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Seripa D, Pilotto A, Paroni G, Fontana A, D'Onofrio G, Gravina C, Urbano M, Cascavilla L, Paris F, Panza F, Padovani A, Pilotto A. Role of the serotonin transporter gene locus in the response to SSRI treatment of major depressive disorder in late life. J Psychopharmacol 2015; 29:623-33. [PMID: 25827644 DOI: 10.1177/0269881115578159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
It has been suggested that the serotonin or 5-hydroxytriptamine (5-HT) transporter (5-HTT) and its gene-linked polymorphic region (5-HTTLPR) are selective serotonin reuptake inhibitor (SSRI) response modulators in late-life depression (LLD), and particularly in late-life major depressive disorder (MDD). Previous studies differed in design and results. Our study aimed to investigate the solute carrier family 6 (neurotransmitter transporter and serotonin) member 4 (SLC6A4) gene locus, encoding 5-HTT and SSRI treatment response in late-life MDD. For a prospective cohort study, we enrolled 234 patients with late-life MDD to be treated with escitalopram, sertraline, paroxetine or citalopram for 6 months. The SLC6A4 polymorphisms rs4795541 (5-HTTLPR), rs140701 and rs3813034 genotypes spanning the SLC6A4 locus were investigated in blinded fashion. No placebo group was included. We assessed responder or non-responder phenotypes according to a reduction in the 21-item version of the Hamilton Depression Rating Scale (HDRS-21) score of ⩾ 50%. At follow-up, 30% of the late-life MDD patients were non-responders to SSRI treatment. No time-course of symptoms and responses was made. A poor response was associated with a higher baseline HDRS-21 score. We observed a significant over-representation of the rs4795541-S allele in the responder patients (0.436 versus 0.321; p = 0.023). The single S-allele dose-additive effect had OR = 1.74 (95% CI 1.12-2.69) in the additive regression model. Our findings suggested a possible influence of 5-HTTLPR on the SSRI response in patients with late-life MDD, which is potentially useful in identifying the subgroups of LLD patients whom need a different pharmacological approach.
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Affiliation(s)
- Davide Seripa
- Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Andrea Pilotto
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giulia Paroni
- Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Andrea Fontana
- Biostatistics Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Grazia D'Onofrio
- Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Carolina Gravina
- Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Maria Urbano
- Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Leandro Cascavilla
- Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Francesco Paris
- Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Francesco Panza
- Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy Department of Basic Medicine, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alberto Pilotto
- Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy Geriatrics Unit, San Antonio Hospital, Padova, Italy
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Albrecht JS, Kiptanui Z, Tsang Y, Khokhar B, Smith GS, Zuckerman IH, Simoni-Wastila L. Patterns of Depression Treatment in Medicare Beneficiaries with Depression after Traumatic Brain Injury. J Neurotrauma 2015; 32:1223-9. [PMID: 25526613 DOI: 10.1089/neu.2014.3651] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There are no clinical guidelines addressing the management of depression after traumatic brain injury (TBI). The objectives of this study were to (1) describe depression treatment patterns among Medicare beneficiaries with a diagnosis of depression post-TBI; (2) compare them with depression treatment patterns among beneficiaries with a diagnosis of depression pre-TBI; and (3) quantify the difference in prevalence of use. We conducted a retrospective analysis of Medicare beneficiaries hospitalized with TBI during 2006-2010. We created two cohorts: beneficiaries with a new diagnosis of depression pre-TBI (n=4841) and beneficiaries with a new diagnosis of depression post-TBI (n=4668). We searched for antidepressant medications in Medicare Part D drug event files and created variables indicating antidepressant use in each 30-day period after diagnosis of depression. We used provider specialty and current procedural terminology to identify psychotherapy in any location. We used generalized estimating equations to quantify the effect of TBI on receipt of depression treatment during the year after diagnosis of depression. Average monthly prevalence of antidepressant use was 42% among beneficiaries with a diagnosis of depression pre-TBI and 36% among those with a diagnosis post-TBI (p<0.001). Beneficiaries with a diagnosis of depression post-TBI were less likely to receive antidepressants compared with a depression diagnosis pre-TBI (adjusted odds ratio [OR] 0.87; 95% confidence interval [CI] 0.82, 0.92). There was no difference in receipt of psychotherapy between the two groups (OR 1.08; 95% CI 0.93, 1.26). Depression after TBI is undertreated among older adults. Knowledge about reasons for this disparity and its long-term effects on post-TBI outcomes is limited and should be examined in future work.
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Affiliation(s)
- Jennifer S Albrecht
- 1 Department of Epidemiology and Public Health, University of Maryland School of Medicine , Baltimore, Maryland
| | | | - Yuen Tsang
- 3 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy , Baltimore, Maryland
| | - Bilal Khokhar
- 3 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy , Baltimore, Maryland
| | - Gordon S Smith
- 4 Shock, Trauma and Anesthesiology Research (STAR)-Organized Research Center, National Study Center for Trauma and Emergency Medical Services, University of Maryland , Baltimore, Maryland
| | - Ilene H Zuckerman
- 2 IMPAQ International , LLC, Columbia, Maryland.,3 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy , Baltimore, Maryland
| | - Linda Simoni-Wastila
- 3 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy , Baltimore, Maryland
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Izquierdo A, Miranda J, Bromley E, Sherbourne C, Ryan G, Kennedy D, Wells K. Grandparenting experiences among adults with a history of depression: a mixed-methods study. Gen Hosp Psychiatry 2015; 37:185-91. [PMID: 25680755 PMCID: PMC4423903 DOI: 10.1016/j.genhosppsych.2014.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 11/19/2014] [Accepted: 11/19/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Grandparenting is an important social role, but how adults with a history of depression experience grandparenting is unknown; we describe grandparenting experiences reported by an ethnically diverse sample of adults with a history of depression. METHOD Mixed-methods study using semistructured interviews of adults at 10-year follow-up and quantitative data collected over 9 years from 280 systematically sampled participants from a longitudinal, multisite trial of quality-improvement interventions for depressed primary care patients; of 280, 110 reported noncustodial grandparenting experiences. RESULTS Of 110 adults reporting grandparenting experiences, 90 (82%) reported any positive experience such as special joy; 57 (52%) reported any stressful experience such as separation; and 27 (34%) reported mixed experiences. Adults with chronic or recent depression were significantly more likely than their respective counterparts to report any stressful experience (P<0.05). There was no significant association between depression status and reporting a positive experience. CONCLUSION(S) Grandparenting was a highly salient and positive experience as reported by ethnically diverse adults 10 years after being identified as depressed in primary care. Depression status was associated with reporting stressful but not positive experiences. Specific themes underlying positive and stressful experiences may have implications for developing strategies to enhance quality of life for adults with a history of depression who are grandparents.
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Affiliation(s)
- Adriana Izquierdo
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, 90024, USA; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90024, USA.
| | - Jeanne Miranda
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, 90024, USA
| | - Elizabeth Bromley
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, 90024, USA; West Los Angeles VA Healthcare Center, Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Los Angeles, CA, 90073, USA
| | | | - Gery Ryan
- RAND Corporation, Santa Monica, CA, 90407, USA
| | | | - Kenneth Wells
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, 90024, USA
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Abstract
Older adults with Diabetes Mellitus (DM) experience greater risk for comorbid depression compared to those who do not have DM. Undetected, untreated or under-treated depression impinges an individual's ability to manage their DM successfully, hinders their adherence to treatment regime, and undermines provider-patient relationships. Thus, in the context of caring for older adults with DM, comorbid depression presents special challenges and opportunities for clinicians. In this article, we summarize the clinical presentation of late-life depression, potential mechanisms of comorbidity of depression and DM, importance of depression in the successful management of DM, and available best practice models for depression treatment.
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Affiliation(s)
- Mijung Park
- Department of Health and Community Systems, University of Pittsburgh, School of Nursing, 3500 Victoria Street, 421 Victoria Building, Pittsburgh, PA 15213, USA.
| | - Charles F Reynolds
- NIMH Center of Excellence in Late Life Depression Prevention and Treatment, Hartford Center of Excellence in Geriatric Psychiatry, Aging Institute of UPMC Senior Services and University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213-2582, USA
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Ngan W, Chiu PKC, Chung HY. Primary Sjogren syndrome masquerading as a false-positive venereal disease research laboratory and fluorescent treponemal antibody absorption test in an elderly woman. J Am Geriatr Soc 2014; 62:1817-8. [PMID: 25243699 DOI: 10.1111/jgs.13013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- William Ngan
- Department of Medicine, Queen Mary Hospital, Hong Kong, China
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Bilotta C, Franchi C, Nobili A, Nicolini P, Djade CD, Tettamanti M, Pasina L, Fortino I, Bortolotti A, Merlino L, Vergani C. Electrocardiographic monitoring for new prescriptions of quetiapine co-prescribed with acetylcholinesterase inhibitors or memantine from 2005 to 2009. A population study on community-dwelling older people in Italy. Eur J Clin Pharmacol 2014; 70:1487-94. [PMID: 25234794 DOI: 10.1007/s00228-014-1750-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 09/08/2014] [Indexed: 01/08/2023]
Abstract
PURPOSE The aims of this study are to analyse, in community-dwelling people aged 65+ living in Italy's Lombardy Region, electrocardiographic (ECG) monitoring for new users of the atypical antipsychotic quetiapine co-prescribed with acetylcholinesterase inhibitors (AChEIs) or memantine and to find independent predictors of ECG monitoring before and after the starting of this prescription. METHODS The Lombardy Region's administrative health database was used to retrieve prescriptions of ECG exams as well as prevalence rates of subjects aged 65+ who were prescribed such psychotropic drugs from 2005 to 2009. Multivariable analyses were adjusted for age, sex, number of drugs, treatment with beta-blockers, digoxin, verapamil or diltiazem, any antiarrhythmic drug and antidepressants. RESULTS Overall 2,623 community-dwelling older people started therapy with quetiapine, co-prescribed with AChEIs or memantine, during these 5 years. At least one ECG was performed in 714 cases (27.2 %) in the 6 months before-and in 398 cases (15.2 %) within 3 months after-the starting of this prescription. ECG monitoring was performed both before and after starting quetiapine in only 160 cases (6.1 %). At multivariable analyses, number of drugs taken, beta-blocker and antiarrhythmic drug use were found to be independent correlates of ECG monitoring whereas female sex was associated with a lower probability of receiving an ECG within 3 months after the initiation of quetiapine (odds ratio 0.78, 95 % CI 0.62-0.98). CONCLUSIONS ECG monitoring for new prescriptions of quetiapine in older people suffering from behavioural and psychological symptoms in dementia was actually performed infrequently, independently of the age of drug users, especially in women. Our results support the need for greater awareness within the medical community of the importance of such ECG monitoring.
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Affiliation(s)
- Claudio Bilotta
- Geriatric Medicine Outpatient Service, Department of Urban Outpatient Services, Istituti Clinici di Perfezionamento Hospital, viale Andrea Doria 52, 20124, Milan, Italy,
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Abstract
As the population ages, primary care providers will be frequently called on to manage psychiatric disorders suffered by their older patients. This overview of delirium, dementia, depression, and alcohol and substance misuse highlights the common presentations and suggests initial approaches to treatment. The challenges facing caregivers are also discussed.
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Affiliation(s)
- Shaune DeMers
- Division of Geriatric Psychiatry, Harborview Medical Center and University of Washington, Box 359760, 325 Ninth Avenue, Seattle, WA 98104-2499, USA.
| | - Kyl Dinsio
- Division of Geriatric Psychiatry, Harborview Medical Center and University of Washington, Box 359760, 325 Ninth Avenue, Seattle, WA 98104-2499, USA
| | - Whitney Carlson
- Division of Geriatric Psychiatry, Harborview Medical Center and University of Washington, Box 359760, 325 Ninth Avenue, Seattle, WA 98104-2499, USA
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Cyprien F, Courtet P, Poulain V, Maller J, Meslin C, Bonafé A, Le Bars E, Ancelin ML, Ritchie K, Artero S. Corpus callosum size may predict late-life depression in women: a 10-year follow-up study. J Affect Disord 2014; 165:16-23. [PMID: 24882172 DOI: 10.1016/j.jad.2014.04.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 04/15/2014] [Accepted: 04/16/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Recent research on late-life depression (LLD) pathophysiology suggests the implication of abnormalities in cerebral white matter and particularly in interhemispheric transfer. Corpus callosum (CC) is the main brain interhemispheric commissure. Hence, we investigated the association between baseline CC measures and risk of LDD. METHODS We studied 467 non-demented individuals without LLD at baseline from a cohort of elderly community-dwelling people (the ESPRIT study). LLD was assessed at year 2, 4, 7 and 10 of the study follow-up. At baseline, T1-weighted magnetic resonance images were manually traced to measure the mid-sagittal areas of the anterior, mid and posterior CC. Multivariate Cox proportional hazards models stratified by sex were used to predict LLD incidence over 10 years. RESULTS A significant interaction between gender and CC size was found (p=0.02). LLD incidence in elderly women, but not in men, was significantly associated with smaller anterior (HR 1.37 [1.05-1.79] p=0.017), mid (HR 1.43 [1.09-1.86] p=0.008), posterior (HR 1.39 [1.12-1.74] p=0.002) and total (HR 1.53 [1.16-2.00] p=0.002) CC areas at baseline in Cox models adjusted for age, education, global cognitive impairment, ischemic pathologies, left-handedness, white matter lesion, intracranial volume and past depression. LIMITATIONS The main limitation was the retrospective assessment of major depression. CONCLUSION Smaller CC size is a predictive factor of incident LLD over 10 years in elderly women independently of cognitive deterioration. Our finding suggests a possible role of CC and reduced interhemispheric connectivity in LLD pathophysiology. Extensive explorations are needed to clarify the mechanisms leading to CC morphometric changes in mood disorders.
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Affiliation(s)
- Fabienne Cyprien
- Inserm, U1061, La Colombière Hospital, Montpellier F-34093, France; University of Montpellier 1, Montpellier F-34000, France; CHRU Carémeau, Nîmes, France
| | - Philippe Courtet
- Inserm, U1061, La Colombière Hospital, Montpellier F-34093, France; University of Montpellier 1, Montpellier F-34000, France; CHRU Montpellier, Montpellier, France
| | - Vanessa Poulain
- Inserm, U1061, La Colombière Hospital, Montpellier F-34093, France
| | - Jerome Maller
- Monash Alfred Psychiatry Research Centre, The Alfred & Monash University School of Psychology and Psychiatry, Melbourne, Australia
| | - Chantal Meslin
- Centre for Mental Health Research, Australian National University, Canberra, Australia
| | - Alain Bonafé
- University of Montpellier 1, Montpellier F-34000, France; CHRU Montpellier, Montpellier, France
| | | | - Marie-Laure Ancelin
- Inserm, U1061, La Colombière Hospital, Montpellier F-34093, France; University of Montpellier 1, Montpellier F-34000, France
| | - Karen Ritchie
- Inserm, U1061, La Colombière Hospital, Montpellier F-34093, France; University of Montpellier 1, Montpellier F-34000, France; Faculty of Medicine, Imperial College, St Mary׳s Hospital, London, United Kingdom
| | - Sylvaine Artero
- Inserm, U1061, La Colombière Hospital, Montpellier F-34093, France; University of Montpellier 1, Montpellier F-34000, France.
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Adapting manualized Behavioural Activation treatment for older adults with depression. COGNITIVE BEHAVIOUR THERAPIST 2014. [DOI: 10.1017/s1754470x14000038] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThere is growing evidence that Behavioural Activation is an effective treatment for older adults with depression. However, there is a lack of detail given in studies about any adaptations made to interventions or efforts made to remove treatment barriers. Factors such as co-morbid physical health problems, cognitive impairment and problems with social support suggest there may be specific treatment considerations when developing interventions for this group. This article aims to describe adaptations made to a general adult Behavioural Activation manual using literature on treatment factors for older adults as an organizational framework. This information may be of use to mental health workers delivering behavioural interventions to older adults with depression and documents the initial phase of developing a complex intervention.
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Changes in the prescribing pattern of antidepressant drugs in elderly patients: an Italian, nationwide, population-based study. Eur J Clin Pharmacol 2014; 70:469-78. [DOI: 10.1007/s00228-013-1636-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 12/23/2013] [Indexed: 11/26/2022]
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Bystad M, Pettersen K, Grønli OK. Depresjon eller demens av Alzheimers type? TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 134:525-8. [DOI: 10.4045/tidsskr.13.0364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Pérez-Zepeda MU, Arango-Lopera VE, Wagner FA, Gallo JJ, Sánchez-García S, Juárez-Cedillo T, García-Peña C. Factors associated with help-seeking behaviors in Mexican older individuals with depressive symptoms: a cross-sectional study. Int J Geriatr Psychiatry 2013; 28:1260-9. [PMID: 23585359 PMCID: PMC3797168 DOI: 10.1002/gps.3953] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 02/15/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Depression in the older individuals is associated with multiple adverse outcomes, such as high health service utilization rates, low pharmacological compliance, and synergistic interactions with other comorbidities. Moreover, the help-seeking process, which usually starts with the feeling "that something is wrong" and ends with appropriate medical care, is influenced by several factors. The aim of this study was to explore factors associated with the pathway of help seeking among older adults with depressive symptoms. METHODS A cross-sectional study of 60-year or older community dwelling individuals belonging to the largest health and social security system in Mexico was carried out. A standardized interview explored the process of seeking health care in four dimensions: depressive symptoms, help seeking, help acquisition, and specialized mental health. RESULTS A total of 2322 individuals were studied; from these, 67.14% (n = 1559) were women, and the mean age was 73.18 years (SD = 7.02); 57.9% had symptoms of depression; 337 (25.1%) participants sought help, and 271 (80.4%) received help; and 103 (38%) received specialized mental health care. In the stepwise model for not seeking help (χ(2) = 81.66, p < 0.0001), significant variables were female gender (odds ratio (OR) = 0.7, 95% confidence interval (CI) 0.511-0.958, p = 0.026), health-care use (OR 3.26, CI 95% 1.64-6.488, p = 0.001). Number of years in school, difficulty in activities, Short Anxiety Screening Test score, and indication that depression is not a disease belief were also significant. CONCLUSIONS Appropriate mental health care is rather complex and is influenced by several factors. The main factors associated with help seeking were gender, education level, recent health service use, and the belief that depression is not a disease. Detection of subjects with these characteristics could improve care of the older individuals with depressive symptoms.
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Affiliation(s)
| | | | - Fernando A. Wagner
- Center for Health Disparities Solutions, School of Community Health and Policy, Morgan State University, Baltimore, Maryland, USA
| | - Joseph J. Gallo
- Department of Mental Health, Bloomberg School of Public Health and Policy, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sergio Sánchez-García
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Área Envejecimiento, Centro Médico Nacional Siglo XXI (CMN-SXXI), Instituto Mexicano del Seguro Social (IMSS), México
| | - Teresa Juárez-Cedillo
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Área Envejecimiento, Centro Médico Nacional Siglo XXI (CMN-SXXI), Instituto Mexicano del Seguro Social (IMSS), México
| | - Carmen García-Peña
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Área Envejecimiento, Centro Médico Nacional Siglo XXI (CMN-SXXI), Instituto Mexicano del Seguro Social (IMSS), México
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Zhang N, Chen H, Zou Y. A joint model of binary and longitudinal data with non-ignorable missingness, with application to marital stress and late-life major depression in women. J Appl Stat 2013. [DOI: 10.1080/02664763.2013.859235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Age related differences in mental health scale scores and depression diagnosis: adult responses to the CIDI-SF and MHI-5. J Affect Disord 2013; 151:639-645. [PMID: 23993442 DOI: 10.1016/j.jad.2013.07.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 07/11/2013] [Accepted: 07/12/2013] [Indexed: 11/24/2022]
Abstract
Inconsistencies surrounding the prevalence levels of depression in later life suggest that the measurement of depression in older people may be problematic. The current study aimed to map responses to a depressive symptom scale, the Mental Health Index-5 (MHI-5) which is part of the Short form 36 (SF-36, Ware et al., 1993) against the diagnostic screening items of the Composite International Diagnostic Instrument-Short Form (CIDI-SF, Kessler et al., 1998) to examine disagreement rates across age groups. The study examined data from a national random sample of 10,641 participants living in Ireland, 58.8% were female and 19% were over 65 (SLÁN, 2007). CIDI-SF depression screening endorsement was lower in older groups, whereas mean MHI-5 depressive symptoms showed less change across age groups. Results showed that the odds of MHI-5 endorsers aged 18-44 endorsing CIDI-SF screening questions were 5 times and 4.5 times (dysphoria and anhedonia, respectively) greater than the odds of people aged 75 or more endorsing these items. Findings suggest that although the risk of depressive disorder may decrease with age, complex diagnostic screening questions may exaggerate lower rates of depression among older people.
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Cardelli M, Marchegiani F, Corsonello A, Lattanzio F, Provinciali M. A review of pharmacogenetics of adverse drug reactions in elderly people. Drug Saf 2013; 35 Suppl 1:3-20. [PMID: 23446782 DOI: 10.1007/bf03319099] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Older adults are more susceptible to the prevalence of therapeutic failure and adverse drug reactions (ADRs). Recent advances in genomic research have shed light on the crucial role of genetic variants, mainly involving genes encoding drug-metabolizing enzymes, drug transporters and genes responsible for a compound's mechanism of action, in driving different treatment responses among individuals, in terms of therapeutic efficacy and safety. The interindividual variations of these genes may account for the differences observed in drug efficacy and the appearance of ADRs in elderly people. The advent of whole genome mapping techniques has allowed researchers to begin to characterize the genetic components underlying serious ADRs. The identification and validation of these genetic markers will enable the screening of patients at risk of serious ADRs and to establish personalized treatment regimens.The aim of this review was to provide an update on the recent developments in geriatric pharmacogenetics in clinical practice by reviewing the available evidence in the PubMed database to September 2012. A Pubmed search was performed (years 1999-2012) using the following two search strategies: ('pharmacogenomic' OR 'pharmacogenetic ') AND ('geriatric' or 'elderly ') AND 'adverse drug reactions'; [gene name] AND ('geriatric' or 'elderly ') AND 'adverse drug reactions', in which the gene names were those contained in the Table of Pharmacogenomic Biomarkers in Drug Labels published online by the US Food and Drug Administration ( http://www.fda.gov/drugs/scienceresearch/researchareas/pharmacogenetics/ucm083378.htm ). Reference lists of included original articles and relevant review articles were also screened. The search was limited to studies published in the English language.
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Affiliation(s)
- Maurizio Cardelli
- Advanced Technology Center for Aging Research, Scientific Technological Area, IRCCS-INRCA, Via Birarelli 8, 60121, Ancona, Italy
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Tsai FJ, Motamed S, Rougemont A. The protective effect of taking care of grandchildren on elders' mental health? Associations between changing patterns of intergenerational exchanges and the reduction of elders' loneliness and depression between 1993 and 2007 in Taiwan. BMC Public Health 2013; 13:567. [PMID: 23758624 PMCID: PMC3689038 DOI: 10.1186/1471-2458-13-567] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 05/10/2013] [Indexed: 11/10/2022] Open
Abstract
Background The 20th century’s rapid industrialization and urbanization brought important social changes to Taiwan, including an increased number of elders living alone, which has increased risk of depression for the elderly. This study aimed to evaluate the changing pattern regarding the effect of intergenerational exchanges on elders’ depressive symptoms from 1993 to 2007. Methods Data from the second-, fourth- and sixth-wave surveys of the Study of Health and Living Status of the Middle-Aged and Elderly in Taiwan were analyzed. This study collected elders’ individual sociodemographic characteristics, their self-reported health status and their intergenerational exchanges, including living with partners or with their children and their provision of care for their grandchildren. Information about elders’ depression was evaluated using the 5-item Epidemiological Studies Depression Scale (CES-D). Changes in elders’ intergenerational exchanges and depressive symptoms were compared during these study periods (chi-square test). Then, logistic regression was performed to determine how significantly elders’ intergenerational exchanges were associated with their depressive symptoms across the three years 1993, 1999 and 2007. Results The prevalence of elders living with partners decreased from 1993 to 2007 by 19%, and that of living with their children decreased from 1993 to 2007 by 7%. Conversely, the percentage of elders providing care for grandchildren dramatically increased, from 9% in 1993 to 21% in 2007. Elderly people had significantly fewer depressive symptoms in 2007 than in 1993. After adjusting for confounders, those living without a partner, living without children or providing no grandchild care had a greater risk of feeling lonely and being depressed. However, during the period 1993 to 2007, the impact on elders’ depression and loneliness of co-residing with a partner or with children decreased at the same time that the impact of their provision of grandchild care increased. In 2007, elders who provided no grandchild care were significantly more likely to feel lonely and sad as well as to have high CES-D scores; these strong associations were not found in 1993 and 1999. Conclusions This study illustrates how taking care of grandchildren protects against depression and loneliness in elderly Taiwanese. We argue the need, in an aging society, for improving intergenerational interaction and recommend careful evaluation of the interaction between population policies and those of social welfare, such as child care.
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Affiliation(s)
- Feng-Jen Tsai
- Master program in Global Health and Development, Taipei Medical University, Taipei, Taiwan.
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Mokhtari M, Nezakatalhossaini M, Esfarjani F. The Effect of 12-Week Pilates Exercises on Depression and Balance Associated with Falling in the Elderly. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.sbspro.2013.01.246] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kitchen KA, McKibbin CL, Wykes TL, Lee AA, Carrico CP, McConnell KA. Depression Treatment Among Rural Older Adults: Preferences and Factors Influencing Future Service Use. Clin Gerontol 2013; 36:10.1080/07317115.2013.767872. [PMID: 24409008 PMCID: PMC3881270 DOI: 10.1080/07317115.2013.767872] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The purpose of this study was to investigate depression treatment preferences and anticipated service use in a sample of adults aged 55 years or older who reside in rural Wyoming. Sixteen participants (mean age = 59) completed 30- to 60-minute, semi-structured interviews. Qualitative methods were used to characterize common themes. Social/provider support and community gatekeepers were perceived by participants as important potential facilitators for seeking depression treatment. In contrast, perceived stigma and the value placed on self-sufficiency emerged as key barriers to seeking treatment for depression in this rural, young-old sample. Participants anticipated presenting for treatment in the primary care sector and preferred a combination of medication and psychotherapy for treatment. Participants were, however, more willing to see mental health professionals if they were first referred by a clergy member or primary care physician.
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Affiliation(s)
| | | | | | - Aaron A Lee
- University of Wyoming, Laramie, Wyoming, USA
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Hinton L, Apesoa-Varano EC, González HM, Aguilar-Gaxiola S, Dwight-Johnson M, Barker JC, Tran C, Zuniga R, Unützer J. Falling through the cracks: gaps in depression treatment among older Mexican-origin and white men. Int J Geriatr Psychiatry 2012; 27:1283-90. [PMID: 22383214 PMCID: PMC3560929 DOI: 10.1002/gps.3779] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 01/09/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study aims (i) to compare depression frequency and self-reported depression treatment in Mexican-origin and white men; (ii) to examine ethnic differences in self-reported prior depression diagnosis and types of treatment; and (iii) to determine whether Mexican-origin men (both English and Spanish language preferring) are less likely than white men to report receiving depression treatment after controlling for potential confounders. METHODS This is a cross-sectional, observational study of Mexican-origin and white men (60 years old and over) presenting for primary care visits at six outpatient clinics in California's Central Valley. Clinical depression was assessed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), module for past-year major depression and questions for chronic depression. Past year, self-reported prior depression diagnosis and treatment (i.e., medication, psychotherapy, mental health referral) were assessed through a structured questionnaire. RESULTS The frequency of past-year clinical depression was similar for both ethnic groups, yet Mexican-origin men were significantly less likely than whites to report receiving a prior diagnosis of depression or prior depression treatment. Compared with whites, the odds of untreated depression in Mexican-origin men was 4.35 (95% CI 1.35-14.08) for those interviewed in English and 10.40 (95% CI 2.11-51.25) for those interviewed in Spanish. For both ethnic groups, the majority (i.e., approximately two-thirds) of men receiving depression treatment also met criteria for past-year clinical depression. CONCLUSIONS Mexican-origin older men in primary care suffer from significant gaps in depression care (i.e., diagnosis and treatment) compared with whites. Delivering effective depression treatment (i.e., so that depression remits) remains elusive for both ethnic groups.
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Affiliation(s)
- Ladson Hinton
- Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA.
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Cherubini A, Nisticò G, Rozzini R, Liperoti R, Di Bari M, Zampi E, Ferrannini L, Aguglia E, Pani L, Bernabei R, Marchionni N, Trabucchi M. Subthreshold depression in older subjects: an unmet therapeutic need. J Nutr Health Aging 2012; 16:909-13. [PMID: 23208031 DOI: 10.1007/s12603-012-0373-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Major depression, defined according to DSM IV TR criteria, is less common in older subjects, while other types of depression are two to three times more prevalent. This heterogeneous group of disturbances has received different names: depression not otherwise specified, minor depression, subthreshold or subsyndromal depression. Moreover, each condition has been defined using heterogeneous criteria by different authors. The term of subthreshold depression will be adopted in this position statement. Subthreshold depression has been associated with the same negative consequences of major depression, including reduced well being and quality of life, worsening health status, greater disability, increased morbidity and mortality. Nevertheless, there is a dearth of clinical trials in this area, and therefore older patients with subthreshold depression are either not treated or they are treated with the same non pharmacological and pharmacological therapies used for major depression, despite the lack of supporting scientific evidence. There is an urgent need to reach a consensus concerning the diagnostic criteria for subthreshold depression as well as to perform clinical trials to identify effective and safe therapies in this too long neglected patient group.
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Affiliation(s)
- A Cherubini
- Department of Geriatrics, Research Hospital of Ancona, Italian National Research Center on Aging (INRCA), Ancona, Italy.
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Abstract
Depression is a common, disabling, and costly condition encountered in older patients. Effective strategies for detection and treatment of late-life depression are summarized based on a case of a 69-year-old woman who struggled with prolonged depression. Clinicians should screen older patients for depression using a standard rating scale, initiate treatment such as antidepressant medications or evidence-based psychotherapy, and monitor depression symptoms. Patients who are not improving should be considered for psychiatric consultation and treatment changes including electroconvulsive therapy. Several changes in treatment approaches are usually needed before patients achieve complete remission. Maintenance treatment and relapse-prevention planning (summarization of early warning signs for depression, maintenance treatments such as medications, and other strategies to reduce the risk of relapse [eg, regular physical activity or pleasant activities]) can reduce the risk of relapse. Collaborative programs, in which primary care clinicians work closely with mental health specialists following a measurement-based treatment-to-target approach, are significantly more effective than typical primary care treatment.
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Affiliation(s)
- Jürgen Unützer
- Psychiatry and Behavioral Sciences Chief of Psychiatry, University of Washington Medical Center Director, UW AIMS Center (http://uwaims.org) Director, IMPACT Implementation Program (http://impact-uw.org) 1959 NE Pacific Street Box 356560 Seattle, Washington 98195-6560
| | - Mijung Park
- Postdoctoral fellow of Geriatric Mental Health Services Research Department of Psychiatry and Behavioral Sciences University of Washington
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Ozminkowski RJ, Musich S, Bottone FG, Hawkins K, Bai M, Unützer J, Hommer CE, Migliori RJ, Yeh CS. The burden of depressive symptoms and various chronic conditions and health concerns on the quality of life among those with Medicare Supplement Insurance. Int J Geriatr Psychiatry 2012; 27:948-58. [PMID: 22025352 DOI: 10.1002/gps.2806] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 08/19/2011] [Accepted: 08/22/2011] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study aims to estimate the burden of currently having depressive symptoms on quality of life independently and in combination with various chronic conditions/health concerns among adults with Medicare Supplement Insurance (i.e., Medigap) coverage. METHODS Data were obtained from the Health Update Survey (HUS). The HUS contains questions on demographics, comorbid conditions, and all of the questions on the Veterans RAND 12-item (VR-12) health status/quality of life survey. The survey was mailed to a random sample of 30,000 insureds from 10 states between 2008 and 2009. On the basis of relevant questions from the survey, respondents were categorized into two groups: those currently suffering from current depressive symptoms (N = 2283) and those who never had depressive symptoms (N = 7058). Multiple regression modeling was used to test the impact on quality of life of depressive symptoms independently or as an interaction of depressive symptoms with various chronic conditions/health concerns. RESULTS Depressive symptoms were common, with an estimated prevalence of 24.4%. The greatest impact of depressive symptoms in combination with various chronic conditions/health concerns on quality of life was on the ability to handle emotional roles, bodily pain, social functioning, and ability to handle physical roles. Most of the significant interactions between depressive symptoms and various chronic conditions/health concerns were demonstrated for those chronic conditions contributing to functional impairment (e.g., difficulty walking, falls, chronic pain, and diabetes). CONCLUSIONS Although depressive symptoms independently reduced quality of life, having depressive symptoms in addition to other chronic conditions/health concerns had a greater impact on quality of life.
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Mort JR, Remund KE, Bradley B. Managing depression for residents in nursing facilities. THE CONSULTANT PHARMACIST : THE JOURNAL OF THE AMERICAN SOCIETY OF CONSULTANT PHARMACISTS 2012; 27:494-503. [PMID: 22910130 DOI: 10.4140/tcp.n.2012.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Review the current Centers for Medicare & Medicaid Services' (CMS) Interpretive Guidelines from the State Operations Manual (SOM) in light of evidence for management of depression found in the literature. DATA SOURCES Articles indexed in PubMed for the last 20 years, American Psychiatric Association Guidelines, CMS Interpretive Guidelines from the SOM, and The American Medical Directors Association (AMDA) Guidelines. STUDY SELECTION AND DATA EXTRACTION Forty published papers were reviewed, and criteria supporting the primary objective were used to identify useful resources. DATA SYNTHESIS The literature included guidelines regarding the management of late-life depression (e.g., dosage and duration of therapy). This literature was examined in relation to the current CMS Interpretive Guidelines, which are provided to state surveyors to help them evaluate whether a nursing facility is in compliance with federal regulations. These guidelines provide explanation and clarification of the actual regulations and so are used during evaluation of the facility. CONCLUSION Current recommendations indicate that a first episode of depression should be treated for 12 months beyond full remission, according to AMDA guidelines. Longer treatment durations (maintenance phase) are needed depending on the resident's situation (e.g., severity or number of episodes). In addition, evidence suggests that antidepressants should remain at the same dose through the maintenance phase of treatment. The Interpretive Guidelines require a dosage reduction to the lowest effective dose by decreasing the dose two times in the first year unless "clinically contraindicated to discontinuation" is documented. This correlates to a dosage reduction within the first nine months of antidepressant treatment. This necessitates that in the majority of depressive episodes, clinicians document their rationale for continuing treatment. Clinicians must commit to this process, and surveyors must acknowledge this appropriate approach to depression management.
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Affiliation(s)
- Jane R Mort
- South Dakota State University College of Pharmacy, Brookings, SD, USA.
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Libório AB, Santos JPL, Minete NFA, Diógenes CDA, Soares AP, Queiroz AL, Barreto DMS. Proteinuria is associated with quality of life and depression in adults with primary glomerulopathy and preserved renal function. PLoS One 2012; 7:e37763. [PMID: 22662214 PMCID: PMC3360627 DOI: 10.1371/journal.pone.0037763] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 04/24/2012] [Indexed: 11/19/2022] Open
Abstract
Background There is no information about HRQoL, depression and associated factors in adult with nephrotic syndrome-associated glomerulopathy. Methodology/Principal Findings Patients with primary glomerulopathy where compared with age and sex-matched hemodialysis patients and healthy subjects. Laboratory data, medical history, comorbid conditions were collected to evaluate factors associated with HRQoL (SF-36) and Depression (Hamilton Depression Rating Scale - HAMD). Glomerulopathy patients had low HRQoL in all eight SF-36 domains and two composite scores (physical and mental) in comparison with healthy subjects. HAMD score also was elevated and there was high depression prevalence. Overall, these data were comparable between glomerulopathy and hemodialysis patients. Using multiple regression analysis, factors associated with low HRQoL physical composite score were: last 24 h-urine protein excretion (−0.183, 95%CI −0.223 to −0.710 for each gram of proteinuria, p = 0.01) and cyclosporine use (−15.315, 95%CI −25.913 to −2.717, p = 0.03). Low HRQoL mental composite score was associated with last 24 h-urine protein excretion (−0.157, 95%CI −0.278 to −0.310 for each gram of proteinuria, p = 0.03) and HMAD score was independently associated with age (0.155, 95%CI 0.318 to 0.988 for each year, p = 0.04), female sex (4.788, 95%CI 1.005 to 8.620, 0 = 0.03), disease duration (0.074, 95%CI 0.021 to 0.128 for each month, p = 0.01) and last 24 h-urine protein excretion (0.050, 95%CI 0.018 to 0.085 for each gram of proteinuria, p = 0.02). Conclusions/Significance Nephrotic-syndrome associated glomerulopathy patients have low HRQoL and high prevalence of depression symptoms, comparable with those of hemodialysis patients. Last 24 h-protein excretion rate is independently associated with physical and mental HRQoL domains in addition to depression.
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Rojas-Fernandez C, Mikhail M. Contemporary concepts in the pharmacotherapy of depression in older people. Can Pharm J (Ott) 2012; 145:128-135.e2. [PMID: 23509528 PMCID: PMC3567508 DOI: 10.3821/145.3.cpj128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Late-life depression is common in older people. Its incidence increases significantly after age 70 to 85, as well as among those living in long-term care facilities. Depression contributes to excess morbidity and complicates management of comorbid conditions in older people. Diagnosis and management of depression often present clinicians with a challenge. Indeed, symptoms of depression in older people may not always be the same as those associated with depression in younger people. Additionally, age-related changes in pharmacokinetics and pharmacodynamics also impact selection, dosing, and monitoring of psychopharmacologic regimens. Optimizing management of depression and providing sound advice to older patients with depression requires knowledge and understanding of many clinical factors. The purpose of this review is to highlight salient issues in late-life depression, with a focus on the pharmacotherapy of depression.
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McDougall GJ, Morgan S, Vaughan PW. Sixteen-month evaluation of depressive symptomatology in older adults. Arch Psychiatr Nurs 2012; 26:e13-21. [PMID: 22449566 PMCID: PMC3314220 DOI: 10.1016/j.apnu.2011.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 11/07/2011] [Accepted: 12/03/2011] [Indexed: 10/14/2022]
Abstract
We examined the prevalence of depressive symptoms over time in a sample of community-residing older adults at baseline, 2 months, 6 months, and 14 months. The nonprobability sample (N = 222) was 90% female, 87% Caucasian, 15% Hispanic, and 12% African American with an average age of 75 years. If depressive symptoms had been measured at only one time, 19% of the sample would have scored above the cutoff versus 39% scoring above the cutoff when measured at all 4 periods. The findings provide evidence that depressive symptoms in older adults are variable and fluctuate over time. The significance of this research was the longitudinal evaluation of depressive symptoms in community-residing elders.
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Bilotta C, Bowling A, Nicolini P, Casè A, Vergani C. Quality of life in older outpatients living alone in the community in Italy. HEALTH & SOCIAL CARE IN THE COMMUNITY 2012; 20:32-41. [PMID: 21718376 DOI: 10.1111/j.1365-2524.2011.01011.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
There is limited knowledge on the relationship between the living conditions of community-dwelling older people and their quality of life (QOL) considered in all its specific domains. The purpose of this study was to determine (1) which dimensions of QOL were independently associated with living alone and (2) the independent correlates of these dimensions of QOL amongst older outpatients. We conducted a cross-sectional survey of 239 community-dwelling outpatients aged 65+ (mean age 81.5 years) consecutively referred to a geriatric medicine clinic in Italy between June and November 2009 (response rate 93%). Subjects underwent a comprehensive geriatric assessment including QOL, which was evaluated by using the Older People's QOL questionnaire. In multivariate logistic regression analyses, living alone was associated with the lowest score-based tertile of two specific dimensions of QOL out of seven, namely 'social relationships and participation' [odds ratio (OR) 2.73, 95% confidence interval (CI) 1.08-6.91] and 'home and neighbourhood' (OR 4.96, 95% CI 1.75-14.07), independently of the main demographic, social, functional and clinical characteristics of the subjects. Amongst the 107 subjects living alone, independent correlates of these dimensions of QOL were depression, having no caregiver and having never been married. Depression, having no caregiver and having never been married could provide a valuable means of identifying older people living alone who are at greater risk of a poor QOL and who would most benefit from effective social and medical interventions.
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Affiliation(s)
- Claudio Bilotta
- Geriatric Medicine Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Italy.
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Samad Z, Brealey S, Gilbody S. The effectiveness of behavioural therapy for the treatment of depression in older adults: a meta-analysis. Int J Geriatr Psychiatry 2011; 26:1211-20. [PMID: 21308789 DOI: 10.1002/gps.2680] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 11/29/2010] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To systematically review the effectiveness of behavioural therapy in depressed older adults. METHODS Electronic databases were searched to July 2009. Reference lists of systematic reviews and identified studies from the search strategy were also screened. Randomised controlled trials (RCTs) of behavioural therapy compared with waiting list controls or other psychotherapies in older adults (aged ≥55 years) with clinical depression were included. One author independently identified studies for inclusion. Two authors extracted data and assessed the included studies for risk of bias. Estimates of depression were combined using a random effects model and the I(2) statistic to examine heterogeneity. RESULTS Four RCTs were included in the meta-analysis. For post-treatment self-rated depression symptoms, behavioural therapy was not significantly more effective than a waiting list control [standardised mean difference (SMD) of -0.52, 95% confidence interval (CI) -1.35 to 0.30, p = 0.21, n = 117], cognitive therapy (SMD of 0.23, 95% CI -0.24 to 0.70, p = 0.33, n = 134) or brief psychodynamic therapy (SMD of -0.37, 95% CI -0.84 to 0.11, p = 0.13, n = 69). For post-treatment clinician-rated depression, behavioural therapy was not significantly more effective than cognitive therapy or brief psychodynamic therapy but was significantly more effective than a waiting list control (weighted mean difference (WMD) of -5.68, 95% CI -7.71 to -3.66, p < 0.001, n = 117). CONCLUSIONS Behavioural therapy in depressed older adults appears to have comparable effectiveness with alternative psychotherapies. Further research is recommended with the need for larger sample sizes, more clarity on trial design and the intervention, longer term follow-up and concomitant economic evaluations.
