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Gebara MA, Brown PJ, Roose SP. Finally, New Hope for the Treatment of LLTRD. Am J Geriatr Psychiatry 2023; 31:1042-1044. [PMID: 37562991 DOI: 10.1016/j.jagp.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023]
Affiliation(s)
- Marie Anne Gebara
- Department of Psychiatry (MAG), University of Pittsburgh, School of Medicine, Pittsburgh, PA.
| | - Patrick J Brown
- Department of Psychiatry (PJB, SPR), Columbia University College of Physicians and Surgeons, The New York State Psychiatric Institute, New York, NY
| | - Steven P Roose
- Department of Psychiatry (PJB, SPR), Columbia University College of Physicians and Surgeons, The New York State Psychiatric Institute, New York, NY
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Vanderschelden B, Gebara MA, Oughli HA, Butters MA, Brown PJ, Farber NB, Flint AJ, Karp JF, Lavretsky H, Mulsant BH, Reynolds CF, Roose SP, Lenze EJ. Change in patient-centered outcomes of psychological well-being, sleep, and suicidality following treatment with intravenous ketamine for late-life treatment-resistant depression. Int J Geriatr Psychiatry 2023; 38:e5964. [PMID: 37392089 DOI: 10.1002/gps.5964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/22/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE To examine whether psychological well-being, sleep, and suicidality improved with treatment with intravenous (IV) ketamine for late-life treatment-resistant depression (TRD). METHODS This is an analysis of secondary outcomes in an open-label late-life TRD study examining the safety, tolerability, and feasibility of IV ketamine infusions. In the acute phase, participants (N = 25) aged 60 years or older received twice-a-week IV ketamine for 4 weeks. Then, participants with Montgomery-Asberg Depression Rating Scale (MADRS) total score <10 or ≥ 30% reduction from baseline proceeded to the continuation phase, an additional four weeks of once-a-week IV ketamine. The secondary outcomes analyzed here are based on the National Institute of Health Toolbox Psychological Well-Being subscales for Positive Affect and General Life Satisfaction, the Pittsburgh Sleep Quality Index, and the Scale for Suicidal Ideation. RESULTS Psychological well-being, sleep, and suicidality improved during the acute phase and those improvements were sustained during the continuation phase. Greater improvements in measures of psychological well-being and sleep were seen in participants who had greater improvements in MADRS scores and moved onto the continuation phase. All but one of the few participants with high suicidality at baseline improved; there were no cases of treatment-emergent suicidality. CONCLUSIONS Psychological well-being, sleep, and suicidality improved in participants with late-life TRD who received IV ketamine for 8 weeks. A future larger and longer controlled trial is needed to confirm and extend these findings. REGISTRATION ClinicalTrials.gov identifier: NCT04504175.
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Affiliation(s)
- Benjamin Vanderschelden
- Department of Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marie Anne Gebara
- Department of Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Hanadi Ajam Oughli
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Patrick J Brown
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, New York, USA
| | - Nuri B Farber
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Alastair J Flint
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Jordan F Karp
- Department of Psychiatry, University of Arizona, College of Medicine-Tucson, Tucson, Arizona, USA
| | - Helen Lavretsky
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Benoit H Mulsant
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Steven P Roose
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, New York, USA
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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Rutherford BR, Choi J, Slifstein M, O'Boyle K, Abi-Dargham A, Brown PJ, Wall MW, Vanegas-Arroyave N, Sakhardande J, Stern Y, Roose SP. Retraction notice to "Neuroanatomical predictors of L-DOPA response in older adults with psychomotor slowing and depression: A pilot study" [J. Affect. Disord. 265 (2020) 439-444]. J Affect Disord 2023; 330:369. [PMID: 36966032 PMCID: PMC10830147 DOI: 10.1016/j.jad.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2023]
Affiliation(s)
- Bret R Rutherford
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | - Jongwoo Choi
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | - Mark Slifstein
- Stony Brook University College of Medicine, New York, NY, United States
| | - Kaleigh O'Boyle
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | | | - Patrick J Brown
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | - Melanie W Wall
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | | | - Jayant Sakhardande
- Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Yaakov Stern
- Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Steven P Roose
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
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Lenze EJ, Mulsant BH, Roose SP, Lavretsky H, Reynolds CF, Blumberger DM, Brown PJ, Cristancho P, Flint AJ, Gebara MA, Gettinger TR, Lenard E, Miller JP, Nicol GE, Oughli HA, Pham VT, Rollman BL, Yang L, Karp JF. Antidepressant Augmentation versus Switch in Treatment-Resistant Geriatric Depression. N Engl J Med 2023; 388:1067-1079. [PMID: 36867173 PMCID: PMC10568698 DOI: 10.1056/nejmoa2204462] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND The benefits and risks of augmenting or switching antidepressants in older adults with treatment-resistant depression have not been extensively studied. METHODS We conducted a two-step, open-label trial involving adults 60 years of age or older with treatment-resistant depression. In step 1, patients were randomly assigned in a 1:1:1 ratio to augmentation of existing antidepressant medication with aripiprazole, augmentation with bupropion, or a switch from existing antidepressant medication to bupropion. Patients who did not benefit from or were ineligible for step 1 were randomly assigned in step 2 in a 1:1 ratio to augmentation with lithium or a switch to nortriptyline. Each step lasted approximately 10 weeks. The primary outcome was the change from baseline in psychological well-being, assessed with the National Institutes of Health Toolbox Positive Affect and General Life Satisfaction subscales (population mean, 50; higher scores indicate greater well-being). A secondary outcome was remission of depression. RESULTS In step 1, a total of 619 patients were enrolled; 211 were assigned to aripiprazole augmentation, 206 to bupropion augmentation, and 202 to a switch to bupropion. Well-being scores improved by 4.83 points, 4.33 points, and 2.04 points, respectively. The difference between the aripiprazole-augmentation group and the switch-to-bupropion group was 2.79 points (95% CI, 0.56 to 5.02; P = 0.014, with a prespecified threshold P value of 0.017); the between-group differences were not significant for aripiprazole augmentation versus bupropion augmentation or for bupropion augmentation versus a switch to bupropion. Remission occurred in 28.9% of patients in the aripiprazole-augmentation group, 28.2% in the bupropion-augmentation group, and 19.3% in the switch-to-bupropion group. The rate of falls was highest with bupropion augmentation. In step 2, a total of 248 patients were enrolled; 127 were assigned to lithium augmentation and 121 to a switch to nortriptyline. Well-being scores improved by 3.17 points and 2.18 points, respectively (difference, 0.99; 95% CI, -1.92 to 3.91). Remission occurred in 18.9% of patients in the lithium-augmentation group and 21.5% in the switch-to-nortriptyline group; rates of falling were similar in the two groups. CONCLUSIONS In older adults with treatment-resistant depression, augmentation of existing antidepressants with aripiprazole improved well-being significantly more over 10 weeks than a switch to bupropion and was associated with a numerically higher incidence of remission. Among patients in whom augmentation or a switch to bupropion failed, changes in well-being and the occurrence of remission with lithium augmentation or a switch to nortriptyline were similar. (Funded by the Patient-Centered Outcomes Research Institute; OPTIMUM ClinicalTrials.gov number, NCT02960763.).
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Affiliation(s)
- Eric J Lenze
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Benoit H Mulsant
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Steven P Roose
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Helen Lavretsky
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Charles F Reynolds
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Daniel M Blumberger
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Patrick J Brown
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Pilar Cristancho
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Alastair J Flint
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Marie A Gebara
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Torie R Gettinger
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Emily Lenard
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - J Philip Miller
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Ginger E Nicol
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Hanadi A Oughli
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Vy T Pham
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Bruce L Rollman
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Lei Yang
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Jordan F Karp
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
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5
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Oughli HA, Gebara MA, Ciarleglio A, Lavretsky H, Brown PJ, Flint AJ, Farber NB, Karp JF, Mulsant BH, Reynolds CF, Roose SP, Yang L, Butters MA, Lenze EJ. Intravenous Ketamine for Late-Life Treatment-Resistant Depression: A Pilot Study of Tolerability, Safety, Clinical Benefits, and Effect on Cognition. Am J Geriatr Psychiatry 2023; 31:210-221. [PMID: 36529623 PMCID: PMC10839705 DOI: 10.1016/j.jagp.2022.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 11/18/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Evidence-based treatment options for late-life treatment-resistant depression (TRD) are limited. Ketamine is a promising treatment for TRD; however, there is a paucity of data on its safety and efficacy in older adults. METHODS In this pilot clinical trial, 25 adults aged ≥60 years with TRD received IV ketamine openly twice a week for 4 weeks; partial responders at the end of this acute phase were eligible to receive weekly infusions for 4 more weeks in a continuation phase. Acceptability, tolerability, and safety, including adverse and serious adverse events (AEs and SAEs), blood pressure changes, dissociation, craving, in addition to rates of depression response and remission were evaluated. The NIH Toolbox Cognitive Battery was used to assess specific measures of executive function (EF) and overall fluid cognition. RESULTS Completion rates were 88% for the acute phase and 100% for the continuation phase. No AEs resulted in participant discontinuation, and there were no SAEs. Treatment-emergent elevation of blood pressure, dissociation, and craving were transient and did not result in any participant discontinuation. Depressive symptoms improved significantly and 48% of participants responded. During the acute phase, the EF measures and the fluid cognition composite score improved (Cohen's d = 0.61), and these improvements were sustained in the continuation phase. CONCLUSION This pilot study suggests that repeated IV ketamine infusions are well-tolerated and are associated with improvement in depression and EF in older adults with TRD. These promising findings need to be confirmed and extended in a larger randomized controlled trial.
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Affiliation(s)
- Hanadi Ajam Oughli
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Marie Anne Gebara
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
| | - Adam Ciarleglio
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, the George Washington University, Washington, DC
| | - Helen Lavretsky
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Patrick J Brown
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, NY
| | - Alastair J Flint
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Centre for Mental Health, University Health Network, Toronto, Canada
| | - Nuri B Farber
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Jordan F Karp
- Department of Psychiatry, College of Medicine-Tucson, University of Arizona, Tucson, AZ
| | - Benoit H Mulsant
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada
| | - Charles F Reynolds
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Steven P Roose
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, NY
| | - Lei Yang
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Meryl A Butters
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
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6
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Cristancho P, Lenard E, Lenze EJ, Miller JP, Brown PJ, Roose SP, Montes-Garcia C, Blumberger DM, Mulsant BH, Lavretsky H, Rollman BL, Reynolds CF, Karp JF. Corrigendum to Optimizing Outcomes of Treatment-Resistant Depression in Older Adults (OPTIMUM): Study Design and Treatment Characteristics of the First 396 Participants Randomized. Am J Geriatr Psychiatry 2019;27(10):1138-1152. doi: 10.1016/j.jagp.2019.04.005. Am J Geriatr Psychiatry 2023; 31:472-473. [PMID: 36922318 DOI: 10.1016/j.jagp.2023.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- Pilar Cristancho
- Department of Psychiatry (PC, EL, EJL), Healthy Mind Lab, School of Medicine, Washington University in St. Louis, St. Louis, MI.
| | - Emily Lenard
- Department of Psychiatry (PC, EL, EJL), Healthy Mind Lab, School of Medicine, Washington University in St. Louis, St. Louis, MI
| | - Eric J Lenze
- Department of Psychiatry (PC, EL, EJL), Healthy Mind Lab, School of Medicine, Washington University in St. Louis, St. Louis, MI
| | - J Philip Miller
- The Division of Biostatistics (JPM), School of Medicine, Washington University in St. Louis, St. Louis, MI
| | - Patrick J Brown
- The Department of Geriatric Psychiatry (PJB, SPR, CMG), Program on Healthy Aging and Late Life Brain Disorders, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY
| | - Steven P Roose
- The Department of Geriatric Psychiatry (PJB, SPR, CMG), Program on Healthy Aging and Late Life Brain Disorders, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY
| | - Carolina Montes-Garcia
- The Department of Geriatric Psychiatry (PJB, SPR, CMG), Program on Healthy Aging and Late Life Brain Disorders, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY
| | - Daniel M Blumberger
- The Centre for Addiction and Mental Health and Department of Psychiatry (DMB, BHM), University of Toronto, Toronto, Ontario, Canada
| | - Benoit H Mulsant
- The Centre for Addiction and Mental Health and Department of Psychiatry (DMB, BHM), University of Toronto, Toronto, Ontario, Canada
| | - Helen Lavretsky
- The Semel Institute for Neuroscience and Human Behavior (HL), University of California, Los Angeles, Los Angeles, CA
| | - Bruce L Rollman
- The Department of Medicine and Center for Behavioral Health and Smart Technology (BLR), University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Charles F Reynolds
- The Department of Psychiatry (CFR, JFK), University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jordan F Karp
- The Department of Psychiatry (CFR, JFK), University of Pittsburgh School of Medicine, Pittsburgh, PA
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7
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He X, Pueraro E, Kim Y, Garcia CM, Maas B, Choi J, Egglefield DA, Schiff S, Sneed J, Brown PJ, Brickman A, Roose SP, Rutherford BR. Corrigendum to "Association of White Matter Integrity with Executive Function and Antidepressant Treatment Outcome in Patients with Late-Life Depression" [The American Journal of Geriatric Psychiatry 29 (2021) 1188-1198]. Am J Geriatr Psychiatry 2023; 31:76-77. [PMID: 36283954 PMCID: PMC9762497 DOI: 10.1016/j.jagp.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Xiaofu He
- Department of Psychiatry, Vagelos College of Physicians and Surgeons (XH, PJB, SPR, BRR), Columbia University, New York, NY; New York State Psychiatric Institute (XH, EP, YK, CMG, JC, PJB, SPR, BRR), New York, NY.
| | | | - Yoojean Kim
- New York State Psychiatric Institute, New York, NY
| | | | - Ben Maas
- Department of Neurology, Taub Institute for Research on
Alzheimer’s Disease and the Aging Brain, G.H. Sergievsky Center, Vagelos
College of Physicians and Surgeons, Columbia University, New York, NY
| | - Jongwoo Choi
- New York State Psychiatric Institute, New York, NY
| | - Dakota A. Egglefield
- The Graduate Center, City University of New York, New
York, NY; Queens College, City University of New York, New York, NY
| | - Sophie Schiff
- The Graduate Center, City University of New York, New
York, NY; Queens College, City University of New York, New York, NY
| | - Joel Sneed
- The Graduate Center, City University of New York, New
York, NY; Queens College, City University of New York, New York, NY
| | - Patrick J. Brown
- Department of Psychiatry, Vagelos College of Physicians
and Surgeons, Columbia University, New York, NY.,New York State Psychiatric Institute, New York, NY
| | - Adam Brickman
- Department of Neurology, Taub Institute for Research on
Alzheimer’s Disease and the Aging Brain, G.H. Sergievsky Center, Vagelos
College of Physicians and Surgeons, Columbia University, New York, NY
| | - Steven P. Roose
- Department of Psychiatry, Vagelos College of Physicians
and Surgeons, Columbia University, New York, NY.,New York State Psychiatric Institute, New York, NY
| | - Bret R Rutherford
- Department of Psychiatry, Vagelos College of Physicians
and Surgeons, Columbia University, New York, NY.,New York State Psychiatric Institute, New York, NY
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8
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Zilcha-Mano S, Solomonov N, Posner JE, Roose SP, Rutherford BR. Proof of Concept of the Contribution of the Interaction between Trait-like and State-like Effects in Identifying Individual-Specific Mechanisms of Action in Biological Psychiatry. J Pers Med 2022; 12:1197. [PMID: 35893291 PMCID: PMC9332605 DOI: 10.3390/jpm12081197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/29/2022] [Accepted: 07/08/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Identifying individual-specific mechanisms of action may facilitate progress toward precision medicine. Most studies seeking to identify mechanisms of action collapse together two distinct components: pre-treatment trait-like characteristics differentiating between individuals and state-like characteristics changing within each individual over the course of treatment. We suggest a conceptual framework highlighting the importance of studying interactions between trait-like and state-like components in the development of moderated mediation models that can guide personalized targeted interventions. Methods: To facilitate implementation of this framework, two empirical demonstrations are presented from a recent clinical trial and neuroimaging study. The first examines limbic reactivity during an emotional face task; the second concerns striatal activation in a monetary reward task. Results: In both tasks, considering the interaction between trait-like and state-like components predicted treatment outcome more robustly than did the trait-like or state-like components examined individually. Conclusions: These findings suggest that the extent to which state-like modulation of neural activations can serve as a potential treatment target depends on the pre-treatment, trait-like levels of activation in these regions. Thus, the interaction between trait-like and state-like components can serve as a promising path to the development of personalized interventions within a precision medicine framework in which mechanisms of action are individual-specific.
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Affiliation(s)
- Sigal Zilcha-Mano
- Department of Psychology, University of Haifa, Mount Carmel, Haifa 31905, Israel
| | - Nili Solomonov
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY 10605, USA;
| | - Jonathan E. Posner
- New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA; (J.E.P.); (S.P.R.); (B.R.R.)
| | - Steven P. Roose
- New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA; (J.E.P.); (S.P.R.); (B.R.R.)
| | - Bret R. Rutherford
- New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA; (J.E.P.); (S.P.R.); (B.R.R.)
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9
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Brewster KK, Zilcha-Mano S, Wallace ML, Kim AH, Brown PJ, Roose SP, Golub JS, Galatioto J, Kuhlmey M, Rutherford BR. A precision medicine tool to understand who responds best to hearing aids in late-life depression. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5721. [PMID: 35499363 PMCID: PMC9942910 DOI: 10.1002/gps.5721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/20/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Accumulating evidence suggests that hearing loss (HL) treatment may benefit depressive symptoms among older adults with Major Depressive Disorder (MDD), but the specific individual characteristics of those who stand to improve most are unknown. METHODS N = 37 patients ≥60 years with HL and MDD received either active or sham hearing aids in this 12-week double-blind randomized controlled trial. A combined moderator approach was utilized in the analysis in order to examine multiple different pretreatment individual characteristics to determine the specific qualities that predicted the best depressive symptom response to hearing aids. Pretreatment characteristics included: Hearing Handicap Inventory for the Elderly (HHIE-S), pure tone average (PTA), speech reception threshold (SRT), Short Physical Performance Battery (SPPB), cognition (Repeatable Battery for the Assessment of Neuropsychological Status). RESULTS The analysis revealed a combined moderator, predicting greater improvement with active versus sham hearing aids, that had a larger effect size than any individual moderator (combined effect size [ES] = 0.49 [95% CI: 0.36, 0.76]). Individuals with worse hearing-related disability (HHIE-S: individual ES = -0.16), speech recognition (SRT: individual ES = -0.14), physical performance (SPPB: individual ES = 0.41), and language functioning (individual ES = 0.19) but with relatively less severe audiometric thresholds (PTA: individual ES = 0.17) experienced greater depressive symptom improvement with active hearing aids. CONCLUSIONS Older adults with relatively worse HL-related, physical, and cognitive functioning may stand to benefit most from hearing aids. Given the large number of older adults experiencing HL and MDD, a non-invasive and scalable means of targeting those most likely to respond to interventions would be valuable.
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Affiliation(s)
- Katharine K. Brewster
- Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Box 92, New York, NY 10032
| | | | | | - Ana H. Kim
- Columbia University Vagelos College of Physicians and Surgeons, Columbia University, Department of Otolaryngology—Head and Neck Surgery
| | - Patrick J. Brown
- Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute
| | - Steven P. Roose
- Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute
| | - Justin S. Golub
- Columbia University Vagelos College of Physicians and Surgeons, Columbia University, Department of Otolaryngology—Head and Neck Surgery
| | - Jessica Galatioto
- Columbia University Vagelos College of Physicians and Surgeons, Columbia University, Department of Otolaryngology—Head and Neck Surgery
| | - Megan Kuhlmey
- Columbia University Vagelos College of Physicians and Surgeons, Columbia University Department of Otolaryngology—Head and Neck Surgery
| | - Bret R. Rutherford
- Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute
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10
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Brown PJ, Ciarleglio A, Roose SP, Montes Garcia C, Chung S, Fernandes S, Rutherford BR. Frailty and Depression in Late Life: A High-Risk Comorbidity With Distinctive Clinical Presentation and Poor Antidepressant Response. J Gerontol A Biol Sci Med Sci 2022; 77:1055-1062. [PMID: 34758065 PMCID: PMC9071391 DOI: 10.1093/gerona/glab338] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To investigate the longitudinal relationship between physical frailty, the clinical representation of accelerated biological aging, and antidepressant medication response in older adults with depressive illness. METHODS An 8-week randomized placebo-controlled trial (escitalopram or duloxetine) followed by 10 months of open antidepressant medication treatment (augmentation, switch strategies) was conducted in an outpatient research clinic. 121 adults aged 60 years or older with major depressive disorder (MDD) or persistent depressive disorder and a 24-item Hamilton Rating Scale for Depression (HRSD) ≥16 were enrolled. Primary measures assessed serially over 12 months include response (50% reduction from baseline HRSD score), remission (HRSD score <10), and frailty (non/intermediate frail [0-2 deficits] vs frail [≥3 deficits]); latent class analysis was used to classify longitudinal frailty trajectories. RESULTS A 2-class model best fit the data, identifying a consistently low frailty risk (63% of the sample) and consistently high frailty risk (37% of the sample) trajectory. Response and remission rates (ps ≤ .002) for adults in the high-risk frailty class were at least 21 percentage points worse than those in the low-risk class over 12 months. Furthermore, subsequent frailty was associated with previous frailty (ps ≤ .01) but not previous response or remission (ps ≥ .10). CONCLUSIONS Antidepressant medication is poorly effective for MDD occurring in the context of frailty in older adults. Furthermore, even when an antidepressant response is achieved, this response does little to improve their frailty. These data suggest that standard psychiatric assessment of depressed older adults should include frailty measures and that novel therapeutic strategies to address comorbid frailty and depression are needed.
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Affiliation(s)
- Patrick J Brown
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York, USA
| | - Adam Ciarleglio
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Steven P Roose
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York, USA
| | - Carolina Montes Garcia
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York, USA
| | - Sarah Chung
- Albert Einstein College of Medicine, New York, New York, USA
| | - Sara Fernandes
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York, USA
| | - Bret R Rutherford
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York, USA
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11
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Roose SP, Brown PJ. What we Know, What We Do Not Know, and What We May Know Soon About Interventions for Treatment Resistant Depression in Late-Life? Am J Geriatr Psychiatry 2022; 30:557-559. [PMID: 34801381 DOI: 10.1016/j.jagp.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Steven P Roose
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York, NY.
| | - Patrick J Brown
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York, NY
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12
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Hamm ME, Karp JF, Lenard E, Dawdani A, Lavretsky H, Lenze EJ, Mulsant BH, Reynolds CF, Roose SP, Brown PJ. "What else can we do?"-Provider perspectives on treatment-resistant depression in late life. J Am Geriatr Soc 2021; 70:1190-1197. [PMID: 34862593 DOI: 10.1111/jgs.17592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/22/2021] [Accepted: 11/03/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Treatment-resistant depression in late-life (TRLLD) is common. Perspectives of primary care providers (PCPs) and psychiatrists treating TRLLD could give insights into the challenges and potential solutions for managing this condition. METHODS To identify perspectives of providers who treat TRLLD, we conducted a qualitative descriptive study using semi-structured interviews with providers treating older adults with TRLLD in five locations across North America (i.e., Los Angeles, New York City, Pittsburgh, St. Louis, and Toronto). We conducted semi-structured interviews with 50 care providers (24 primary care providers [PCPs], 22 psychiatrists, and 4 depression care managers). Interviews elicited providers' perspectives on treatment options for TRLLD, including treatment within the primary care setting and referral to psychiatry, and sought suggestions for improvement. RESULTS We identified four themes. (1) Treating TRLLD takes an emotional toll on providers; (2) existing psychiatric services are inadequate to meet the needs of patients with TRLLD, mainly because of lack of access; (3) PCPs often attempt to treat TRLLD, even when they are not comfortable doing so; and (4) to better meet the needs of patients with TRLLD, providers recommend integrated care models involving PCPs, psychiatrists, and psychotherapists, potentially made more feasible by the growth of telehealth. CONCLUSIONS Findings from these qualitative interviews show the challenges in providing care for TRLLD. These findings can guide knowledge dissemination to psychiatrists, PCPs, policy-makers, and other stakeholders involved in the mental health system. They can also inform structural changes to clinical practice that may increase the implementation of the best treatment strategies across settings to improve long-term outcomes for TRLLD.
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Affiliation(s)
- Megan E Hamm
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jordan F Karp
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Emily Lenard
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Alicia Dawdani
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Helen Lavretsky
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Charles F Reynolds
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Steven P Roose
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, New York, USA
| | - Patrick J Brown
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, New York, USA
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13
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He X, Pueraro E, Kim Y, Garcia CM, Maas B, Choi J, Egglefield DA, Schiff S, Sneed JR, Brown PJ, Brickman AM, Roose SP, Rutherford BR. Association of White Matter Integrity With Executive Function and Antidepressant Treatment Outcome in Patients With Late-Life Depression. Am J Geriatr Psychiatry 2021; 29:1188-1198. [PMID: 33551234 PMCID: PMC8298620 DOI: 10.1016/j.jagp.2021.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/25/2020] [Accepted: 01/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE While patients with late-life depression (LLD) often exhibit microstructural white matter alterations that can be identified with diffusion tensor imaging (DTI), there is a dearth of information concerning the links between DTI findings and specific cognitive performance, as well as between DTI measures and antidepressant treatment outcomes. DESIGN Neuroimaging and cognitive tests were conducted at baseline in 71 older adults participating in a larger, 8-week duration antidepressant randomized controlled trial. Correlations between DTI measures of white matter integrity evaluated with tract-based spatial statistics, baseline neurocognitive performance, and prospective antidepressant treatment outcome were evaluated. RESULTS Fractional anisotropy (FA), an index of white matter integrity, was significantly positively associated with better cognitive function as measured by the Initiation/Perseveration subscale of the Dementia Rating Scale in the bilateral superior longitudinal fasciculus (SLF), bilateral SLF-temporal, and right corticospinal tract (CST). An exploratory analysis limited to these tracts revealed that increased FA in the right CST, right SLF, and right SLF-temporal tracts was correlated with a greater decrease in depressive symptoms. Increased FA in the right CST predicted a greater chance of remission, while increased FA in the right CST and the right SLF predicted a greater chance of treatment response. CONCLUSION In late-life depression LLD subjects, white matter integrity was positively associated with executive function in white matter tracts which act as key connecting structures underlying the cognitive control network. These tracts may play a role as a positive prognostic factor in antidepressant treatment outcome.
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Affiliation(s)
- Xiaofu He
- Department of Psychiatry (XH, JRS, PJB, SPR, BRR), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; The New York State Psychiatric Institute (XH, EP, YK, CMG, JC, JRS, PJB, SPR, BRR), New York, NY.
| | - Elena Pueraro
- The New York State Psychiatric Institute, New York, NY
| | - Yoojean Kim
- The New York State Psychiatric Institute, New York, NY
| | | | - Ben Maas
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, G.H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Jongwoo Choi
- The New York State Psychiatric Institute, New York, NY
| | - Dakota A. Egglefield
- The Graduate Center, City University of New York,Queens College, City University of New York
| | - Sophie Schiff
- The Graduate Center, City University of New York,Queens College, City University of New York
| | - Joel R. Sneed
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY,The New York State Psychiatric Institute, New York, NY,The Graduate Center, City University of New York,Queens College, City University of New York
| | - Patrick J. Brown
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY,The New York State Psychiatric Institute, New York, NY
| | - Adam M. Brickman
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, G.H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Steven P. Roose
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY,The New York State Psychiatric Institute, New York, NY
| | - Bret R. Rutherford
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY,The New York State Psychiatric Institute, New York, NY
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14
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Zilcha-Mano S, Wallace ML, Brown PJ, Sneed J, Roose SP, Rutherford BR. Who benefits most from expectancy effects? A combined neuroimaging and antidepressant trial in depressed older adults. Transl Psychiatry 2021; 11:475. [PMID: 34526482 PMCID: PMC8443672 DOI: 10.1038/s41398-021-01606-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/27/2021] [Accepted: 08/12/2021] [Indexed: 12/22/2022] Open
Abstract
Depressed patients' expectations of improvement drive placebo effects in antidepressant clinical trials, yet there is considerable heterogeneity in the magnitude of expectancy effects. The present study seeks to identify those individuals who benefit most from expectancy effects using baseline neuroimaging and cognitive measures. Older adult outpatients diagnosed with major depressive disorder (MDD) participated in a prospective, 8-week clinical trial in which expectancy was experimentally manipulated and its effects on depression outcome measured. Based on the literature, we selected a priori 12 cognitive and brain-based variables linked to depression and expectancy, together with demographic variables, and incorporated them into a combined moderator. The combined moderator was developed as a weighted combination of the individual moderators, and was used to identify individuals who benefited most from expectancy effects. The combined moderator was found to predict differential change in depression severity scores between the high- vs. low-expectancy groups with a medium-size effect (Spearman effect size: 0.28). While at the sample level no expectancy effect was found, the combined moderator divided older adults with MDD into those who did and those who did not improve as the result of expectancy manipulation, with those benefiting from the manipulation showing greater processing speed, executive function, and frontostriatal white matter tract integrity. The findings suggest that it is possible to identify a subgroup of older adult individuals with MDD for whom expectancy manipulation results in greater antidepressant treatment response, supporting a precision medicine approach. This subgroup is characterized by distinct cognitive dysfunction and neuroimaging impairments profiles.
