“What else can we do?”—Provider perspectives on treatment‐resistant depression in late life

Hamm, Megan; Karp, Jordan F.; Lenard, Emily; Dawdani, Alicia; Lavretsky, Helen; Lenze, Eric J.; Mulsant, Benoit H.; Reynolds, Charles F.; Roose, Steven P.; Brown, Patrick J.

doi:10.1111/jgs.17592

Cited by 8 publications

(3 citation statements)

References 40 publications

(71 reference statements)

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“…Patients with LLD can leverage the advantages of telecare to connect with health care professionals, overcoming geographical distance and physical limitations, thereby reducing the psychological burden of coping with the disease [ 43 ]. Furthermore, professional psychological support is crucial for patients with LLD, and it can encourage patients to express their feelings and release stress [ 44 ]. However, it is worth noting that despite telecare offering more possibilities for treating LLD, the complexity of the medical population makes it challenging.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Telecare Interventions on Depression Symptoms Among Older Adults: Systematic Review and Meta-Analysis

Wu,

Li,

et al. 2024

JMIR Mhealth Uhealth

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Background Depression is the most common psychiatric disorder among older adults. Despite the effectiveness of pharmacological and psychological therapies, many patients with late-life depression (LLD) are unable to access timely treatment. Telecare has been shown to be effective in addressing patients' psychosocial issues, while its effectiveness in serving patients with LLD remains unclear. Objective This study aimed to evaluate the effectiveness of telecare in reducing depression and anxiety symptoms and improving quality of life (QoL) in patients with LLD. Methods Databases including the Cochrane Library, Web of Science, PubMed, Embase, and EBSCO were searched for randomized controlled trials (RCTs) evaluating the effectiveness of telecare for LLD from database establishment to December 28, 2022. Results A total of 12 RCTs involving 1663 participants were identified in this study. The meta-analysis showed that (1) telecare significantly reduced depressive symptoms in patients with LLD compared to those in usual care (UC; standardized mean difference [SMD]=–0.46, 95% CI –0.53 to –0.38; P<.001), with the best improvement observed within 3 months of intervention (SMD=–0.72, 95% CI –1.16 to –0.28; P<.001); (2) other scales appeared more effective than the Patient Health Questionnaire-9 for LLD in telecare interventions (SMD=–0.65, 95% CI –0.96 to –0.35; P<.001); (3) telecare was more effective than telephone-based interventions for remote monitoring of LLD (SMD=–1.13, 95% CI –1.51 to –0.76; P<.001); (4) the reduction of depressive symptoms was more pronounced in patients with LLD with chronic conditions (SMD=–0.67, 95% CI –0.89 to –0.44; P<.001); (5) telecare was more effective for LLD in Europe and the Americas than in other regions (SMD=–0.73, 95% CI –0.99 to –0.47; P<.001); (6) telecare significantly reduced anxiety symptoms in patients with LLD (SMD=–0.53, 95% CI –0.73 to –0.33; P=.02); and (7) there was no significant improvement in the psychological components of QoL in patients with LLD compared to those receiving UC (SMD=0.30, 95% CI 0.18-0.43; P=.80). Conclusions Telecare is a promising modality of care for treatment, which can alleviate depression and anxiety symptoms in patients with LLD. Continued in-depth research into the effectiveness of telecare in treating depression could better identify where older patients would benefit from this intervention.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of Telecare Interventions on Depression Symptoms Among Older Adults: Systematic Review and Meta-Analysis

Wu,

Li,

et al. 2024

JMIR Mhealth Uhealth

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“…Major depressive disorder (MDD) is a chronic psychiatric disorder common in older adults characterized by failure to achieve remission despite appropriate treatment with first-line antidepressant medications. MDD could not only reduce quality of life and burden the healthcare system, it may also increase the risk of death [1,2]. The definition of Treatment-resistant depression (TRD) has not been agreed upon.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of aripiprazole or bupropion augmentation and switching in patients with treatment-resistant depression or major depressive disorder: A systematic review and meta-analysis of randomized controlled trials