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Affiliation(s)
- Zara Samad
- Humber Mental Health Trust, Trust Headquarters, Willerby Hill, Willerby, East Yorkshire, UK
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de Abajo FJ. Effects of selective serotonin reuptake inhibitors on platelet function: mechanisms, clinical outcomes and implications for use in elderly patients. Drugs Aging 2011; 28:345-67. [PMID: 21542658 DOI: 10.2165/11589340-000000000-00000] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Among the antidepressants, the selective serotonin reuptake inhibitors (SSRIs) are often preferred to other classes of antidepressants in the treatment of depression in the elderly because of their better safety profile. Most of the known effects of SSRIs, either beneficial or adverse, are linked to their inhibitory action on the serotonin reuptake transporter (5-HTT). This reuptake mechanism is present not only in neurons but also in other cells such as platelets. Serotoninergic mechanisms seem to play an important role in haemostasis, and their importance in this regard has long been underestimated. Abnormal activation may lead to a pro-thrombotic state, as may occur in patients with major depressive disorder, whilst downregulation, as occurs in patients treated with SSRIs, may have two clinical consequences, both of particular interest in the elderly. On the one hand, there may be an increased risk of bleeding; on the other hand, a reduction in thrombotic risk may be possible. Polymorphism in the promoter region of the gene that transcribes the 5-HTT has been shown to have a relevant impact on its function and, in turn, on the beneficial and adverse effects of SSRIs. Bleeding has been a concern since the introduction of SSRIs, with multiple case reports published and communicated to the pharmacovigilance systems. The first epidemiological study was published in 1999 and since then, 34 epidemiological studies from different areas, most of them including elderly patients in their study populations, have been published with a variety of results. Broadly, the epidemiological evidence supports a moderately increased risk of bleeding associated with the use of SSRIs, which may be critically dependent on patient susceptibility and the presence of risk factors. The impairment of primary haemostasis induced by SSRIs may result, as a beneficial counterpart, in a reduction in the thrombotic risk. A small number of clinical trials and an increasing number of epidemiological studies that include elderly patients have been conducted to clarify whether SSRIs reduce the risk of primary and secondary ischaemic disorders. However, the results have been inconclusive with some studies suggesting a preventive effect and others no effect or even an increased risk. Behind such contradictory results may be the role of depression itself as a cardiovascular risk factor and, therefore, a major confounding factor. How to disentangle its effect from that of the antidepressants is the methodological challenge to be overcome in future studies. In this complex scenario, the elderly seem to be at a crossroads, because they are the group in which both the risks and the benefits can be the greatest. Studies performed to date have provided us with some clues that can help orient clinicians in taking the most appropriate course of action. For instance, as the gastrointestinal bleeding risk appears to increase with age, prudent advice in patients with a previous history of upper-gastrointestinal bleeding or peptic ulcer, and in those who take NSAIDs, oral anticoagulants, antiplatelet drugs or corticosteroids, would be to suggest addition of an acid-suppressing agent to the drug regimen in those elderly patients in whom SSRIs are indicated.
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Affiliation(s)
- Francisco J de Abajo
- Clinical Pharmacology Unit, Hospital Universitario Príncipe de Asturias, Madrid, Spain
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81
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Huang JF, Wong RH, Chen CC, Mao IF, Huang CC, Chang WH, Wang L. Trajectory of depression symptoms and related factors in later life--a population based study. J Affect Disord 2011; 133:499-508. [PMID: 21616542 DOI: 10.1016/j.jad.2011.04.048] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 04/18/2011] [Accepted: 04/27/2011] [Indexed: 12/01/2022]
Abstract
BACKGROUND A number of studies of elderly depression have examined the association between depression and its related factors; however, they did not observe how the development of related factors influenced elderly depression over time. This study aims to understand the rising trajectory of depressive symptoms found in elderly male and female, and whether the causation of depression due to related factors would be heterogeneous between male and female over a decade from 1993 to 2003. METHOD This study uses the data from the "Survey of Health and Living Status of the Elderly in Taiwan". A total of 1017 elderly Taiwanese, aged 60 and over, completed four survey modules. The latent growth curve model and general growth mixture model were used to identify the trajectories of depression symptoms, and to assess their related factors in the elderly male and female in Taiwan during the 10 year survey study. RESULT The results showed that a rising trajectory of depressive symptoms came about for both Taiwan elderly male and female over ten years. We also found that in the trajectories of depressive symptoms between elderly male and female across four waves of data, the results were heterogeneous. The trajectory of depressive symptoms in males was affected by perceived health and disability; the trajectory of depressive symptoms in females was influenced by disability and social support. CONCLUSION These findings demonstrated that the final depressive symptoms of the elderly would differ from the elderly with developmentally different depressive related factors. The findings also highlighted the developmental trajectories of depressive symptom in terms of their related factors in the elderly.
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Affiliation(s)
- Jui-Fang Huang
- Department of Public Health, Chung Shan Medical University, Taichung, Taiwan, Republic of China
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Martino SC, Elliott MN, Kanouse DE, Farley DO, Burkhart Q, Hays RD. Depression and the health care experiences of Medicare beneficiaries. Health Serv Res 2011; 46:1883-904. [PMID: 21762146 DOI: 10.1111/j.1475-6773.2011.01293.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To compare health care experiences of Medicare beneficiaries with and without symptoms of depression and investigate the role of patient confidence in shaping these experiences. DATA SOURCES Data came from the 2009 CAHPS Medicare 4.0 Fee-for-Service (FFS) Survey, which was fielded to a national probability sample of 298,492 FFS Medicare beneficiaries. STUDY DESIGN Linear regression was used to model associations of depression with four global ratings and three composite measures of health care and to test whether beneficiaries' confidence in their ability to recognize the need for care mediates these associations. PRINCIPAL FINDINGS Beneficiaries with depressive symptoms reported worse experiences with care across the full range of patient experience covered by the CAHPS survey. Depressive symptoms were associated with decreased patient confidence and decreased confidence was in turn associated with poorer reports of care. CONCLUSIONS Our study highlights depressive symptoms as a risk factor for poorer experiences of health care and highlights depressed patients' confidence in recognizing their need for care and for designing programs to improve the health care of this population.
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Affiliation(s)
- Steven C Martino
- RAND, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213-2665, USA.
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Abstract
Primary care settings present important opportunities for the detection and management of depression in older adults. In this article, the authors review the common barriers to effective treatment of geriatric depression, identify treatment strategies that can substantially improve the effectiveness of treatment in this setting, and highlight the opportunities for addressing health disparities in geriatric depression care. The importance of engaging and supporting family caregivers of depressed older adults and the 3 strategic areas to improve the treatment of geriatric depression in primary care are also discussed.
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84
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Steinman MA, Lund BC, Miao Y, Boscardin WJ, Kaboli PJ. Geriatric conditions, medication use, and risk of adverse drug events in a predominantly male, older veteran population. J Am Geriatr Soc 2011; 59:615-21. [PMID: 21410446 DOI: 10.1111/j.1532-5415.2011.03331.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine whether geriatric conditions and functional impairment are independent risk factors for adverse drug events (ADEs). DESIGN Prospective cohort study. SETTING Veterans Affairs Medical Center. PARTICIPANTS Three hundred seventy-seven veterans aged 65 and older and taking five or more medications. MEASUREMENTS Geriatric conditions and functional status were assessed using participant interviews and structured assessments at study baseline. ADEs were elicited during participant interviews 3 and 12 months after study enrollment using validated methods. RESULTS The strong majority (97%) of participants were male, with a mean age of 74 ± 5; 123 (33%) had one or more dependencies in instrumental activities of daily living (IADLs). Over the 1-year study period, 126 participants (33%) developed 167 ADEs. Upon multivariable analysis, risk of ADEs was not associated with any of the geriatric conditions that there was sufficient power to evaluate, including IADL function, cognitive impairment, depression, visual impairment, incontinence, constipation, and a summative measure of geriatric burden comprising the above and history of falls or gait instability. In exploratory analyses, the strongest factor associated with ADEs was the number of drugs added to a participant's medication regimen during the 1-year study period (incidence rate ratio 1.11 per each added drug, 95% confidence interval=1.03-1.19). CONCLUSION Common geriatric conditions and IADL function were not associated with ADEs in a predominantly male, older veteran population. Although it is important to consider the unique circumstances of each participant, excessive caution in prescribing to older adults with these geriatric conditions may not be warranted.
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Affiliation(s)
- Michael A Steinman
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.
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85
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Bilotta C, Casè A, Nicolini P, Mauri S, Castelli M, Vergani C. Social vulnerability, mental health and correlates of frailty in older outpatients living alone in the community in Italy. Aging Ment Health 2010; 14:1024-36. [PMID: 21069609 DOI: 10.1080/13607863.2010.508772] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine the main social, functional and clinical characteristics of community-dwelling older outpatients living alone and to find correlates of frailty in this population. METHOD Cross-sectional survey of 302 community-dwelling outpatients aged 65+ (median age 82 years) consecutively referred to a geriatric medicine clinic in Italy from June to November 2009. Participants underwent a comprehensive geriatric assessment including frailty status evaluated by means of the study of osteoporotic fractures (SOF) criteria. Student's t-test and the chi-squared test were used to compare subjects 'living alone' and 'not living alone' as well as 'frail' and 'not frail' subjects among the participants living alone. Multiple logistic regression analyses were performed to find independent correlates of frailty among participants living alone. RESULTS Participants 'living alone' were 124 (41%). Compared to subjects 'not living alone' (n = 178), they were older, received less assistance from informal and formal caregivers, had poorer living and financial conditions, a better cognitive status and functional self-sufficiency but a worse emotional status. One-third of them (n = 41) were frail. Among frail elders (n = 116), subjects living alone also showed a higher prevalence of unexpected new diagnoses of dementia than those not living alone. Independent correlates of frailty among participants living alone were: having experienced a severe acute disease in the past year (odds ratio [OR] 303.9; 95% confidence interval [CI] 13-7091; p < 0.001), dependence in the bathing BADL ability (OR 62.74; 95% CI 12.17-323.32; p < 0.001), depression (OR 10.43; 95% CI 2.31-47.13; p = 0.002) and incontinence (OR 3.98; 95% CI 1.01-15.66; p = 0.048). CONCLUSION In older outpatients living alone, including those who were frail, we found a lower availability of personal assistance, significantly more social and financial vulnerability and a higher risk of depression. In frail elders there was also a higher prevalence of underdiagnosed dementia. In order to better recognise frail subjects in this specific population, four independent correlates of frailty were identified.