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Affiliation(s)
- Sigal Zilcha-Mano
- Department of Psychology, University of Haifa, Mount Carmel, 31905, Haifa, Israel.
| | - Meredith L. Wallace
- grid.21925.3d0000 0004 1936 9000University of Pittsburgh Department of Psychiatry, Statistics, and Biostatistics, Pittsburgh, PA USA
| | - Patrick J. Brown
- grid.413734.60000 0000 8499 1112Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY USA
| | - Joel Sneed
- grid.262273.00000 0001 2188 3760Queens College of the City University of New York, New York, NY USA
| | - Steven P. Roose
- grid.413734.60000 0000 8499 1112Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY USA
| | - Bret R. Rutherford
- grid.413734.60000 0000 8499 1112Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY USA
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15
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Brewster KK, Hu MC, Wall MM, Brown PJ, Zilcha-Mano S, Roose SP, Stein A, Golub JS, Rutherford BR. Age-Related Hearing Loss, Neuropsychological Performance, and Incident Dementia in Older Adults. J Alzheimers Dis 2021; 80:855-864. [PMID: 33579835 DOI: 10.3233/jad-200908] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Age-related hearing loss (HL) has been associated with dementia, though the neurocognitive profile of individuals with HL is poorly understood. OBJECTIVE To characterize the neurocognitive profile of HL. METHODS N = 8,529 participants from the National Alzheimer's Coordinating Center ≥60 years and free of cognitive impairment who were characterized as Untreated-, Treated-, or No HL. Outcomes included executive function (Trail Making Test [TMT] Part B), episodic memory (Immediate/Delayed Recall), language fluency (Vegetables, Boston Naming Test), and conversion to dementia. Regression models were fit to examine associations between HL and neurocognitive performance at baseline. Cox proportional hazards models examined the links between HL, neurocognitive scores, and development of dementia over follow-up. RESULTS At baseline, those with Untreated HL (versus No HL) had worse neurocognitive performance per standardized difference on executive function (TMT Part B [mean difference = 0.05 (95% CI 0.00, 0.10)]) and language fluency (Vegetables [mean difference = -0.07 (95% CI -0.14, -0.01)], Boston Naming Test [mean difference = -0.07 (95% CI -0.13, -0.01)]). No differences in these neurocognitive performance scores were demonstrated between Treated HL and No HL groups other than MMSE [mean difference = -0.06 (95% CI -0.12, 0.00)]. Through follow-up, executive dysfunction differed by hearing group (χ2(2) = 46.08, p < 0.0001) and was present among 39.12% in No HL, 44.85% in Untreated HL, and 49.40% in Treated HL. Worse performance across all cognitive domains predicted incident dementia. CONCLUSION The observed association between Untreated HL and lower cognitive ability that improved when hearing aids were worn may reflect an inability to hear the test instructions. Future studies using cognitive assessments validated for use in HL are needed to evaluate the neuropsychological profile of HL and identify individuals at risk for dementia.
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Affiliation(s)
- Katharine K Brewster
- New York State Psychiatric Institute, New York, NY, USA.,Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Mei-Chen Hu
- New York State Psychiatric Institute, New York, NY, USA.,Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Melanie M Wall
- New York State Psychiatric Institute, New York, NY, USA.,Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Patrick J Brown
- New York State Psychiatric Institute, New York, NY, USA.,Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Sigal Zilcha-Mano
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.,University of Haifa, Haifa, Israel
| | - Steven P Roose
- New York State Psychiatric Institute, New York, NY, USA.,Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Alexandra Stein
- New York State Psychiatric Institute, New York, NY, USA.,Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Justin S Golub
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Bret R Rutherford
- New York State Psychiatric Institute, New York, NY, USA.,Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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16
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Brown PJ, Ciarleglio A, Roose SP, Garcia CM, Chung S, Alvarez J, Stein A, Gomez S, Rutherford BR. Frailty Worsens Antidepressant Treatment Outcomes in Late Life Depression. Am J Geriatr Psychiatry 2021; 29:944-955. [PMID: 33388223 PMCID: PMC8225710 DOI: 10.1016/j.jagp.2020.12.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/08/2020] [Accepted: 12/21/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To investigate the relationship between frailty and treatment response to antidepressant medications in adults with late life depression (LLD). METHODS Data were evaluated from 100 individuals over age 60 years (34 men, 66 women) with a depressive diagnosis, who were assessed for frailty at baseline (characteristics include gait speed, grip strength, activity levels, fatigue, and weight loss) and enrolled in an 8-week trial of antidepressant medication followed by 10 months of open-treatment. RESULTS Frail individuals (n = 49 with ≥3 deficits in frailty characteristics) did not differ at baseline from the non/intermediate frail (n = 51 with 0-2 deficits) on demographic, medical comorbidity, cognitive, or depression variables. On average, frail individuals experienced 2.82 fewer Hamilton Rating Scale for Depression (HRSD) points of improvement (t = 2.12, df 89, p = 0.037) than the non/intermediate frail over acute treatment, with this difference persisting over 10 months of open-treatment. Weak grip strength and low physical activity levels were each associated with decreased HRSD improvement, and lower response and remission rates over the course of the study. Despite their poorer outcomes, frail individuals received more antidepressant medication trials than the non/intermediate frail. CONCLUSION Adults with LLD and frailty have an attenuated response to antidepressant medication and a greater degree of disability compared to non/intermediate frail individuals. This disability and attenuated response remain even after receiving a greater number of antidepressant medication trials. Future research must focus on understanding the specific pathophysiology associated with the frail-depressed phenotype to permit the design and implementation of precision medicine interventions for this high-risk population.
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Affiliation(s)
- Patrick J. Brown
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York, NY USA
| | - Adam Ciarleglio
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington D.C
| | - Steven P. Roose
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York, NY USA
| | - Carolina Montes Garcia
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York, NY USA
| | - Sarah Chung
- Albert Einstein College of Medicine, New York, NY USA
| | - Johana Alvarez
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York, NY USA
| | - Alexandra Stein
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York, NY USA
| | - Stephanie Gomez
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York, NY USA
| | - Bret R. Rutherford
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York, NY USA
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17
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Brewster KK, Hu MC, Zilcha-Mano S, Stein A, Brown PJ, Wall MM, Roose SP, Golub JS, Rutherford BR. Age-Related Hearing Loss, Late-Life Depression, and Risk for Incident Dementia in Older Adults. J Gerontol A Biol Sci Med Sci 2021; 76:827-834. [PMID: 32959064 PMCID: PMC8427720 DOI: 10.1093/gerona/glaa242] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hearing loss (HL), late-life depression, and dementia are 3 prevalent and disabling conditions in older adults, but the interrelationships between these disorders remain poorly understood. METHODS N = 8529 participants ≥60 years who were free of cognitive impairment at baseline were analyzed from National Alzheimer's Coordinating Center Uniform Data Set. Participants had either No HL, Untreated HL, or Treated HL. Primary outcomes included depression (15-item Geriatric Depression Scale ≥5) and conversion to dementia. A longitudinal logistic model was fit to examine the association between HL and changes in depressive symptoms across time. Two Cox proportional hazards models were used to examine HL and the development of dementia: Model A included only baseline variables and Model B included time-varying depression to evaluate for the direct effect of changes in depression on dementia over time. RESULTS Treated HL (vs no HL) had increased risk for depression (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.04-1.54, p = .02) and conversion to dementia (hazard ratio [HR] = 1.29, 95% CI = 1.03-1.62, p = .03). Baseline depression was a strong independent predictor of conversion to dementia (HR = 2.32, 95% CI = 1.77-3.05, p < .0001). Development/persistence of depression over time was also associated with dementia (HR = 1.89, 95% CI = 1.47-2.42, p < .0001), but only accounted for 6% of the direct hearing-dementia relationship (Model A logHR = 0.26 [SE = 0.12] to Model B logHR = 0.24 [SE = 0.12]) suggesting no significant mediation effect of depression. CONCLUSIONS Both HL and depression are independent risk factors for eventual conversion to dementia. Further understanding the mechanisms linking these later-life disorders may identify targets for early interventions to alter the clinical trajectories of at-risk individuals.
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Affiliation(s)
- Katharine K Brewster
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York
| | - Mei-Chen Hu
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York
| | - Sigal Zilcha-Mano
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York.,Department of Psychiatry, University of Haifa, Israel
| | - Alexandra Stein
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York
| | - Patrick J Brown
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York
| | - Melanie M Wall
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York
| | - Steven P Roose
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York
| | - Justin S Golub
- Columbia University Department of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons, New York
| | - Bret R Rutherford
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York
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18
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Rutherford BR, Zilcha-Mano S, Chrisanthopolous M, Salzman C, Zhu C, Cimino N, Yehuda R, Neria Y, Roose SP. Symptom profiles and treatment status of older adults with chronic post-traumatic stress disorder. Int J Geriatr Psychiatry 2021; 36:1216-1222. [PMID: 33577126 DOI: 10.1002/gps.5514] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/31/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Failure to diagnose and treat post-traumatic stress disorder (PTSD) may help explain the substantial disability, increased cognitive decline, and adverse health outcomes suffered by older adults with this disorder. To evaluate this possibility, we examined symptom differences among older and younger individuals with PTSD and measured the frequency with which older adults receive standard of care treatment. METHODS Clinician-Administered PTSD Scale for DSM (CAPS) scores were compared between younger and older adults with PTSD. Profiles were calculated for the most dominant CAPS symptom cluster reported by each participant, and the age cutoff best differentiating symptom clusters between individuals was determined. Clinical interview data (older adult sample only) were evaluated by trained raters to determine rates at which PTSD participants accessed treatment. RESULTS Among 108 individuals with PTSD, 69% of participants <67 years old had Criterion C (avoidance) symptoms as the most dominant cluster compared to 39% of participants ≥67 (p = 0.016). Eight percent of participants <67 years had Criterion E (hyperarousal) symptoms as the most dominant cluster compared to 30% of participants ≥67 (p = 0.016). Less than 25% of the older adults (N = 53 subsample) were receiving a first-line pharmacotherapy option for PTSD, and 0% of participants were currently participating in an evidence-based psychotherapy for PTSD. CONCLUSIONS Clinicians evaluating patients should be aware that different symptom profiles may be present between younger and older adults with PTSD. Despite their high risk for adverse neuropsychiatric and other health consequences, older adults with PTSD appear to infrequently receive first-line clinical treatment.
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Affiliation(s)
- Bret R Rutherford
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York, USA
| | | | | | - Chloe Salzman
- Department of Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Carlen Zhu
- Department of Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Nicolas Cimino
- Department of Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Rachel Yehuda
- Department of Psychiatry, James J. Peters VA Medical Center, Mt. Sinai School of Medicine, New York, New York, USA
| | - Yuval Neria
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York, USA
| | - Steven P Roose
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York, USA
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19
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Rutherford BR, Choi CJ, Chrisanthopolous M, Salzman C, Zhu C, Montes-Garcia C, Liu Y, Brown PJ, Yehuda R, Flory J, Neria Y, Roose SP. The COVID-19 Pandemic as a Traumatic Stressor: Mental Health Responses of Older Adults With Chronic PTSD. Am J Geriatr Psychiatry 2021; 29:105-114. [PMID: 33153871 PMCID: PMC7582036 DOI: 10.1016/j.jagp.2020.10.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Individuals with post-traumatic stress disorder (PTSD) who experience additional traumas or stressful life events may undergo symptomatic worsening, but no data exist on whether exposure to the COVID-19 pandemic in a high infection area worsens mental health among older adults with chronic PTSD. METHODS Seventy-six older adults (N = 46 with PTSD and N = 30 trauma-exposed comparison subjects [TE]) for whom prepandemic data were available were interviewed between April 1 and May 8, 2020 to quantify depressive (Hamilton Rating Scale for Depression [HRSD]) and PTSD symptom (Post-traumatic Stress Disorder Checklist [PCL-5]) levels. Group differences in baseline characteristics as well as pre-post pandemic symptom levels were examined, and participant characteristics were assessed as moderators of symptom change. RESULTS Compared to TEs, individuals with PTSD more often reported living alone and experiencing a physical illness (χ2 = 5.1, df = 1, p = 0.02). PCL-5 scores among individuals with PTSD decreased during the COVID-19 pandemic by 7.1 points (t(69) = -3.5, p = 0.0008), whereas the TE group did not change significantly. Overall no significant differences in HRSD were found between groups, but a race or ethnicity variable was found to moderate HRSD symptom change. Non-black or Hispanic individuals with PTSD experienced significantly increased HRSD scores during the pandemic compared to black or Hispanic PTSD participants. CONCLUSION The findings are indicative of complexity in the responses of older individuals with PTSD to further stressful life events as well as possibly unique aspects to the COVID-19 pandemic as a stressor. Sources of resilience may exist based on experience with prior traumas as well as increasing age promoting more adaptive coping styles.