Ji,

Feng,

Liu

2024

PLoS ONE

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Objectives To report the first and largest systematic review and meta-analysis of randomized controlled trials (RCT) to evaluate the efficacy and safety of aripiprazole or bupropion augmentation and switching in patients with treatment-resistant depression (TRD) or major depressive disorder(MDD). Methods We conducted a systematic literature retrieval via PubMed, Embase, Web of Science, and Cochrane until April 2023 for RCT, which evaluated the efficacy and safety of aripiprazole or bupropion augmentation and switching for patients with TRD or MDD. Outcomes measured were changes in the Montgomery-Asberg Depression Rating Scale (MADRS), response and remission rate, and serious adverse events. Results Five RCTs, including 4480 patients, were included for meta-analysis. Among them, two RCTs were rated as "high risk" in three aspects (allocation concealment, blinding of participants and personnel and blinding of outcome assessment) because of the non-blind method, and the quality evaluation of the remaining works of literature was "low risk". Augmentation treatment with Aripiprazole (A-ARI) was associated with a significant higher response rate compared with augmentation treatment with bupropion (A-BUP) (RR: 1.15; 95% CI: 1.05, 1.25; P = 0.0007; I2 = 23%). Besides, A-ARI had a significant higher remission rate compared with switching to bupropion (S-BUP) (RR: 1.22; 95% CI: 1.00, 1.49; P = 0.05; I2 = 59%) and A-BUP had a significant higher remission rate compared with S-BUP (RR: 1.20; 95% CI: 1.06, 1.36; P = 0.0004; I2 = 0%). In addition, there was no significant difference in remission rate(RR: 1.05; 95% CI: 0.94, 1.17; P = 0.42; I2 = 33%), improvement of MADRS(WMD: -2.07; 95% CI: -5.84, 1.70; P = 0.28; I2 = 70%) between A-ARI and A-BUP. No significant difference was observed in adverse events and serious adverse events among the three treatment strategies. Conclusions A-ARI may be a better comprehensive antidepressant treatment strategy than A-BUP or S-BUP for patients with TRD or MDD. More large-scale, multi-center, double-blind RCTs are needed to further evaluated the efficacy and safety of aripiprazole or bupropion augmentation and switching treatment strategies.

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“…Latelife depression also presents an opportunity for intervention. With appropriate recognition, diagnosis, and treatment, the symptoms of depression can be effectively managed and alleviated, although treatment resistance is prevalent [11,12]. Early intervention can prevent worsening depressive symptoms, reduce disability, enhance cognitive function, and improve overall health outcomes in older adults [13][14][15].…”

Section: Introduction Depression In Elderlymentioning

confidence: 99%

Low Functional network integrity in cognitively unimpaired and MCI subjects with depressive symptoms: results from a multi-center fMRI study

Csukly,

Tombor,

Hidasi

et al. 2024

Transl Psychiatry

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Evidence suggests that depressive symptomatology is a consequence of network dysfunction rather than lesion pathology. We studied whole-brain functional connectivity using a Minimum Spanning Tree as a graph-theoretical approach. Furthermore, we examined functional connectivity in the Default Mode Network, the Frontolimbic Network (FLN), the Salience Network, and the Cognitive Control Network. All 183 elderly subjects underwent a comprehensive neuropsychological evaluation and a 3 Tesla brain MRI scan. To assess the potential presence of depressive symptoms, the 13-item version of the Beck Depression Inventory (BDI) or the Geriatric Depression Scale (GDS) was utilized. Participants were assigned into three groups based on their cognitive status: amnestic mild cognitive impairment (MCI), non-amnestic MCI, and healthy controls. Regarding affective symptoms, subjects were categorized into depressed and non-depressed groups. An increased mean eccentricity and network diameter were found in patients with depressive symptoms relative to non-depressed ones, and both measures showed correlations with depressive symptom severity. In patients with depressive symptoms, a functional hypoconnectivity was detected between the Anterior Cingulate Cortex (ACC) and the right amygdala in the FLN, which impairment correlated with depressive symptom severity. While no structural difference was found in subjects with depressive symptoms, the volume of the hippocampus and the thickness of the precuneus and the entorhinal cortex were decreased in subjects with MCI, especially in amnestic MCI. The increase in eccentricity and diameter indicates a more path-like functional network configuration that may lead to an impaired functional integration in depression, a possible cause of depressive symptomatology in the elderly.

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“What else can we do?”—Provider perspectives on treatment‐resistant depression in late life

Cited by 8 publications

References 40 publications

Effectiveness of Telecare Interventions on Depression Symptoms Among Older Adults: Systematic Review and Meta-Analysis

Effectiveness of Telecare Interventions on Depression Symptoms Among Older Adults: Systematic Review and Meta-Analysis

Efficacy and safety of aripiprazole or bupropion augmentation and switching in patients with treatment-resistant depression or major depressive disorder: A systematic review and meta-analysis of randomized controlled trials

Low Functional network integrity in cognitively unimpaired and MCI subjects with depressive symptoms: results from a multi-center fMRI study

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