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Affiliation(s)
- Claudio Bilotta
- Department of Internal Medicine, Geriatric Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via Pace 9, 20122 Milan, Italy.
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86
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Affiliation(s)
- Michelle T Dang
- Division of nursing, California State University at Sacramento, CA, USA
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87
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Rosen D, Morse JQ, Reynolds CF. Adapting problem-solving therapy for depressed older adults in methadone maintenance treatment. J Subst Abuse Treat 2010; 40:132-41. [PMID: 21036509 DOI: 10.1016/j.jsat.2010.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 09/02/2010] [Accepted: 09/15/2010] [Indexed: 11/18/2022]
Abstract
Late-life depression is prevalent in older adults who are dependent on opiates. Depressive disorders among opiate abusers have detrimental effects on their well-being and ability to refrain from illegal drugs. There are numerous barriers to the provision of appropriate mental health care to older adults receiving methadone maintenance treatment. This article focuses on problem-solving therapy (PST) and presents evidence that PST may be a promising nonpharmacological treatment for older methadone clients with comorbid depressive disorders that can be applied within the staffing and resource limits of methadone maintenance treatment facilities. The advantages of PST relative to other behavioral therapies for this population are based on evidence that PST is less cognitively demanding for an older adult population with mood and substance use disorders. A properly modified PST for an older adult substance-dependent population with subsyndromal or diagnosed depression may be a viable option for methadone maintenance programs with limited resources.
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Affiliation(s)
- Daniel Rosen
- University of Pittsburgh, Pittsburgh, PA 15260, USA.
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88
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Rojas-Fernandez CH, Miller LJ, Sadowski CA. Considerations in the Treatment of Geriatric Depression. Res Gerontol Nurs 2010; 3:176-86. [DOI: 10.3928/19404921-20100526-01] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 04/13/2010] [Indexed: 11/20/2022]
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Bostwick JM. A generalist's guide to treating patients with depression with an emphasis on using side effects to tailor antidepressant therapy. Mayo Clin Proc 2010; 85:538-50. [PMID: 20431115 PMCID: PMC2878258 DOI: 10.4065/mcp.2009.0565] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This review provides a guide to the primary care physician for diagnosing and managing depression. To identify relevant articles, a PubMed search (ending date parameter, October 15, 2009) was conducted using the keywords depression, antidepressants, side effects, adverse effects, weight gain, sexual dysfunction, and sleep disturbance, and the reference lists of relevant articles were hand searched. This review explores the challenges in diagnosing depression that will and will not respond to antidepressants (ADs) and describes the value of 2-question screening instruments followed by in-depth questioning for positive screening results. It underscores the implications of veiled somatic presentations in which underlying depression is missed, leading to fruitless and expensive medical work-ups. Following this survey of the difficulties in diagnosing depression, the 4 options generalists have for treating a patient with depression are discussed: watchful waiting, antidepressant therapy, psychotherapy, and psychiatric referral. This review proposes that physicians, once they decide to prescribe, use AD side effects to advantage by selecting medications to minimize negative and maximize positive possibilities, thereby improving adherence. It focuses on the 3 most troubling adverse effects-sleep disturbance, sexual dysfunction, and weight gain. It provides AD-prescribing principles to assist primary care physicians in successfully managing depression and appropriately referring patients to a psychiatrist. Antidepressant therapy is not a panacea for treating patients with depression. An approach blending enlightened observation, medications, and psychotherapy often helps depressed patients recover to their former baselines.
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Affiliation(s)
- J Michael Bostwick
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA.
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90
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Abstract
Pharmacists have traditionally focused on the appropriate use of medications to enhance the functional status of the elderly patient. However, in the proper provision of pharmaceutical care, the influence of lifestyle factors on the use and misuse of medications cannot be ignored. The pharmacist collaborates with other members of the health care team to ensure that drugs are dosed according to known changes occurring with age such as pharmacokinetic and pharmacodynamic alterations. Also, medications that may decrease cognitive function, impair gait/balance, or reduce sensory stimulation must be avoided. The appropriate use of medications can improve the functional status and reduce morbidity in the elderly patient, and drug adherence issues should be addressed to ensure that the elderly patient can receive the optimal benefit from his or her medication regimen. Pharmacists, in collaboration with physicians and other health care providers, can help to ensure that a comprehensive approach to patient care occurs, one that involves medications, diet, and exercise as it embraces the mind, body, and spirit.
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91
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Abstract
OBJECTIVE Prior studies on the association of trait neuroticism and cognitive function in older adults have yielded mixed findings. The authors tested hypotheses that neuroticism is associated with measures of cognition and that depression moderates these relationships. DESIGN Cross-sectional observational study. SETTING Primary care offices. PARTICIPANTS Primary care patients aged > or =65 years. MEASUREMENTS Trait neuroticism was assessed by the NEO-Five Factor Inventory. Major and minor depressions were determined by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and depressive symptom severity by the Hamilton Depression Rating Scale (Ham-D). Cognitive measures included the Mini-Mental State Examination (MMSE), Initiation-Perseveration subscale of the Mattis Dementia Rating Scale, and Trail-Making tests A and B. RESULTS In multiple regression analyses, neuroticism was associated with MMSE score independent of depression diagnosis (beta = -0.04, chi2 = 14.2, df = 1, p = 0.0002, 95% confidence interval [CI] = -0.07 to -0.02) and Ham-D score (beta = -0.04, chi2 = 8.97, df = 1, p = 0.003, 95% CI = -0.06 to -0.01). Interactions between neuroticism and depression diagnosis (chi2 = 7.21, df = 2, p = 0.03) and Ham-D scores (chi2 = 0.55, df = 1, p = 0.46) failed to lend strong support to the moderation hypothesis. CONCLUSION Neuroticism is associated with lower MMSE scores. Findings do not confirm a moderating role for depression but suggest that depression diagnosis may confer additional risk for poorer global cognitive function in patients with high neuroticism. Further study is necessary.
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Day care centre attendance and quality of life in depressed older adults living in the community. Eur J Ageing 2010; 7:29-35. [PMID: 28798615 DOI: 10.1007/s10433-010-0138-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Late-life depression is associated with disabled functioning and a poor quality of life (QOL). The aim of this cross-sectional study was to find out whether the attendance of a day care centre (DC) was associated with QOL in community-dwelling older adults suffering from a depressive disorder without dementia. The study enrolled 149 depressed older adults aged 70 or older, who consecutively underwent a comprehensive geriatric assessment from April to July 2008 at the Geriatric Medicine Unit of the Fondazione Ospedale Maggiore Policlinico in Milan, Italy. QOL was evaluated by means of the European Quality of Life Visual Analogue Scale (EuroQol VAS). DC attendance was quantified as number of days of attendance per week in the past month. Participants attending a DC at least once a week (n = 17) had a higher mean EuroQol VAS score than non-attendants (n = 132) (mean ± SD 58.8 ± 19 vs. 45.3 ± 22.5; P = 0.019). In multiple linear regression analysis a higher weekly attendance of DCs was related to a better quality of life according to the EuroQol VAS score (unstandardized coefficient 3.048, 95% CI 0.063-6.033, P = 0.045) after correction for age, sex, balance and gait abilities, comorbidity, pharmacotherapy, living alone, and severity of depression. Therefore, in older outpatients suffering from a depressive disorder without dementia the attendance of a DC was an independent correlate of the QOL. A randomized controlled longitudinal study will be necessary to determine whether attending a DC is really effective on the QOL in the management of late-life depression.
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93
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Lyness JM, Yu Q, Tang W, Tu X, Conwell Y. Risks for depression onset in primary care elderly patients: potential targets for preventive interventions. Am J Psychiatry 2009; 166:1375-83. [PMID: 19833788 PMCID: PMC2982671 DOI: 10.1176/appi.ajp.2009.08101489] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Prevention of late-life depression, a common, disabling condition with often poor outcomes in primary care, requires identification of seniors at highest risk of incident episodes. The authors examined a broad range of clinical, functional, and psychosocial predictors of incident depressive episodes in a well-characterized cohort of older primary care patients. METHOD In this observational cohort study, patients age >/=65 years without current major depression, recruited from practices in general internal medicine, geriatrics, and family medicine, received annual follow-up assessments over a period of 1 to 4 years. Of 617 enrolled subjects, 405 completed the 1-year follow-up evaluation. The Structured Clinical Interview for DSM-IV (SCID) determined incident major depressive episodes. Each risk indicator's predictive utility was examined by calculating the risk exposure rate, incident risk ratio, and population attributable fraction, leading to determination of the number needed to treat in order to prevent incident depression. RESULTS A combination of risks, including minor or subsyndromal depression, impaired functional status, and history of major or minor depression, identified a group in which fully effective treatment of five individuals would prevent one new case of incident depression. CONCLUSIONS Indicators routinely assessed in primary care identified a group at very high risk for onset of major depressive episodes. Such markers may inform current clinical care by fostering the early detection and intervention critical to improving patient outcomes and may serve as the basis for future studies refining the recommendations for screening and determining the effectiveness of preventive interventions.
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Affiliation(s)
- Jeffrey M Lyness
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY 14642, USA.
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94
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Abstract
BACKGROUND Depression is common among older cancer patients, but little is known about the optimal approach to caring for this population. This analysis evaluates the effectiveness of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) program, a stepped care management program for depression in primary care patients who had an ICD-9 cancer diagnosis. METHODS Two hundred fifteen cancer patients were identified from the 1,801 participants in the parent study. Subjects were 60 years or older with major depression (18%), dysthymic disorder (33%), or both (49%), recruited from 18 primary care clinics belonging to 8 health-care organizations in 5 states. Patients were randomly assigned to the IMPACT intervention (n = 112) or usual care (n = 103). Intervention patients had access for up to 12 months to a depression care manager who was supervised by a psychiatrist and a primary care provider and who offered education, care management, support of antidepressant management, and brief, structured psychosocial interventions including behavioral activation and problem-solving treatment. RESULTS At 6 and 12 months, 55% and 39% of intervention patients had a 50% or greater reduction in depressive symptoms (SCL-20) from baseline compared to 34% and 20% of usual care participants (P = 0.003 and P = 0.029). Intervention patients also experienced greater remission rates (P = 0.031), more depression-free days (P < 0.001), less functional impairment (P = 0.011), and greater quality of life (P = 0.039) at 12 months than usual care participants. CONCLUSIONS The IMPACT collaborative care program appears to be feasible and effective for depression among older cancer patients in diverse primary care settings.
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Affiliation(s)
- Jesse R Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 356560, Seattle, WA 98195, USA.
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Chemali Z, Chahine LM, Fricchione G. The use of selective serotonin reuptake inhibitors in elderly patients. Harv Rev Psychiatry 2009; 17:242-53. [PMID: 19637073 DOI: 10.1080/10673220903129798] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Depression is common among the elderly, and several factors need to be taken into account in selecting the appropriate antidepressant in this age group. Various physiologic changes occur in individuals as they age, potentially leading to changes in the pharmacodynamic and pharmacokinetic properties of drugs in elderly individuals. The efficacy of various medications, their side-effect profiles, and the potential for drug-drug interactions may differ in older patients compared to younger ones. The selective serotonin reuptake inhibitors (SSRIs), which are seen as being among the first-line agents for treatment of depression in elderly patients, have been shown to be effective but carry with them side effects and drug-drug interactions that warrant special attention when these medications are prescribed to older individuals. This review focuses on the pharmacology of SSRIs in elderly patients and on practical issues related to using these medications.
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Obesity and metabolic syndrome increase the risk of incident depression in older men: the health in men study. Am J Geriatr Psychiatry 2009; 17:889-98. [PMID: 19910877 DOI: 10.1097/jgp.0b013e3181b047e3] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Obesity has been associated with increased risk of prevalent depression among young and middle-aged adults, but the association between obesity (and its various measures, including the metabolic syndrome [MetS]) and incident depression has not been examined adequately in the elderly. OBJECTIVES This study evaluated the association between various measures of obesity and incident depression over a 10-year period in a large cohort of community-based older men. METHODS The authors recruited 12,216 men aged 65-84 years living in Perth, Australia, between 1996 and 1998, and measured their height, weight, waist and hip circumference, and blood pressure. Participants also completed a questionnaire that included information about the clinical diagnosis and treatment for diabetes, hypertension, and high cholesterol or triglycerides. The authors then used the Western Australian Linked Data System to retrieve information about the following ICD-10 diagnoses between January 1, 1966, and December 31, 2006: depressive episode, recurrent depressive disorder, and dysthymia. RESULTS The authors excluded 150 men from these analyses because of prior history of depression or missing data. The mean age of our 12,066 participants was 72 +/- 4 years at the time of recruitment, and they were followed up for an average of 8 +/- 2 years. There were 3,623 deaths during follow-up, and 481 men received the diagnosis of depression. The incidence of depression was 5 per 1,000 person-years. Adjusted Cox proportional hazard models showed that men with body mass index (BMI) > or =30 had a 31% (95% confidence interval [CI] = 5%-64%) increase in the risk of depression compared with that of nonobese men (BMI <30). The association between depression and waist circumference > or =102 cm and waist/hip > or =1 did not reach statistical significance. Men with MetS at the time of recruitment had a 137% (95% CI = 60%-251%) increase in the adjusted risk of incident depression. CONCLUSIONS Our results indicate that obesity and MetS are associated with an increase in the risk of incident depression among older men. If this association is truly causal, reducing the prevalence of obesity and MetS could potentially lead to a decline in the prevalence and incidence of depression in later life.
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Soukup GR, Sperfeld AD, Uttner I, Karitzky J, Ludolph AC, Kassubek J, Schreiber H. Frontotemporal cognitive function in X-linked spinal and bulbar muscular atrophy (SBMA): a controlled neuropsychological study of 20 patients. J Neurol 2009; 256:1869-75. [PMID: 19572162 DOI: 10.1007/s00415-009-5212-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 05/14/2009] [Accepted: 06/08/2009] [Indexed: 01/18/2023]
Abstract
A cross-sectional neuropsychological study of cognitive functions in 20 male patients with genetically proven spinal and bulbar muscular atrophy (SBMA) was performed, with a comparison of their cognitive performance with that of 20 age- and education-matched control subjects. Neuropsychological assessment covered executive functioning, memory, and attentional control. The SBMA patients revealed deficits in verbal and non-verbal fluency as well as concept formation. Additionally, they showed significant memory deficits in all of the investigated domains of working memory, short-term and long-term memory. With respect to attentional control, the SBMA patients underperformed in relevant subtests, although performance differences did not reach significance overall. We conclude that fronto-temporal cognitive functions are impaired in SMBA, although at a subclinical level. Thus, functional deficits in SBMA are not confined to motor neurons but also affect extramotor networks.
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Affiliation(s)
- Georg Rüdiger Soukup
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
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Bao Y, Post EP, Ten Have TR, Schackman BR, Bruce ML. Achieving Effective Antidepressant Pharmacotherapy in Primary Care: The Role of Depression Care Management in Treating Late-Life Depression. J Am Geriatr Soc 2009; 57:895-900. [DOI: 10.1111/j.1532-5415.2009.02226.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gerretsen P, Pollock BG. Pharmacogenetics and the serotonin transporter in late-life depression. Expert Opin Drug Metab Toxicol 2009; 4:1465-78. [PMID: 19040324 DOI: 10.1517/17425250802560279] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The etiologies of variable antidepressant response remain elusive. Aging and age-related illness add to the complexity and heterogeneity of late-life depression. The serotonin transporter (5-HTT) is the principal site of initial action for several antidepressants, including serotonin re-uptake inhibitors (SSRIs). The serotonin transporter-linked polymorphic region (5-HTTLPR) is the most widely studied polymorphism of the 5-HTT gene, SLC6A4, and is suspected of conferring vulnerability to elderly depression and resistance to treatment. OBJECTIVE To present an up-to-date account of the influence of 5-HTT polymorphisms on elderly depression, antidepressant response and susceptibility to medication side effects. METHOD A Medline search (1993 - 2008) of 5-HTT gene variation studies and analyses that included elderly depressed subjects was performed using the terms: 'serotonin transporter'; '5-HTT'; 'SERT'; '5-HTTLPR'; 'late-life depression'; 'elderly depression'; 'geriatric depression'; 'antidepressants' and 'SSRIs'. Reference sections were gleaned for relevant articles that may have been overlooked by the search strategy. CONCLUSION 5-HTTLPR may influence treatment response variability in late-life depression in a number of ways. Indirectly, 5-HTTLPR seems to influence the likelihood of adverse effects and non-adherence. Directly, the promoter region may contribute to response variability during the initial stages of treatment, which is explained, in part, by a gene-concentration interaction for paroxetine. Subjects with the S allele may be at an increased risk of adverse drug reactions and may require higher initial SSRI plasma concentrations to maximize response. Conversely, patients with the L/L genotype may respond even at lower concentrations.
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Affiliation(s)
- Philip Gerretsen
- Faculty of Medicine University of Toronto, Centre for Addiction and Mental Health, Division of Psychiatry, Toronto, Ontario, M5S 2S1, Canada
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Watson K, Summers KM. Depression in Patients with Heart Failure: Clinical Implications and Management. Pharmacotherapy 2009; 29:49-63. [DOI: 10.1592/phco.29.1.49] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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