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Affiliation(s)
- Bret R. Rutherford
- Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY,Send correspondence and reprint requests to Bret R. Rutherford, M.D., Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Box 98, New York, NY 10032
| | - C. Jean Choi
- Division of Mental Health Data Science, New York State Psychiatric Institute, New York, NY
| | | | | | - Carlen Zhu
- New York State Psychiatric Institute, New York, NY
| | | | - Ying Liu
- Division of Mental Health Data Science, New York State Psychiatric Institute, New York, NY
| | - Patrick J. Brown
- Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY
| | - Rachel Yehuda
- James J. Peters VA Medical Center, Mt. Sinai School of Medicine, Mt. Sinai, NY
| | - Janine Flory
- James J. Peters VA Medical Center, Mt. Sinai School of Medicine, Mt. Sinai, NY
| | - Yuval Neria
- Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY
| | - Steven P. Roose
- Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY
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20
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Hamm ME, Brown PJ, Karp JF, Lenard E, Cameron F, Dawdani A, Lavretsky H, Miller JP, Mulsant BH, Pham VT, Reynolds CF, Roose SP, Lenze EJ. Experiences of American Older Adults with Pre-existing Depression During the Beginnings of the COVID-19 Pandemic: A Multicity, Mixed-Methods Study. Am J Geriatr Psychiatry 2020; 28:924-932. [PMID: 32682619 PMCID: PMC7305766 DOI: 10.1016/j.jagp.2020.06.013] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/10/2020] [Accepted: 06/14/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine the effect of the COVID-19 pandemic on the mental health of older adults with pre-existing major depressive disorder (MDD). PARTICIPANTS Participants were 73 community-living older adults with pre-existing MDD (mean age 69 [SD 6]) in Los Angeles, New York, Pittsburgh, and St Louis. DESIGN AND MEASUREMENTS During the first 2 months of the pandemic, the authors interviewed participants with a semistructured qualitative interview evaluating access to care, mental health, quality of life, and coping. The authors also assessed depression, anxiety, and suicidality with validated scales and compared scores before and during the pandemic. RESULTS Five themes from the interviews highlight the experience of older adults with MDD: 1) They are more concerned about the risk of contracting the virus than the risks of isolation. 2) They exhibit resilience to the stress and isolation of physical distancing. 3) Most are not isolated socially, with virtual contact with friends and family. 4) Their quality of life is lower, and they worry their mental health will suffer with continued physical distancing. 5) They are outraged by an inadequate governmental response to the pandemic. Depression, anxiety, and suicidal ideation symptom scores did not differ from scores before the pandemic. CONCLUSION Most older adults with pre-existing MDD show resilience in the first 2 months of the COVID-19 pandemic but have concerns about the future. Policies and interventions to provide access to medical services and opportunities for social interaction are needed to help to maintain mental health and quality of life as the pandemic continues.
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Affiliation(s)
- Megan E Hamm
- University of Pittsburgh, Department of General Internal Medicine, Pittsburgh, PA.
| | - Patrick J Brown
- Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, NY
| | - Jordan F Karp
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA
| | - Emily Lenard
- Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Flor Cameron
- University of Pittsburgh, Department of General Internal Medicine, Pittsburgh, PA
| | - Alicia Dawdani
- University of Pittsburgh, Department of General Internal Medicine, Pittsburgh, PA
| | - Helen Lavretsky
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA
| | - J Philip Miller
- Washington University in St. Louis, Division of Biostatistics, St. Louis, MO
| | - Benoit H Mulsant
- University of Toronto, Department of Psychiatry, Toronto, ON, Canada
| | - Vy T Pham
- Washington University in St. Louis, School of Medicine, St. Louis, MO
| | | | - Steven P Roose
- Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, NY
| | - Eric J Lenze
- Washington University in St. Louis, School of Medicine, St. Louis, MO
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21
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Brewster KK, Pavlicova M, Stein A, Chen M, Chen C, Brown PJ, Roose SP, Kim AH, Golub JS, Brickman A, Galatioto J, Kuhlmey M, Rutherford BR. A pilot randomized controlled trial of hearing aids to improve mood and cognition in older adults. Int J Geriatr Psychiatry 2020; 35:842-850. [PMID: 32291802 PMCID: PMC7656495 DOI: 10.1002/gps.5311] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/30/2020] [Accepted: 04/11/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Age-related hearing loss (ARHL) is a prevalent condition associated with increased risk for depression and cognitive decline. This 12-week prospective, double-blind pilot randomized controlled trial (RCT) of hearing aids (HAs) for depressed older adults with ARHL evaluated the feasibility of a novel research design. METHODS/DESIGN N = 13 individuals aged ≥60 years with Major Depressive Disorder or Persistent Depressive Disorder and at least mild hearing loss (pure tone average ≥ 30 dB) were randomized to receive full- (active) vs low-amplification (sham) HAs added to psychiatric treatment as usual. Duration of HA use in hours/day, adverse events frequency, attrition rate, and maintenance of the study blinding were the primary outcome measures. RESULTS Compliance with HAs was excellent (>9 hours/day for both groups) and rates of adverse events and drop-outs did not differ between groups. Preliminary data demonstrated differential improvement for active vs sham HAs on hearing functioning (Hearing Handicap Inventory for the Elderly [nonparametric effect size (np-ES) = 0.62]), depressive symptoms (Inventory for Depressive Symptomatology [np-ES = 0.31]), cognition (Repeatable Battery for the Assessment of Neuropsychological Status Immediate Memory [np-ES = 0.25]), and general functioning (World Health Organization Disability Assessment Schedule [np-ES = 0.53]). Significantly greater than 50% of both groups correctly guessed their treatment assignment, indicating incomplete concealment of treatment allocation. CONCLUSIONS This pilot RCT for ARHL and late-life depression was feasible to execute and showed clinical promise, but improved methods of blinding the experimental treatments are needed. Larger studies should investigate whether hearing remediation may be an effective preventative and/or therapeutic strategy for late-life depression and cognitive decline.
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Affiliation(s)
- Katharine K. Brewster
- Columbia University College of Physicians and Surgeons
- New York State Psychiatric Institute
| | | | - Alexandra Stein
- Columbia University College of Physicians and Surgeons
- New York State Psychiatric Institute
| | - Mei Chen
- New York State Psychiatric Institute
| | - Chen Chen
- New York State Psychiatric Institute
| | - Patrick J. Brown
- Columbia University College of Physicians and Surgeons
- New York State Psychiatric Institute
| | - Steven P. Roose
- Columbia University College of Physicians and Surgeons
- New York State Psychiatric Institute
| | - Ana H. Kim
- Columbia University College of Physicians and Surgeons
- Columbia University Department of Otolaryngology—Head and Neck Surgery
| | - Justin S. Golub
- Columbia University College of Physicians and Surgeons
- Columbia University Department of Otolaryngology—Head and Neck Surgery
| | - Adam Brickman
- Columbia University College of Physicians and Surgeons
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain and Department of Neurology
| | - Jessica Galatioto
- Columbia University College of Physicians and Surgeons
- Columbia University Department of Otolaryngology—Head and Neck Surgery
| | - Megan Kuhlmey
- Columbia University College of Physicians and Surgeons
- Columbia University Department of Otolaryngology—Head and Neck Surgery
| | - Bret R. Rutherford
- Columbia University College of Physicians and Surgeons
- New York State Psychiatric Institute
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22
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Rutherford BR, Choi J, Slifstein M, O'Boyle K, Abi-Dargham A, Brown PJ, Wall MW, Vanegas-Arroyave N, Sakhardande J, Stern Y, Roose SP. Neuroanatomical predictors of L-DOPA response in older adults with psychomotor slowing and depression: A pilot study. J Affect Disord 2020; 265:439-444. [PMID: 32090770 PMCID: PMC7042346 DOI: 10.1016/j.jad.2020.01.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/07/2020] [Accepted: 01/15/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Declining function in dopamine circuits is implicated in normal aging and late-life depression (LLD). Dopamine augmentation recently has shown therapeutic promise, but predictors of response are unknown. METHODS Depressed elders with slowed gait underwent baseline magnetic resonance imaging (MRI) and [11C]raclopride positron emission tomography (PET). Subjects then received open treatment with carbidopa/levodopa (L-DOPA) for three weeks. Linear regressions examined relationships between baseline MRI measures, [11C]raclopride binding, and behavioral outcomes. RESULTS Among N = 16 participants aged 72.5 ± 6.8 years, higher left superior temporal gyrus volume was associated with higher processing speed at baseline, while cortical thinning in a processing speed network was associated with greater improvement following L-DOPA. Greater volume and cortical thickness in brain regions associated with mobility were associated with higher baseline gait speed. Higher baseline white matter hyperintensity volume predicted less post-L-DOPA improvement on dual task gait speed and IDS-SR scores. Higher [11C]raclopride binding in the associative striatum was associated with cortical thickness in some, but not all, processing speed brain regions, while higher binding in sensorimotor striatum was significantly associated with left caudate volume. LIMITATIONS Limiting the conclusions drawn from this pilot study are the small sample size and open administration of L-DOPA. CONCLUSIONS Greater baseline brain volumes and cortical thickness in regions supporting cognition and gait were associated with higher behavioral performance, while lower structural integrity was associated with increased responsivity to L-DOPA. If substantiated in larger studies, these findings could facilitate the targeting of dopaminergic treatments to those LLD patients most likely to respond.
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Affiliation(s)
- Bret R Rutherford
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States.
| | - Jongwoo Choi
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | - Mark Slifstein
- Stony Brook University College of Medicine, New York, NY, United States
| | - Kaleigh O'Boyle
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | | | - Patrick J Brown
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | - Melanie W Wall
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | | | - Jayant Sakhardande
- Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Yaakov Stern
- Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Steven P Roose
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
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Lavretsky H, Roose SP. The Efficacy and Safety of Esketamine for the Treatment-Resistant Depression in Older Adults: Comments on TRANSFORM-3 Trial Results. Am J Geriatr Psychiatry 2020; 28:142-144. [PMID: 31734082 DOI: 10.1016/j.jagp.2019.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Helen Lavretsky
- Late Life Mood, Stress, and Wellness Program, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA (HL), Los Angeles, CA.
| | - Steven P Roose
- College of Physicians and Surgeons, Columbia University, New York State Psychiatric Institute (SPR), New York, NY
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Abstract
BACKGROUND Patient expectancy is an important source of placebo effects in antidepressant clinical trials, but all prior studies measured expectancy prior to the initiation of medication treatment. Little is known about how expectancy changes during the course of treatment and how such changes influence clinical outcome. Consequently, we undertook the first analysis to date of in-treatment expectancy during antidepressant treatment to identify its clinical and demographic correlates, typical trajectories, and associations with treatment outcome. METHODS Data were combined from two randomized controlled trials of antidepressant medication for major depressive disorder in which baseline and in-treatment expectancy assessments were available. Machine learning methods were used to identify pre-treatment clinical and demographic predictors of expectancy. Multilevel models were implemented to test the effects of expectancy on subsequent treatment outcome, disentangling within- and between-patient effects. RESULTS Random forest analyses demonstrated that whereas more severe depressive symptoms predicted lower pre-treatment expectancy, in-treatment expectancy was unrelated to symptom severity. At each measurement point, increased in-treatment patient expectancy significantly predicted decreased depressive symptoms at the following measurement (B = -0.45, t = -3.04, p = 0.003). The greater the gap between expected treatment outcomes and actual depressive severity, the greater the subsequent symptom reductions were (B = 0.49, t = 2.33, p = 0.02). CONCLUSIONS Greater in-treatment patient expectancy is associated with greater subsequent depressive symptom reduction. These findings suggest that clinicians may benefit from monitoring and optimizing patient expectancy during antidepressant treatment. Expectancy may represent another treatment parameter, similar to medication compliance and side effects, to be regularly monitored during antidepressant clinical management.
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Affiliation(s)
- Sigal Zilcha-Mano
- Department of Psychology, University of Haifa, Mount Carmel, Haifa 31905, Israel
| | - Patrick J Brown
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
| | - Steven P Roose
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
| | - Kiley Cappetta
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
| | - Bret R Rutherford
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
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Cristancho P, Lenard E, Lenze EJ, Miller JP, Brown PJ, Roose SP, Montes-Garcia C, Blumberger DM, Mulsant BH, Lavretsky H, Rollman BL, Reynolds CF, Karp JF. Optimizing Outcomes of Treatment-Resistant Depression in Older Adults (OPTIMUM): Study Design and Treatment Characteristics of the First 396 Participants Randomized. Am J Geriatr Psychiatry 2019; 27:1138-1152. [PMID: 31147244 DOI: 10.1016/j.jagp.2019.04.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/16/2019] [Accepted: 04/17/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Evidence from clinical trials comparing effectiveness and safety of pharmacological strategies in older adults unresponsive to first-line antidepressants is limited. The study, Optimizing Outcomes of Treatment-Resistant Depression in Older Adults (OPTIMUM), tests three hypotheses concerning pharmacotherapy strategies for treatment-resistant late-life depression: 1) augmentation strategies will provide greater improvement than switching monotherapies; 2) augmentation strategies will have lower tolerability and more safety concerns than switching monotherapies; and 3) age will moderate the effectiveness and safety differences between treatment strategies. The authors describe the methodology, processes for stakeholder engagement, challenges, and lessons learned in the early phases of OPTIMUM. METHODS This pragmatic randomized clinical trial located in five North American regions will enroll 1,500 participants aged 60 years and older unresponsive to two or more antidepressant trials. The authors evaluate two strategies (medication augmentation versus switch) using four medications (aripiprazole, bupropion, lithium, and nortriptyline) via a stepwise, prespecified protocol. Primary outcomes include: 1) symptom remission (Montgomery Asberg Depression scale ≤10); 2) psychological well-being, comprising positive affect, general life satisfaction, and purpose; and 3) safety (rates of serious adverse events and prevalence of falls and fall-related injuries). RESULTS To date, 396 participants have been randomized. The authors report on four challenges: 1) engagement and recruitment; 2) increasing polypharmacy in older adults, resulting in potentially hazardous scenarios; 3) reporting adverse events and procedure standardization across sites; and 4) dissemination of results. CONCLUSION Solutions to these challenges, including early inclusion of stake holders, will inform future pragmatic studies in older adults with depression.
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Affiliation(s)
- Pilar Cristancho
- Department of Psychiatry (PC, EL, EJL), Healthy Mind Lab, School of Medicine, Washington University in St. Louis, St. Louis.
| | - Emily Lenard
- Department of Psychiatry (PC, EL, EJL), Healthy Mind Lab, School of Medicine, Washington University in St. Louis, St. Louis
| | - Eric J Lenze
- Department of Psychiatry (PC, EL, EJL), Healthy Mind Lab, School of Medicine, Washington University in St. Louis, St. Louis
| | - J Philip Miller
- the Division of Biostatistics (JPM), School of Medicine, Washington University in St. Louis, St. Louis
| | - Patrick J Brown
- the Department of Geriatric Psychiatry (PJB, SPR, CMG), Program on Healthy Aging and Late Life Brain Disorders, New York State Psychiatric Institute, Columbia University Medical Center, New York
| | - Steven P Roose
- the Department of Geriatric Psychiatry (PJB, SPR, CMG), Program on Healthy Aging and Late Life Brain Disorders, New York State Psychiatric Institute, Columbia University Medical Center, New York
| | - Carolina Montes-Garcia
- the Department of Geriatric Psychiatry (PJB, SPR, CMG), Program on Healthy Aging and Late Life Brain Disorders, New York State Psychiatric Institute, Columbia University Medical Center, New York
| | - Daniel M Blumberger
- the Centre for Addiction and Mental Health and Department of Psychiatry (DMB, BHM), University of Toronto, Toronto
| | - Benoit H Mulsant
- the Centre for Addiction and Mental Health and Department of Psychiatry (DMB, BHM), University of Toronto, Toronto
| | - Helen Lavretsky
- the Semel Institute for Neuroscience and Human Behavior (HL), University of California, Los Angeles
| | - Bruce L Rollman
- the Department of Medicine and Center for Behavioral Health and Smart Technology (BLR), University of Pittsburgh School of Medicine, Pittsburgh
| | - Charles F Reynolds
- the Department of Psychiatry (CFR, JFK), University of Pittsburgh School of Medicine, Pittsburgh
| | - Jordan F Karp
- the Department of Psychiatry (CFR, JFK), University of Pittsburgh School of Medicine, Pittsburgh
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Brown PJ, Brennan N, Ciarleglio A, Chen C, Garcia CM, Gomez S, Roose SP, Rutherford BR, Simonsick EM, Spencer RG, Ferrucci L. Declining Skeletal Muscle Mitochondrial Function Associated With Increased Risk of Depression in Later Life. Am J Geriatr Psychiatry 2019; 27:963-971. [PMID: 31104966 PMCID: PMC7388241 DOI: 10.1016/j.jagp.2019.03.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/29/2019] [Accepted: 03/29/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Late-life depression (LLD) is a chronic and heterogeneous disorder. Recent studies have implicated non-normative age-related processes in its pathogenesis. This investigation examined both cross-sectional and longitudinal associations between skeletal muscle mitochondrial function and LLD. METHODS Data from 603 men and women from the Baltimore Longitudinal Study on Aging were analyzed, of whom 167 provided data from a follow-up visit. Muscle bioenergetics was measured by postexercise recovery rate of phosphocreatine (PCr) using phosphorus magnetic resonance spectroscopy. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) Scale. RESULTS There was no cross-sectional association between baseline depression status and either the PCr recovery rate constant (kPCr; t = -0.553, df = 542; p = 0.580) or mitochondrial capacity largely independent of exercise intensity (adenosine triphosphate maximum [ATPmax]; t = 0.804, df = 553; p = 0.422). Covariate-adjusted Firth logistic regression models however showed that greater decreases in skeletal muscle mitochondrial function from baseline to follow-up were associated with higher odds of clinically significant depressive symptoms (CES-D ≥16) at follow-up (ΔATPmax: odds ratio = 2.63, χ2 = 5.62, df =1; p = 0.018; ΔkPCr: odds ratio = 2.32, χ2 = 5.79, df =1; p = 0.016). CONCLUSION Findings suggest that declining skeletal muscle mitochondrial function in older adults is associated with clinically significant depressive symptoms at follow-up, thereby providing preliminary support for the hypothesis that mitochondrial dysfunction may be a potential key pathophysiological mechanism in adults with LLD.
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Affiliation(s)
- Patrick J Brown
- Neurobiology and Therapeutics of Aging Division (PJB, SPR, BRR), Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York.
| | - Nicholas Brennan
- Intramural Research Program (NB, EMS, LF), National Institute on Aging, Bethesda, Maryland
| | - Adam Ciarleglio
- Milken Institute School of Public Health (AC), George Washington University, Washington DC
| | - Chen Chen
- Mailman School of Public Health (CC), Columbia University, New York State Psychiatric Institute, New York
| | | | - Stephanie Gomez
- New York State Psychiatric Institute (CMG, SG), New York, NY
| | - Steven P Roose
- Neurobiology and Therapeutics of Aging Division (PJB, SPR, BRR), Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York
| | - Bret R Rutherford
- Neurobiology and Therapeutics of Aging Division (PJB, SPR, BRR), Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York
| | - Eleanor M Simonsick
- Intramural Research Program (NB, EMS, LF), National Institute on Aging, Bethesda, Maryland
| | - Richard G Spencer
- Laboratory of Clinical Investigation (RGS), National Institute on Aging
| | - Luigi Ferrucci
- Intramural Research Program (NB, EMS, LF), National Institute on Aging, Bethesda, Maryland
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Zilcha-Mano S, Wang Z, Peterson B, Wall MM, Chen Y, Wager TD, Brown PJ, Roose SP, Rutherford BR. Neural mechanisms of expectancy-based placebo effects in antidepressant clinical trials. J Psychiatr Res 2019; 116:19-25. [PMID: 31176108 PMCID: PMC6790474 DOI: 10.1016/j.jpsychires.2019.05.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/22/2019] [Accepted: 05/23/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Patient expectancy of therapeutic improvement is a primary mediator of placebo effects in antidepressant clinical trials, but its mechanisms are poorly understood. This study employed a novel antidepressant trial design, with integrated functional magnetic resonance imaging (fMRI), to manipulate patient outcome expectancy and examine its neural mediators. METHOD Twenty-three depressed outpatients, in a randomized controlled trial were assigned to either Open (high outcome expectancy) or Placebo-controlled (low outcome expectancy) treatment with citalopram for eight weeks. fMRI scans were acquired before and after the expectancy manipulation (before medication treatment), while participants performed a masked emotional face task. Focusing on an amygdala region-of-interest (ROI), we tested a model where reduction in amygdala activation mediated outcome expectancy effects on the slope of change in depressive symptoms. RESULTS Following the manipulation, significant differences between conditions were found in neural activation changes in the amygdala, as well as in superior temporal gyrus, insula, and thalamus. Findings support the proposed mediation model according to which activation in the left amygdala ROI decreased significantly in the Open as opposed to the Placebo-controlled group following randomization (p = 0.009) for sad vs. neutral face contrast. The reduced left amygdala activation, in turn, was a significant predictor of decreased depressive symptoms during the trial (p = 0.007), and the mediation model was significant. CONCLUSIONS Results from this study, the first designed to identify the neural mechanisms of expectancy augmentation in an antidepressant randomized control trial, suggest that therapeutic modulation of amygdala activity may be an important pathway by which patient outcome expectancy influences depressive symptoms. CLINICALTRIALS. GOV IDENTIFIER NCT01919216; Trial name: Placebo Effects in the Treatment of Depression: Cognitive and Neural Mechanisms, URL: https://clinicaltrials.gov/ct2/show/NCT01919216.
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Affiliation(s)
- Sigal Zilcha-Mano
- Department of Psychology, University of Haifa Mount Carmel, Haifa, 31905, Israel.
| | - Zhishun Wang
- (b)Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, USA.
| | | | - Melanie M. Wall
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute
| | - Ying Chen
- (b)Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, USA.
| | - Tor D. Wager
- Department of Psychology and Neuroscience and the Institute of Cognitive Science, University of Colorado at Boulder
| | - Patrick J. Brown
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute
| | - Steven P. Roose
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute
| | - Bret R Rutherford
- (b)Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, USA.
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Rutherford BR, Slifstein M, Chen C, Abi-Dargham A, Brown PJ, Wall MW, Vanegas-Arroyave N, Stern Y, Bailey V, Valente E, Roose SP. RETRACTED: Effects of L-DOPA Monotherapy on Psychomotor Speed and [ 11C]Raclopride Binding in High-Risk Older Adults With Depression. Biol Psychiatry 2019; 86:221-229. [PMID: 31178096 PMCID: PMC6641997 DOI: 10.1016/j.biopsych.2019.04.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/22/2019] [Accepted: 04/04/2019] [Indexed: 01/28/2023]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of Biological Psychiatry Editor John H. Krystal, M.D., with agreement from all authors except Chen Chen and Emily Valente. These two co-authors moved and, with no forwarding information that was available or could be found, they were therefore unable to be contacted. The authors have uncovered irregularities and deviations from the approved protocol related to the work reported in this article. Treatment with antidepressant medications within the past 28 days was an exclusion criterion: “Subjects were excluded for… current treatment or treatment within the past 4 weeks with psychotropic or other medications known to affect dopamine.” Individuals taking an ineffective antidepressant medication who otherwise met study criteria were to undergo a study-supervised medication taper to discontinue their medication for the required period prior to study participation. The published article does not describe that a subgroup of participants (15 out of the 47 consented subjects) enrolled in the study while taking an ineffective antidepressant medication. Of this subgroup, 10 individuals were successfully tapered off their medication and were among the 36 subjects contributing data to the analyses described. In addition, the authors have found that 8 participants did not complete the required 28-day washout prior to beginning the study. For these 8 participants, the medication-free period ranged from 1 to 21 days, with a mean of 10.1 days. Separately, an inclusion criterion was that eligible subjects “had Center for Epidemiologic Studies—Depression Rating scale score ≤ 10.” However, the authors have found that 3 ineligible participants were included, each of whom had depressive symptom scores 1 point out of range for eligibility. Lastly, the CONSORT diagram in Figure S1 states that 11 participants were lost to follow-up. However, this is incorrect. Instead, 9 participants were lost to follow up and 2 participants were screen failures. The authors voluntarily informed the Journal of these honest errors upon discovery. Because of the extent of these issues, the editors and authors concluded that the only course of action was to retract this paper. However, the authors are revising the paper, which the Journal will consider further for publication.
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Affiliation(s)
- Bret R Rutherford
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York; New York State Psychiatric Institute, New York, New York.
| | - Mark Slifstein
- Stony Brook University Renaissance College of Medicine, Stony Brook, New York
| | - Chen Chen
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York; New York State Psychiatric Institute, New York, New York
| | - Anissa Abi-Dargham
- Stony Brook University Renaissance College of Medicine, Stony Brook, New York
| | - Patrick J Brown
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York; New York State Psychiatric Institute, New York, New York
| | - Melanie W Wall
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York; New York State Psychiatric Institute, New York, New York
| | | | - Yaakov Stern
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | | | - Emily Valente
- New York State Psychiatric Institute, New York, New York
| | - Steven P Roose
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York; New York State Psychiatric Institute, New York, New York
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Zilcha-Mano S, Roose SP, Brown PJ, Rutherford BR. Not Just Nonspecific Factors: The Roles of Alliance and Expectancy in Treatment, and Their Neurobiological Underpinnings. Front Behav Neurosci 2019; 12:293. [PMID: 30760986 PMCID: PMC6361734 DOI: 10.3389/fnbeh.2018.00293] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 11/13/2018] [Indexed: 12/14/2022] Open
Abstract
Therapeutic factors such as alliance and expectancy have been found to greatly affect treatment outcome in both psychotherapy and psychopharmacotherapy. Often, these factors are referred to as nonspecific because of their common roles across treatment modalities. Here we argue that conceptualizing such factors as nonspecific is not accurate at best, misleading at worst and may undermine treatment outcome across various modalities. We argue that alliance and expectancy contain both a trait-like common factor component and a state-like specific effect, and that it is clinically, conceptually and methodologically critical to disentangle the two. In other words, both alliance and expectancy may also function as active ingredients of treatment, leading to better outcome. We review the literature regarding the neurobiological underpinnings of alliance and of the expectancy effect, and suggest how future studies on the neurobiological basis of these effects can shed further light on the potentially distinct mechanisms of the trait-like and state-like components of each therapeutic factor.
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Affiliation(s)
| | - Steven P Roose
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Patrick J Brown
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Bret R Rutherford
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York, NY, United States
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Zilcha-Mano S, Roose SP, Brown PJ, Rutherford BR. Abrupt Symptom Improvements in Antidepressant Clinical Trials: Transient Placebo Effects or Therapeutic Reality? J Clin Psychiatry 2018; 80. [PMID: 30549486 DOI: 10.4088/jcp.18m12353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/05/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND According to prevailing models and classical reports, abrupt responses to antidepressant medication are not true drug responses but rather transient placebo effects. By contrast, recent reports suggest that early sudden improvements have a lasting effect and appear in most patients receiving medication. Clinical guidelines influenced by these contradictory findings are mixed and confusing. OBJECTIVE To evaluate the occurrence and effects of abrupt improvements in symptoms in placebo vs antidepressant conditions in individuals with late-life depression, using a rigorous method of identifying sudden gains, developed and tested in scores of studies in psychotherapy research. METHODS We analyzed data (collected during 1999-2002) from 174 patients 75 years or older, with unipolar depression (based on DSM-IV), who were randomly assigned to citalopram or placebo. We tested differences between conditions in the prevalence of sudden gains, and their effect on outcome, using χ² analyses and linear regression models. Pretreatment predictors of sudden gains were identified using a machine learning approach. RESULTS 36.2% of patients showed stable sudden gains, without significant differences between medication and placebo conditions (χ²₁ = 0.95, P = .33). The mean reduction in the Hamilton Depression Rating Scale score was 7.2 points greater for patients who showed sudden gains (t₁₇₂ = -7.52, P < .0001). Higher levels of pretreatment symptom severity and higher processing speed increased the likelihood of showing sudden gains. CONCLUSION Even in a geriatric population, which is likely to show more sustained depression and less fluctuation, sudden gains were common. The findings may necessitate modifying current models of mechanisms of change of antidepressant medication and may affect guidelines for best clinical practice.
