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Patrick RE, Dickinson RA, Gentry MT, Kim JU, Oberlin LE, Park S, Principe JL, Teixeira AL, Weisenbach SL. Treatment resistant late-life depression: A narrative review of psychosocial risk factors, non-pharmacological interventions, and the role of clinical phenotyping. J Affect Disord 2024; 356:145-154. [PMID: 38593940 DOI: 10.1016/j.jad.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Treatment resistant depression (TRD) is a subset of major depressive disorder (MDD) in which symptoms do not respond to front line therapies. In older adults, the assessment and treatment of TRD is complicated by psychosocial risk factors unique to this population, as well as a relative paucity of research. METHODS Narrative review aimed at (1) defining TRLLD for clinical practice and research; (2) describing psychosocial risk factors; (3) reviewing psychological and non-pharmacological treatments; (4) discussing the role of clinical phenotyping for personalized treatment; and (5) outlining research priorities. RESULTS Our definition of TRLLD centers on response to medication and neuromodulation in primary depressive disorders. Psychosocial risk factors include trauma and early life adversity, chronic physical illness, social isolation, personality, and barriers to care. Promising non-pharmacological treatments include cognitive training, psychotherapy, and lifestyle interventions. The utility of clinical phenotyping is highlighted by studies examining the impact of comorbidities, symptom dimensions (e.g., apathy), and structural/functional brain changes. LIMITATIONS There is a relative paucity of TRLLD research. This limits the scope of empirical data from which to derive reliable patterns and complicates efforts to evaluate the literature quantitatively. CONCLUSIONS TRLLD is a complex disorder that demands further investigation given our aging population. While this review highlights the promising breadth of TRLLD research to date, more research is needed to help elucidate, for example, the optimal timing for implementing risk mitigation strategies, the value of collaborative care approaches, specific treatment components associated with more robust response, and phenotyping to help inform treatment decisions.
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Affiliation(s)
- Regan E Patrick
- Department of Neuropsychology, McLean Hospital, Belmont, MA, United States of America; Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America.
| | - Rebecca A Dickinson
- Department of Neuropsychology, McLean Hospital, Belmont, MA, United States of America; Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States of America
| | - Melanie T Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States of America
| | - Joseph U Kim
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Lauren E Oberlin
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, United States of America; AdventHealth Research Institute, Neuroscience, Orlando, FL, United States of America
| | - Soohyun Park
- Department of Psychiatry, Tufts Medical Center, Boston, MA, United States of America
| | - Jessica L Principe
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Antonio L Teixeira
- Department of Psychiatry & Behavioral Sciences, UT Health Houston, Houston, TX, United States of America
| | - Sara L Weisenbach
- Department of Neuropsychology, McLean Hospital, Belmont, MA, United States of America; Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
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Roy JC, Desmidt T, Dam S, Mirea-Grivel I, Weyl L, Bannier E, Barantin L, Drapier D, Batail JM, David R, Coloigner J, Robert GH. Connectivity patterns of the core resting-state networks associated with apathy in late-life depression. J Psychiatry Neurosci 2023; 48:E404-E413. [PMID: 37914222 PMCID: PMC10620011 DOI: 10.1503/jpn.230008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/28/2023] [Accepted: 08/03/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Apathy is associated with reduced antidepressant response and dementia in late-life depression (LLD). However, the functional cerebral basis of apathy is understudied in LLD. We investigated the functional connectivity of 5 resting-state networks (RSN) hypothesized to underlie apathy in LLD. METHODS Resting-state functional MRI data were collected from individuals with LLD who did not have dementia as well as healthy older adults between October 2019 and April 2022. Apathy was evaluated using the diagnostic criteria for apathy (DCA), the Apathy Evaluation Scale (AES) and the Apathy Motivation Index (AMI). Subnetworks whose connectivity was significantly associated with each apathy measure were identified via the threshold-free network-based statistics. Regions that were consistently associated with apathy across the measures were reported as robust findings. RESULTS Our sample included 39 individuals with LLD who did not have dementia and 26 healthy older adults. Compared with healthy controls, individuals with LLD had an altered intra-RSN and inter-RNS connectivity in the default mode, the cingulo-opercular and the frontoparietal networks. All 3 apathy measurements showed associations with modified intra-RSN connectivity in these networks, except for the DCA in the cingulo-opercular network. The AMI scores showed stronger associations with the cingulo-opercular and frontoparietal networks, whereas the AES had stronger associations with the default mode network and the goal-oriented behaviour network. LIMITATIONS The study was limited by the small number of participants without apathy according to the DCA, which may have reduced the statistical power of between-group comparisons. Additionally, the reliance on specific apathy measures may have influenced the observed overlap in brain regions. CONCLUSION Our findings indicate that apathy in LLD is consistently associated with changes in both intra-RSN and inter-RSN connectivity of brain regions implicated in goal-oriented behaviours. These results corroborate previous findings of altered functional RSN connectivity in severe LLD.
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Affiliation(s)
- Jean-Charles Roy
- From the Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, Rennes, France (Roy, Mirea-Grivel, Louise, Drapier, Batail, Robert); the Centre d'investigation clinique (CIC) de Rennes 1414, CHU de Rennes, Institut national de la santé et de la recherche médicale (INSERM), Rennes, France (Roy, Drapier, Batail, Robert); l'Université de Rennes, Inria Centre, Centre National de la Recherche Scientifique, IRISA, INSERM, Empenn U1228 ERL, Rennes, France (Roy, Dam, Bannier, Coloigner, Robert); the Service de Radiologie, CHU Rennes, Rennes, France (Bannier); the CHU de Tours, Tours, France (Desmidt, Barantin); the UMR 1253, iBrain, Université de Tours, INSERM, Tours, France (Desmidt, Barantin); the CIC 1415, CHU de Tours, INSERM, Tours, France (Desmidt); the CoBTeK (Cognition Behaviour Technology) Lab, University Côte d'Azur, Nice, France (David)
| | - Thomas Desmidt
- From the Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, Rennes, France (Roy, Mirea-Grivel, Louise, Drapier, Batail, Robert); the Centre d'investigation clinique (CIC) de Rennes 1414, CHU de Rennes, Institut national de la santé et de la recherche médicale (INSERM), Rennes, France (Roy, