The current Review article provides a narrative review about the neurobiological underpinnings and treatment of treatment resistant late-life depression (TRLLD). The manuscript focuses on therapeutic targets of late-life depression, which include pharmacological, psychological, biophysical and exercise treatment approaches. Therefore, we summarize available evidences on that kind of therapies for patients suffering from late-life depression. The search for evidences of therapeutic options of late-life depression were done using searching websites as "pubmed", and using the searching terms "depression", "late-life depression", "treatment", "biophysical therapy", "exercise therapy", "pharmacological therapy" and "psychological therapy". To the end, we summarize and discuss current data, providing some directions for further research.Treatment recommendations for elderly depressive patients favour a multimodal approach, containing psychological, pharmacological and secondary biophysical therapeutic options. Particularly, a combination of psychotherapy and antidepressant medication reflects the best therapeutic option. However, mostly accepted and used is the pharmacological treatment although evidence suggests that the drug therapy is not as effective as it is in younger depressive patients. Further studies employing larger samples and longer follow-up periods are necessary and may focus on comparability of study designs and involve novel approaches to establish the validity and reliability of multimodal treatment programs.

Transcranial magnetic stimulation for treatment-resistant depression: Naturalistic treatment outcomes for younger versus older patients

“…Compared to their younger counterparts, elderly depressed patients often suffer from a greater burden of cognitive, physical, and functional impairment (Knöchel et al, 2015; Mulsant and Pollock, 1998); poorer course of major depressive disorder (MDD; Licht-Strunk et al, 2007); inadequate antidepressant response or early symptom relapse (Knöchel et al, 2015; Whyte et al, 2004); and more medication side-effects (Lyness et al, 1996). Older patients may also experience more medical comorbidities and significant psychosocial stressors, such as social isolation and caregiver dependence (Knöchel et al, 2015). Given that depression in older age involves these unique clinical challenges, it is important to understand whether available treatments for TRD can be applied in this population.…”

“…A number of neurobiologically plausible mechanisms for an age-related TMS treatment effect have been posited, including atrophy of cortical gray matter (with associated greater coil-to-cortex distance), reduced synaptic connectivity, declining axon conduction velocities, and aging-related changes in lateralization, myelination, cerebrovascular function, and immune-inflammatory control (Bashir et al, 2014; Berlingeri et al, 2013; Knöchel et al, 2015; Kozel et al, 2000). Each of these factors could presumably alter the electromagnetic and anatomic properties of cortical tissue underneath the TMS coil, thereby altering the effect of TMS induced currents.…”

Accuracy of 12 short versions of the Geriatric Depression Scale to detect depression in a prospective study of a high-risk population with different levels of cognition

“…Another aspect that has to be discussed is thatdespite almost all participants receiving antidepressants at the 1-year follow-up, one in four individuals exhibited depressive symptomatology fulfilling criteria for major depression. Treatmentrefractory depression is common in old age (Knochel et al, 2015). Although the short GDS scales detected MDD with low to moderate accuracy, short scales with high sensitivity (88% for the Broekman 7-item version in our sample) could be useful in the follow-up care of high-risk populations.…”

Late life depression: nursing actions that can help

“…Antidepressant medications are usually trialed for approximately 6 weeks; should not be withdrawn abruptly and can be expected to be taken for at least 2 years . However, it is important to note that as many as one‐third of older adults will not respond to antidepressant treatment; relapse rates for those who do respond are high; and the approach is less efficacious than for younger people …”

“…41 However, it is important to note that as many as one-third of older adults will not respond to antidepressant treatment; relapse rates for those who do respond are high; and the approach is less efficacious than for younger people. 13,42 3.5 | Psychological treatment likely to be helpful. 11 Therefore, exploring people's own ideas about the depression they are experiencing and the solutions they believe are valuable is foundational to any treatment approach.…”