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Affiliation(s)
- Sigal Zilcha-Mano
- Department of Psychology, University of Haifa, Mount Carmel, Haifa 31905, Israel. .,Department of Psychology, University of Haifa, Mount Carmel, Israel
| | - Steven P Roose
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, USA
| | - Patrick J Brown
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, USA
| | - Bret R Rutherford
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, USA
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Brown PJ, Wall MM, Chen C, Levine ME, Yaffe K, Roose SP, Rutherford BR. Biological Age, Not Chronological Age, Is Associated with Late-Life Depression. J Gerontol A Biol Sci Med Sci 2018; 73:1370-1376. [PMID: 28958059 PMCID: PMC6132120 DOI: 10.1093/gerona/glx162] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 08/22/2017] [Indexed: 11/14/2022] Open
Abstract
Background The pathophysiology of late-life depression (LLD) is complex and heterogeneous, with age-related processes implicated in its pathogenesis. This study examined the cross-sectional and longitudinal association between depressive symptoms and a baseline multibiomarker algorithm of biological age (BA) that aggregates indicators of inflammatory, metabolic, cardiovascular, lung, liver, and kidney functioning. Method Data were analyzed from 2,776 men and women from the prospective observational Health Aging and Body Composition Study, who had both evaluable chronological age (CA) and BA. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Results A covariate-adjusted regression model showed that BA (B = 0.03, p = .0471) but not CA (B = -0.01, p = .7185) is associated with baseline CES-D scores. The mean baseline BA for individuals with a CES-D ≥ 10 was 1.28 years greater than in those with a CES-D < 10. Comparatively, there is only a 0.05-year difference in mean CA between the two depression groups. A covariate-adjusted longitudinal model found that baseline BA predicts CES-D score at follow-up (B = 0.04, p = .0058), whereas CA does not (B = 0.03, p = .4125). Additionally, an older BA significantly predicted a CES-D ≥ 10 (B = 0.02, p = .032) over a 10-year period. Conclusions A multibiomarker index of an older adult's BA outperformed their CA in predicting subsequent increased and clinically significant depressive symptoms. This result supports the evolving view of LLD as a brain disorder resulting from deleterious age-associated changes across numerous physiological systems.
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Affiliation(s)
- Patrick J Brown
- Program on Healthy Aging and Late Life Brain Disorders, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute
| | - Melanie M Wall
- Department of Biostatistics, Mailman School of Public Health, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute
| | - Chen Chen
- Department of Biostatistics, Mailman School of Public Health, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute
| | - Morgan E Levine
- Department of Human Genetics, David Geffen School of Medicine, University of California at Los Angeles
| | - Kristine Yaffe
- Department of Psychiatry, University of California, San Francisco
| | - Steven P Roose
- Department of Biostatistics, Mailman School of Public Health, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute
| | - Bret R Rutherford
- Department of Biostatistics, Mailman School of Public Health, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute
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Brewster KK, Ciarleglio A, Brown PJ, Chen C, Kim HO, Roose SP, Golub JS, Rutherford BR. Age-Related Hearing Loss and Its Association with Depression in Later Life. Am J Geriatr Psychiatry 2018; 26:788-796. [PMID: 29752060 PMCID: PMC6008216 DOI: 10.1016/j.jagp.2018.04.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 04/06/2018] [Accepted: 04/06/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To evaluate the association between age-related hearing loss (ARHL) and depressive symptoms in older adults over time. METHODS Data from the Health Aging and Body Composition study (N = 3075, aged 70-79 at baseline) were used previously to conduct a longitudinal latent class analysis to evaluate depression trajectories (Center for Epidemiologic Studies Depression [CES-D] Scale) over 10 years. Restricting to the subset of subjects who had hearing information available (N = 1204), self-reported hearing categories were evaluated over the same period. Association between depression classes and hearing categories were assessed via multinomial logistic regression analyses. Correlation analyses and two-sample t-tests were used to assess cross-sectional associations between depression status and audiometric hearing measures. RESULTS Low-probability (N = 644), increasing-probability (N = 385), and high-probability (N = 175) trajectories of depressive symptoms were identified for the 10-year period. Impaired/Worsening (N = 182) and Healthy/Improving (N = 1,022) hearing categories were defined using self-reports. With the low-probability depression trajectory as the reference group, subjects reporting Impaired/Worsening hearing had 1.63 times increased odds of having an increasing- (p = 0.0088, 95% CI [1.13, 2.34]) and 1.85 times increased odds of having a high-probability depression trajectory (p = 0.0102, 95% CI [1.16, 2.96]). At Year 5, individuals with depressive symptoms (10CES-D ≥ 10) had impaired hearing ability measured by audiometric threshold for low-frequency (Adjusted mean difference = 2.29 dBHL, p = 0.0005) and mid-frequency sounds (Adjusted mean difference = 2.28 dBHL,p = 0.0049) compared to those with 10CES-D < 10. CONCLUSIONS ARHL was associated with increased depressive symptoms in older adults. Future studies should investigate whether treatment of ARHL may be an effective prevention and/or therapeutic strategy for depressive symptoms.
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Affiliation(s)
- Katharine K Brewster
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY.
| | - Adam Ciarleglio
- Columbia University Mailman School of Public Health, New York State Psychiatric Institute, New York, NY
| | - Patrick J Brown
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY
| | - Chen Chen
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY
| | - Hae-Ok Kim
- Columbia University College of Physicians and Surgeons, Department of Otolaryngology-Head and Neck Surgery, New York, NY
| | - Steven P Roose
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY
| | - Justin S Golub
- Columbia University College of Physicians and Surgeons, Department of Otolaryngology-Head and Neck Surgery, New York, NY
| | - Bret R Rutherford
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY
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Zilcha-Mano S, Roose SP, Brown PJ, Rutherford BR. A Machine Learning Approach to Identifying Placebo Responders in Late-Life Depression Trials. Am J Geriatr Psychiatry 2018; 26:669-677. [PMID: 29398354 PMCID: PMC5993576 DOI: 10.1016/j.jagp.2018.01.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 12/20/2017] [Accepted: 01/04/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Despite efforts to identify characteristics associated with medication-placebo differences in antidepressant trials, few consistent findings have emerged to guide participant selection in drug development settings and differential therapeutics in clinical practice. Limitations in the methodologies used, particularly searching for a single moderator while treating all other variables as noise, may partially explain the failure to generate consistent results. The present study tested whether interactions between pretreatment patient characteristics, rather than a single-variable solution, may better predict who is most likely to benefit from placebo versus medication. METHODS Data were analyzed from 174 patients aged 75 years and older with unipolar depression who were randomly assigned to citalopram or placebo. Model-based recursive partitioning analysis was conducted to identify the most robust significant moderators of placebo versus citalopram response. RESULTS The greatest signal detection between medication and placebo in favor of medication was among patients with fewer years of education (≤12) who suffered from a longer duration of depression since their first episode (>3.47 years) (B = 2.53, t(32) = 3.01, p = 0.004). Compared with medication, placebo had the greatest response for those who were more educated (>12 years), to the point where placebo almost outperformed medication (B = -0.57, t(96) = -1.90, p = 0.06). CONCLUSION Machine learning approaches capable of evaluating the contributions of multiple predictor variables may be a promising methodology for identifying placebo versus medication responders. Duration of depression and education should be considered in the efforts to modulate placebo magnitude in drug development settings and in clinical practice.
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Affiliation(s)
| | - Steven P Roose
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY
| | - Patrick J Brown
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY
| | - Bret R Rutherford
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY
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Abstract
Recent research has linked age-related hearing loss to impaired performance across cognitive domains and increased risk for dementia diagnosis. The data linking hearing impairment to incident late-life depression are more mixed but suggest that diminished hearing does increase risk for depression. Behavioral mechanisms may explain these associations, such as the withdrawal of older adults from situations in which they may have difficulty hearing and communicating, which may contribute to the development of social isolation, loneliness, and consequent cognitive decline and depression. At a neural level, chronic hearing loss leads to reduced activation in central auditory pathways, resulting in compensatory increased activation in the cognitive control network, dysfunctional auditory-limbic connectivity, and deafferentation-induced atrophy in frontal brain regions. These pathologic changes decrease cognitive performance and increase depression risk by reducing cognitive reserve, increasing executive dysfunction, and disrupting normative emotion reactivity and regulation. Based on the available data and informed by this model, evidence-based suggestions are proposed for clinicians treating older adults, and a research agenda is advanced to facilitate the development of rationally designed and age-appropriate psychiatric treatments for older adults with age-related hearing loss. First and foremost, treating hearing loss should be investigated as a means of improving cognitive and depressive outcomes in well-designed studies incorporating comprehensive psychiatric assessments, randomization, objective documentation of compliance, and analyses of treatment mediators that will facilitate further therapeutic development. Multimodal neuroimaging studies integrating audiometric, neuropsychological, and clinical assessments also are needed to further evaluate the model proposed. [AJP at 175: Remembering Our Past As We Envision Our Future April 1995: Effect of Hearing Enhancement on Medical Status Ratings Twenty-one elderly psychiatric patients had lower levels of psychopathology when assessed while wearing hearing aids. (Am J Psychiatry 1995; 152:629-631 )].
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Affiliation(s)
- Bret R Rutherford
- From the New York State Psychiatric Institute, New York; and the Department of Psychiatry and the Department of Otolaryngology-Head & Neck Surgery, Columbia University College of Physicians and Surgeons, Columbia University, New York
| | - Katharine Brewster
- From the New York State Psychiatric Institute, New York; and the Department of Psychiatry and the Department of Otolaryngology-Head & Neck Surgery, Columbia University College of Physicians and Surgeons, Columbia University, New York
| | - Justin S Golub
- From the New York State Psychiatric Institute, New York; and the Department of Psychiatry and the Department of Otolaryngology-Head & Neck Surgery, Columbia University College of Physicians and Surgeons, Columbia University, New York
| | - Ana H Kim
- From the New York State Psychiatric Institute, New York; and the Department of Psychiatry and the Department of Otolaryngology-Head & Neck Surgery, Columbia University College of Physicians and Surgeons, Columbia University, New York
| | - Steven P Roose
- From the New York State Psychiatric Institute, New York; and the Department of Psychiatry and the Department of Otolaryngology-Head & Neck Surgery, Columbia University College of Physicians and Surgeons, Columbia University, New York
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Affiliation(s)
- Deborah L. Cabaniss
- Columbia University Center for Psychoanalytic Training and Research, Deborah L. Cabaniss, 903 Park Avenue, NY, NY, 10021 USA ‐
| | - Jonah W. Schein
- Columbia University Center for Psychoanalytic Training and Research, Deborah L. Cabaniss, 903 Park Avenue, NY, NY, 10021 USA ‐
| | - Paul Rosen
- Columbia University Center for Psychoanalytic Training and Research, Deborah L. Cabaniss, 903 Park Avenue, NY, NY, 10021 USA ‐
| | - Steven P. Roose
- Columbia University Center for Psychoanalytic Training and Research, Deborah L. Cabaniss, 903 Park Avenue, NY, NY, 10021 USA ‐
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Brown PJ, Badreddine D, Roose SP, Rutherford B, Ayonayon HN, Yaffe K, Simonsick EM, Goodpaster B. Muscle fatigability and depressive symptoms in later life. Int J Geriatr Psychiatry 2017; 32:e166-e172. [PMID: 28198046 DOI: 10.1002/gps.4678] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/11/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Fatigability is the degree to which performance decreases during a specific activity of a given intensity and duration. Depression is known to heighten subjective fatigue, but whether its association with physical fatigability is unknown. Further, whether fatigability is a precursor or risk factor for the development of subsequent depressive symptoms is also unclear. METHODS Data are from the Health Aging and Body Composition Study with fatigability assessed using isokinetic dynamometry of the knee extensors at year 3, and depressive symptoms ascertained longitudinally using the Center for Epidemiologic Studies Depression (CES-D) scale. The relationship between fatigability and depressive symptoms was evaluated using linear and Cox regression models. RESULTS There was a significant cross-sectional association between fatigability and depressive symptomatology (β = -0.06, p = 0.02), after adjusting for demographic variables, medical comorbidities, cognition, gait speed, and physical activity levels. Greater fatigability was associated with greater adjusted scores on the 10-item CES-D (F2, 1695 = 38.65, p < 0.001), with individuals with greater fatigability on average reporting an adjusted CES-D score 0.5 point greater than those individuals with higher levels of resistance to fatigability (mean of 70% or better; p < 0.001). Fatigability however was not associated with the development of depression at follow-up (p = 0.828). CONCLUSIONS This study found an association between skeletal muscle fatigability and higher depressive symptoms in older adults, but no longitudinal association was identified. These findings suggest that age-related changes in energy capacity may affect the phenomenology of late life depression. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Patrick J Brown
- Division of Geriatric Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
| | | | - Steven P Roose
- Division of Geriatric Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
| | - Bret Rutherford
- Division of Geriatric Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
| | - Hilsa N Ayonayon
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Kristine Yaffe
- Neurology, Psychiatry, Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Eleanor M Simonsick
- Intramural Research Program, Translational Gerontology Branch, National Institute on Aging, Baltimore, MD, USA
| | - Bret Goodpaster
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital and Sanford Burnham Presbys Medical Discovery Institute, Orlando, FL, USA
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- Translational Research Institute for Metabolism and Diabetes, Florida Hospital and Sanford Burnham Presbys Medical Discovery Institute, Orlando, FL, USA
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Zilcha-Mano S, Roose SP, Brown PJ, Rutherford BR. Early Symptom Trajectories as Predictors of Treatment Outcome for Citalopram Versus Placebo. Am J Geriatr Psychiatry 2017; 25:654-661. [PMID: 28318797 PMCID: PMC5429879 DOI: 10.1016/j.jagp.2017.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/30/2017] [Accepted: 02/01/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The high percentage of failed clinical trials for anti-depressant medications, especially in elderly populations, obscures the fact that some patients may benefit greatly from treatment. Early detection of patients who may benefit most from antidepressant medication may improve treatment decisions. We examined whether depressed patients in a large clinical trial exhibit distinct trajectories of early symptom change that predict differential response to medication or placebo. METHODS We reanalyzed data of 174 patients aged 75 years and older with unipolar depression who were randomly assigned to citalopram or placebo. We used growth mixture modeling to identify trajectories of early change (weeks 1-4) on the Hamilton Rating Scale for Depression in the citalopram and placebo conditions. RESULTS In the citalopram condition, two distinct trajectories of early change were detected that were associated with significantly different symptom reduction, but only one trajectory was detected for the placebo condition. One of the early trajectories of patients receiving citalopram (N = 33) showed significantly better symptomatic change than placebo; the other trajectory (N = 51) did not differ significantly from placebo. Poor baseline functional scores predicted trajectory membership, so that individuals with a score below 4.5 on baseline instrumental activities of daily living showed a higher tendency to be in the trajectory that outperformed placebo. CONCLUSIONS The subgroup of citalopram-treated patients exhibiting better symptom trajectory early in a trial are likely to have beneficial outcomes relative to placebo. Future research should focus on developing reliable pre-treatment clinical and biological measures to identify this subgroup.
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Affiliation(s)
| | - Steven P Roose
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY
| | - Patrick J Brown
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY
| | - Bret R Rutherford
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY
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Rutherford BR, Taylor WD, Brown PJ, Sneed JR, Roose SP. Biological Aging and the Future of Geriatric Psychiatry. J Gerontol A Biol Sci Med Sci 2017; 72:343-352. [PMID: 27994004 PMCID: PMC6433424 DOI: 10.1093/gerona/glw241] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/08/2016] [Indexed: 01/21/2023] Open
Abstract
Advances in understanding the biological bases of aging have intellectually revitalized the field of geriatric psychiatry and broadened its scope to include promoting successful aging and studying resilience factors in older adults. To describe the process by which this paradigm shift has occurred and illustrate its implications for treatment and research of late-life brain disorders, late-life depression is discussed as a prototype case. Prior phases of geriatric psychiatry research were focused on achieving depressive symptom relief, outlining pharmacokinetic and pharmacodynamic differences between older and younger adults, and identifying moderators of treatment response. Building on this work, current geriatric psychiatry researchers have begun to disentangle the etiologic complexity in late-life depression by focusing on the causative aging-related processes involved, identifying both neurobiological and behavioral intermediates, and finally delineating depression subtypes that are distinguishable by their underlying biology and the treatment approach required. In this review, we discuss several age-related processes that are critical to the development of late-life mood disorders, outline implications of these processes for the clinical evaluation and management of later-life psychiatric disorders, and finally put forth suggestions for better integrating aging and developmental processes into the National Institute of Mental Health's Research Domain Criteria.
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Affiliation(s)
- Bret R Rutherford
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute
| | - Warren D Taylor
- Vanderbilt University Medical Center, Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Tennessee Valley Health Care Center
| | - Patrick J Brown
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute
| | - Joel R Sneed
- Queens College of the City University of New York
| | - Steven P Roose
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute
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Kerner NA, Roose SP, Pelton GH, Ciarleglio A, Scodes J, Lentz C, Sneed JR, Devanand DP. Association of Obstructive Sleep Apnea with Episodic Memory and Cerebral Microvascular Pathology: A Preliminary Study. Am J Geriatr Psychiatry 2017; 25:316-325. [PMID: 28040430 PMCID: PMC5316492 DOI: 10.1016/j.jagp.2016.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 11/15/2016] [Accepted: 11/16/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate the impact of obstructive sleep apnea (OSA) on neurocognitive function and brain morphology in older adults with depression and cognitive impairment. METHODS We prospectively screened OSA with the STOP-Bang questionnaire in the last 25 patients enrolled into the Donepezil Treatment of Cognitive Impairment and Depression (DOTCODE) trial. High and low probability of OSA were defined as a STOP-Bang score of ≥5 (h-OSA) and of <5 (l-OSA), respectively. Baseline magnetic resonance imaging (MRI) was used to evaluate brain morphology. The initial 16 weeks of antidepressant treatment were part of the DOTCODE trial. RESULTS After 16 weeks of antidepressant treatment, the h-OSA group performed significantly worse on the Selective Reminding Test delayed recall task than the l-OSA group, controlling for baseline performance (F = 19.1, df = 1,22, p < 0.001). In 19 of 25 participants who underwent brain MRI, the h-OSA group had significantly greater volumes of MRI hyperintensities in deep white matter, periventricular white matter, and subcortical gray matter compared with the l-OSA group. There was no significant association between OSA and hippocampal or entorhinal cortex volumes in our sample, even after controlling for intracranial volume. CONCLUSIONS OSA is associated with impaired verbal episodic memory and microvascular damage in older adults with depression and cognitive impairment. One possibility is that by contributing to cerebral microvascular damage, OSA may exacerbate progressive memory decline.
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Affiliation(s)
- Nancy A. Kerner
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University / Columbia University Medical Center, New York, NY, 10032,The Late-life Depression Clinic, the Memory Disorders Clinic, and the Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY 10032
| | - Steven P. Roose
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University / Columbia University Medical Center, New York, NY, 10032,The Late-life Depression Clinic, the Memory Disorders Clinic, and the Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY 10032
| | - Gregory H. Pelton
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University / Columbia University Medical Center, New York, NY, 10032,The Late-life Depression Clinic, the Memory Disorders Clinic, and the Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY 10032,Department of Neurology, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, NY, 10032
| | - Adam Ciarleglio
- Division of Biostatistics, Department of Psychiatry, College of Physicians and Surgeons of Columbia University / Columbia University Medical Center, New York, NY, 10032
| | - Jennifer Scodes
- Division of Biostatistics, Department of Psychiatry, College of Physicians and Surgeons of Columbia University / Columbia University Medical Center, New York, NY, 10032
| | - Cody Lentz
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University / Columbia University Medical Center, New York, NY, 10032
| | - Joel R. Sneed
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University / Columbia University Medical Center, New York, NY, 10032,The Late-life Depression Clinic, the Memory Disorders Clinic, and the Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY 10032,Queens College, City University of New York, New York
| | - D. P. Devanand
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University / Columbia University Medical Center, New York, NY, 10032,The Late-life Depression Clinic, the Memory Disorders Clinic, and the Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY 10032,Department of Neurology, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, NY, 10032
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Rutherford BR, Wall MM, Brown PJ, Choo TH, Wager TD, Peterson BS, Chung S, Kirsch I, Roose SP. Patient Expectancy as a Mediator of Placebo Effects in Antidepressant Clinical Trials. Am J Psychiatry 2017; 174:135-142. [PMID: 27609242 PMCID: PMC5288269 DOI: 10.1176/appi.ajp.2016.16020225] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Causes of placebo effects in antidepressant trials have been inferred from observational studies and meta-analyses, but their mechanisms have not been directly established. The goal of this study was to examine in a prospective, randomized controlled trial whether patient expectancy mediates placebo effects in antidepressant studies. METHOD Adult outpatients with major depressive disorder were randomly assigned to open or placebo-controlled citalopram treatment. Following measurement of pre- and postrandomization expectancy, participants were treated with citalopram or placebo for 8 weeks. Independent samples t tests determined whether patient expectancy differed between the open and placebo-controlled groups, and mixed-effects models assessed group effects on Hamilton Depression Rating Scale (HAM-D) scores over time while controlling for treatment assignment. Finally, mediation analyses tested whether between-group differences in patient expectancy mediated the group effect on HAM-D scores. RESULTS Postrandomization expectancy scores were significantly higher in the open group (mean=12.1 [SD=2.1]) compared with the placebo-controlled group (mean=11.0 [SD=2.0]). Mixed-effects modeling revealed a significant week-by-group interaction, indicating that HAM-D scores for citalopram-treated participants declined at a faster rate in the open group compared with the placebo-controlled group. Patient expectations postrandomization partially mediated group effects on week 8 HAM-D. CONCLUSIONS Patient expectancy is a significant mediator of placebo effects in antidepressant trials. Expectancy-related interventions should be investigated as a means of controlling placebo responses in antidepressant clinical trials and improving patient outcome in clinical treatment.
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Affiliation(s)
- Bret R Rutherford
- From Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York; the Department of Psychology and Neuroscience and the Institute of Cognitive Science, University of Colorado at Boulder, Boulder, Colo.; the Institute for the Developing Mind, Children's Hospital Los Angeles; the Keck School of Medicine at the University of Southern California, Los Angeles; Harvard Medical School, Boston; and Beth Israel Deaconess Medical Center, Boston
| | - Melanie M Wall
- From Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York; the Department of Psychology and Neuroscience and the Institute of Cognitive Science, University of Colorado at Boulder, Boulder, Colo.; the Institute for the Developing Mind, Children's Hospital Los Angeles; the Keck School of Medicine at the University of Southern California, Los Angeles; Harvard Medical School, Boston; and Beth Israel Deaconess Medical Center, Boston
| | - Patrick J Brown
- From Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York; the Department of Psychology and Neuroscience and the Institute of Cognitive Science, University of Colorado at Boulder, Boulder, Colo.; the Institute for the Developing Mind, Children's Hospital Los Angeles; the Keck School of Medicine at the University of Southern California, Los Angeles; Harvard Medical School, Boston; and Beth Israel Deaconess Medical Center, Boston
| | - Tse-Hwei Choo
- From Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York; the Department of Psychology and Neuroscience and the Institute of Cognitive Science, University of Colorado at Boulder, Boulder, Colo.; the Institute for the Developing Mind, Children's Hospital Los Angeles; the Keck School of Medicine at the University of Southern California, Los Angeles; Harvard Medical School, Boston; and Beth Israel Deaconess Medical Center, Boston
| | - Tor D Wager
- From Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York; the Department of Psychology and Neuroscience and the Institute of Cognitive Science, University of Colorado at Boulder, Boulder, Colo.; the Institute for the Developing Mind, Children's Hospital Los Angeles; the Keck School of Medicine at the University of Southern California, Los Angeles; Harvard Medical School, Boston; and Beth Israel Deaconess Medical Center, Boston
| | - Bradley S Peterson
- From Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York; the Department of Psychology and Neuroscience and the Institute of Cognitive Science, University of Colorado at Boulder, Boulder, Colo.; the Institute for the Developing Mind, Children's Hospital Los Angeles; the Keck School of Medicine at the University of Southern California, Los Angeles; Harvard Medical School, Boston; and Beth Israel Deaconess Medical Center, Boston
| | - Sarah Chung
- From Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York; the Department of Psychology and Neuroscience and the Institute of Cognitive Science, University of Colorado at Boulder, Boulder, Colo.; the Institute for the Developing Mind, Children's Hospital Los Angeles; the Keck School of Medicine at the University of Southern California, Los Angeles; Harvard Medical School, Boston; and Beth Israel Deaconess Medical Center, Boston
| | - Irving Kirsch
- From Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York; the Department of Psychology and Neuroscience and the Institute of Cognitive Science, University of Colorado at Boulder, Boulder, Colo.; the Institute for the Developing Mind, Children's Hospital Los Angeles; the Keck School of Medicine at the University of Southern California, Los Angeles; Harvard Medical School, Boston; and Beth Israel Deaconess Medical Center, Boston
| | - Steven P Roose
- From Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York; the Department of Psychology and Neuroscience and the Institute of Cognitive Science, University of Colorado at Boulder, Boulder, Colo.; the Institute for the Developing Mind, Children's Hospital Los Angeles; the Keck School of Medicine at the University of Southern California, Los Angeles; Harvard Medical School, Boston; and Beth Israel Deaconess Medical Center, Boston
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Abstract
OBJECTIVE This study aimed to review the data on the effect of selective serotonin reuptake inhibitors (SSRIs) on bleeding during or after operative procedures and to offer guidelines for clinical management. DATA SOURCES Search of PubMed and MEDLINE for all articles in English from 1990-2016 with key words depression, antidepressants, bleeding, platelets, and operation. STUDY SELECTION Studies were included if they reported information on bleeding complications during operative or childbirth procedures in patients taking antidepressants. DATA EXTRACTION Because of the limited number and heterogeneity of studies with respect to the range of operative procedures and definition of bleeding complications, a qualitative approach was taken to summarize results rather than abstracting and aggregating data. RESULTS The weight of the evidence is that SSRI use increases the risk of bleeding complications during and immediately after surgery. However, given the limited data, we cannot estimate the risk for a given patient having a given procedure. CONCLUSIONS Clinicians must consider the risk-to-benefit ratio of discontinuing an SSRI before an elective operative procedure. Discontinuing SSRI medications may result in discontinuation syndrome, symptom recrudescence, or relapse of depression, whereas continuing an SSRI during surgery exposes patients to significant bleeding risks. Antidepressant prescribers must be cognizant of and take responsibility for discussing this potential problem and considering different options. This issue must also be the responsibility of the doctor performing the procedure, but, frequently, it will be the prescribing physician who alerts the surgeon to the potential bleeding risk associated with SSRIs.
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Affiliation(s)
- Steven P. Roose
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Box 98, New York, NY 10032, 646-774-8661 (telephone), 646-774-5854 (fax),
| | - Bret R Rutherford
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY 10032
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Brown PJ, Rutherford BR, Yaffe K, Tandler JM, Ray JL, Pott E, Chung S, Roose SP. The Depressed Frail Phenotype: The Clinical Manifestation of Increased Biological Aging. Am J Geriatr Psychiatry 2016; 24:1084-1094. [PMID: 27618646 PMCID: PMC5069140 DOI: 10.1016/j.jagp.2016.06.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/14/2016] [Accepted: 06/16/2016] [Indexed: 01/06/2023]
Abstract
Depression in later life is a severe public health problem, associated with higher rates of mortality, suicide, and dementia. Effectiveness of treatment is limited by the failure to deconstruct the heterogeneity of the illness and because diagnostic criteria, pathophysiological models, and treatment algorithms for depression are primarily based on studies of younger adults even though symptoms of the illness and physiology of the patient change with age. Thus, understanding how aging interacts with depressive illness may elucidate endophenotypes of late-life depression with different clinical manifestations and underlying mechanisms that can then be targeted with more personalized approaches to treatment. This paper proposes a model for the critical confluence between depression and frailty, a high-risk morbidity and mortality syndrome of later life. This model hypothesizes that characteristics of frailty in adults with late life depression represent the clinical manifestation of greater biological aging and their presence in the context of a depressive illness exposes elders to deleterious trajectories. Potential common biological substrates that may result in the manifestation of the depressed frail phenotype including mitochondrial functioning, dopaminergic neurotransmission, and inflammatory processes and implications for the assessment and treatment of adults with late-life depression are discussed. As society continues to live longer, the preservation of the quality of these added years becomes paramount, and the combined impact of depression and frailty on the preservation of this quality warrants the attention of clinical researchers and physicians.
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Affiliation(s)
- Patrick J. Brown
- College of Physicians and Surgeons, Columbia University, New York, NY USA,New York State Psychiatric Institute, New York, NY USA
| | - Bret R. Rutherford
- College of Physicians and Surgeons, Columbia University, New York, NY USA,New York State Psychiatric Institute, New York, NY USA
| | - Kristine Yaffe
- Neurology, Psychiatry, Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | | | | | - Emily Pott
- New York State Psychiatric Institute, New York, NY USA
| | - Sarah Chung
- New York State Psychiatric Institute, New York, NY USA
| | - Steven P. Roose
- College of Physicians and Surgeons, Columbia University, New York, NY USA,New York State Psychiatric Institute, New York, NY USA
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Lenze EJ, Ramsey A, Brown PJ, Reynolds CF, Mulsant BH, Lavretsky H, Roose SP. Older Adults' Perspectives on Clinical Research: A Focus Group and Survey Study. Am J Geriatr Psychiatry 2016; 24:893-902. [PMID: 27591916 PMCID: PMC5026966 DOI: 10.1016/j.jagp.2016.07.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/25/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Clinical trials can benefit from patient perspectives to inform trial design, such as choice of outcome measures. We engaged older adults in focus groups and surveys to get their perspective regarding needs in clinical research. The goal was to inform the development of a new clinical trial of medication strategies for treatment-resistant depression in older adults. METHODS Older adults with depression participated in focus groups and a subsequent survey in St. Louis and New York. They were queried regarding research design features including outcomes, clinical management, mobile technology and iPad-administered assessments, the collection of DNA, and the receipt of their personal results. RESULTS Patients told us: (1) psychological well-being and symptomatic remission are outcomes that matter to them; (2) it is important to measure not only benefits but risks (such as risk of falling) of medications; (3) for pragmatic trials in clinical settings, the research team should provide support to clinicians to ensure that medications are properly prescribed; (4) technology-based assessments are acceptable but there were concerns about data security and burden; (5) DNA testing is very important if it could improve precision care; (6) participants want to receive aggregate findings and their own personal results at the end of the study. CONCLUSIONS Patients gave useful and wide-ranging guidance regarding clinical and comparative effectiveness research in older adults. We discuss these findings with the goal of making the next generation of geriatric studies more impactful and patient-centered.
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Affiliation(s)
- Eric J. Lenze
- Washington University, St Louis, Missouri (Department of Psychiatry, 660 S. Euclid Box 8134, St Louis, MO 63110
| | - Alex Ramsey
- Washington University, St Louis, Missouri (Department of Psychiatry, 660 S. Euclid Box 8134, St Louis, MO 63110
| | - Patrick J. Brown
- College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute
| | | | - Benoit H. Mulsant
- Centre for Addiction and Mental Health and University of Toronto Department of Psychiatry
| | - Helen Lavretsky
- UCLA, UCLA Semel Institute for Neuroscience and Human Behavior
| | - Steven P. Roose
- College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute
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Hsu JH, Mulsant BH, Lenze EJ, Karp JF, Lavretsky H, Roose SP, Reynolds CF, Blumberger DM. Impact of Prior Treatment on Remission of Late-Life Depression with Venlafaxine and Subsequent Aripiprazole or Placebo Augmentation. Am J Geriatr Psychiatry 2016; 24:918-22. [PMID: 27538352 PMCID: PMC5026879 DOI: 10.1016/j.jagp.2016.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/26/2016] [Accepted: 04/27/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Treatment history can inform clinical decisions about subsequent treatment choices. The authors examined the impact of prior antidepressant treatment on treatment outcomes with venlafaxine only and then with augmentation with aripiprazole or placebo in depressed older adults. METHODS The authors analyzed outcome data from a randomized, placebo-controlled clinical trial of aripiprazole augmentation in depressed older adults. The study consisted of an open-label lead-in phase with venlafaxine XR, followed by a placebo-controlled phase of aripiprazole augmentation. Treatment history was assessed with the Antidepressant Treatment History Form. RESULTS Documented prior treatment failure predicted a reduced remission rate with venlafaxine. However, aripiprazole augmentation was efficacious in those with prior treatment failure (42.6% remission with aripiprazole versus 25.8% with placebo; χ(2) = 3.87 df = 1, p = 0.049). CONCLUSION Aripiprazole augmentation is an efficacious strategy in older depressed adults who fail to remit with two or more adequate antidepressant trials, including a course of venlafaxine.
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Affiliation(s)
- Jonathan H. Hsu
- Campbell Family Research Institute, Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto
| | - Benoit H. Mulsant
- Campbell Family Research Institute, Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto
| | - Eric J. Lenze
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine
| | - Jordan F. Karp
- University of Pittsburgh School of Medicine, Pittsburgh, PA,VAPHS Geriatric Research, Education, and Clinical Center, Pittsburgh, PA
| | - Helen Lavretsky
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Steven P. Roose
- Columbia University and the New York State Psychiatric Institute, New York, NY
| | | | - Daniel M. Blumberger
- Campbell Family Research Institute, Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto
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Affiliation(s)
- Steven P Roose
- Steven P. Roose, MD, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, USA. ; Bret R. Rutherford, MD
| | - Bret R Rutherford
- Steven P. Roose, MD, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, USA. ; Bret R. Rutherford, MD
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Kerner NA, Roose SP. Obstructive Sleep Apnea is Linked to Depression and Cognitive Impairment: Evidence and Potential Mechanisms. Am J Geriatr Psychiatry 2016; 24:496-508. [PMID: 27139243 PMCID: PMC5381386 DOI: 10.1016/j.jagp.2016.01.134] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 11/17/2015] [Accepted: 01/12/2016] [Indexed: 12/19/2022]
Abstract
Obstructive sleep apnea (OSA) is highly prevalent but very frequently undiagnosed. OSA is an independent risk factor for depression and cognitive impairment/dementia. Herein the authors review studies in the literature pertinent to the effects of OSA on the cerebral microvascular and neurovascular systems and present a model to describe the key pathophysiologic mechanisms that may underlie the associations, including hypoperfusion, endothelial dysfunction, and neuroinflammation. Intermittent hypoxia plays a critical role in initiating and amplifying these pathologic processes. Hypoperfusion and impaired cerebral vasomotor reactivity lead to the development or progression of cerebral small vessel disease (C-SVD). Hypoxemia exacerbates these processes, resulting in white matter lesions, white matter integrity abnormalities, and gray matter loss. Blood-brain barrier (BBB) hyperpermeability and neuroinflammation lead to altered synaptic plasticity, neuronal damage, and worsening C-SVD. Thus, OSA may initiate or amplify the pathologic processes of C-SVD and BBB dysfunction, resulting in the development or exacerbation of depressive symptoms and cognitive deficits. Given the evidence that adequate treatment of OSA with continuous positive airway pressure improves depression and neurocognitive functions, it is important to identify OSA when assessing patients with depression or cognitive impairment. Whether treatment of OSA changes the deteriorating trajectory of elderly patients with already-diagnosed vascular depression and cognitive impairment/dementia remains to be determined in randomized controlled trials.
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Pelton GH, Harper OL, Roose SP, Marder K, D'Antonio K, Devanand DP. Combined treatment with memantine/es-citalopram for older depressed patients with cognitive impairment: a pilot study. Int J Geriatr Psychiatry 2016; 31:648-55. [PMID: 26559790 DOI: 10.1002/gps.4375] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/18/2015] [Accepted: 09/21/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The objective of the study is to assess combined antidepressant and memantine treatment in older patients presenting with depression and cognitive impairment. METHODS Thirty-five depressed patients with cognitive impairment participated in this open-label pilot study. We evaluated whether, over a 48-week period, combined antidepressant (primarily es-citalopram) and memantine treatment was effective in the treatment of cognitive impairment and depression. Neuropsychological testing was performed, and antidepressant response monitored at baseline and at the 12, 24, and 48-week time points. RESULTS Treatment with escitalopram (mean daily dose 18.62 mg, SD 5.15) and memantine (mean daily dose 13.62 mg, SD 6.67) was associated with improvement in Hamilton Depression Rating Scale scores over the 48-week study period. Patients demonstrated significant improvement in the primary outcome of cognitive performance (Selective Reminding Test total immediate recall; SRT-IR) over the 48-week treatment period (p = 0.0147). Significant improvement was also observed in measures of naming and verbal fluency but not in the other cognitive domains. One of the 35 patients (2.9%) converted to Alzheimer's disease over the 48-week treatment period. In the amnestic mild cognitive impairment subsample (n = 22), the conversion rate was 4.5%, a rate lower than in other reports of patients with DEP-CI. CONCLUSIONS In this open-label trial, combined antidepressant and memantine treatment in patients with DEP-CI was associated with improved cognition and a low rate of conversion to dementia compared with published studies in patients with DEP-CI. Although limited by the open-label study design that incorporates practice effects that can improve cognitive test performance, the findings suggest the need for a larger randomized placebo-controlled trial.
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Affiliation(s)
- Gregory H Pelton
- Late Life Depression Clinic, The Memory Disorders Center, and The Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY, USA
- The College of Physicians and Surgeons of Columbia University, New York, NY, USA
- Department of Neurology, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Oliver L Harper
- The College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Steven P Roose
- Late Life Depression Clinic, The Memory Disorders Center, and The Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY, USA
- The College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Karen Marder
- The College of Physicians and Surgeons of Columbia University, New York, NY, USA
- Department of Neurology, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Kristina D'Antonio
- Late Life Depression Clinic, The Memory Disorders Center, and The Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - D P Devanand
- Late Life Depression Clinic, The Memory Disorders Center, and The Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY, USA
- The College of Physicians and Surgeons of Columbia University, New York, NY, USA
- Department of Neurology, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Roose SP, Rutherford BR, Wall MM, Thase ME. Practising evidence-based medicine in an era of high placebo response: number needed to treat reconsidered. Br J Psychiatry 2016; 208:416-20. [PMID: 27143006 PMCID: PMC4853640 DOI: 10.1192/bjp.bp.115.163261] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 06/03/2015] [Indexed: 11/23/2022]
Abstract
The number needed to treat (NNT) statistic was developed to facilitate the practice of evidence-based medicine. Placebo was assumed to be therapeutically inert when the NNT was originally conceived, but more recent data for conditions such as major depressive disorder (MDD) suggest that the placebo control condition can have considerable therapeutic effects. Complications arise because the NNT calculated from randomised controlled trials (RCTs) reflects a comparison between medication plus clinical management and placebo plus clinical management, whereas, in the clinical setting, physicians choose between prescribing open medication, observing a patient over time with a supportive approach, and doing nothing. Thus, NNTs derived from clinical trials are not directly relevant to clinical decision-making, because they are based on control conditions that do not exist in standard practice. Additional difficulties may arise when using NNTs to compare alternative treatments for MDD, such as medication and psychotherapy, since these comparisons require the control conditions upon which the respective NNTs are based to be similar.Whereas pill placebo conditions include intensive clinical management and elicit expectations of improvement, attention control conditions for psychotherapy research are less well developed. Often the effects of psychotherapy are gauged against a wait-list control condition, which has substantially fewer therapeutic components than a pill placebo control condition. To improve the clinical utility of NNTs for the treatment of MDD, we advocate effectiveness studies that include treatment conditions resembling actual clinical practice, rather than using placebo-controlled RCTs for this purpose. Until such studies are performed, the effect of bias in comparing NNTs across treatments can be controlled by ensuring that the RCT control conditions upon which the NNTs are based are comparable.
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Affiliation(s)
- Steven P. Roose
- Correspondence: Dr Steven P. Roose, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Box 98, New York, NY 10032, USA.
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Pimontel MA, Rindskopf D, Rutherford BR, Brown PJ, Roose SP, Sneed JR. A Meta-Analysis of Executive Dysfunction and Antidepressant Treatment Response in Late-Life Depression. Am J Geriatr Psychiatry 2016; 24:31-41. [PMID: 26282222 PMCID: PMC4928373 DOI: 10.1016/j.jagp.2015.05.010] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 05/01/2015] [Accepted: 05/13/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Depressed older adults with executive dysfunction (ED) may respond poorly to antidepressant treatment. ED is a multifaceted construct and different studies have measured different aspects of ED, making it unclear which aspects predict poor response. Meta-analytic methods were used to determine whether ED predicts poor antidepressant treatment response in late-life depression and to determine which domains of executive functioning are responsible for this relationship. METHODS A Medline search was conducted to identify regimented treatment trials contrasting executive functioning between elderly responders and nonresponders; only regimented treatment trials for depressed outpatients aged 50 and older were included. Following the most recent PRISMA guidelines, 25 measures of executive functioning were extracted from eight studies. Six domains were identified: cognitive flexibility, planning and organization, response inhibition, selective attention, verbal fluency, and the Dementia Rating Scale Initiation/Perseveration composite score (DRS I/P). Hedge's g was calculated for each measure of executive functioning. A three-level Bayesian hierarchical linear model (HLM) was used to estimate effect sizes for each domain of executive functioning. RESULTS The effect of planning and organization was significantly different from zero (Bayesian HLM estimate of domain effect size: 0.91; 95% CI: 0.32-1.58), whereas cognitive flexibility, response inhibition, selective attention, verbal fluency, and the DRS I/P composite score were not. CONCLUSION The domain of planning and organization is meaningfully associated with poor antidepressant treatment response in late-life depression. These findings suggest that therapies that focus on planning and organization may provide effective augmentation strategies for antidepressant nonresponders with late-life depression.
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Rutherford BR, Bailey VS, Schneier FR, Pott E, Brown PJ, Roose SP. INFLUENCE OF STUDY DESIGN ON TREATMENT RESPONSE IN ANXIETY DISORDER CLINICAL TRIALS. Depress Anxiety 2015; 32:944-57. [PMID: 26437267 PMCID: PMC4922308 DOI: 10.1002/da.22433] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/05/2015] [Accepted: 09/12/2015] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The influence of study design variables and publication year on response to medication and placebo was investigated in clinical trials for social anxiety disorder (SAD), generalized anxiety disorder (GAD), and panic disorder (PD). METHOD Hierarchical linear modeling determined whether publication year, treatment assignment (medication vs. placebo), study type (placebo-controlled or active comparator), study duration, and the number of study visits affected the mean change associated with medication and placebo. RESULTS In the 66 trials examined, the change associated with both medication and placebo increased over time (t = 4.23, df = 39, P < .001), but average drug-placebo differences decreased over time (t = -2.04, df = 46, P = .047). More severe baseline illness was associated with greater drug-placebo differences for serotonin norepinephrine reuptake inhibitors (SNRIs, t = 3.46, df = 106, P = .001) and selective serotonin reuptake inhibitors (SSRI, t = 10.37, df = 106, P < .001). Improvement with medication was significantly greater in active-comparator studies compared to placebo-controlled trials (t = 3.41, df = 39, P = .002). A greater number of study visits was associated with greater symptom improvement in PD trials relative to SAD (t = 2.83, df = 39, P = .008) and GAD (t = 2.16, df = 39, P = .037). CONCLUSIONS Placebo response is substantial in SAD, GAD, and PD trials, and its rise over time has been associated with diminished drug-placebo differences. Study design features that influence treatment response in anxiety disorder trials include patient expectancy, frequency of follow-up visits, and baseline illness severity.
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Affiliation(s)
- Bret R Rutherford
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York,Correspondence to: Bret R. Rutherford, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Box 98, New York, NY 10032.
| | | | - Franklin R. Schneier
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York
| | - Emily Pott
- New York State Psychiatric Institute, New York, New York
| | - Patrick J. Brown
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York
| | - Steven P. Roose
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York
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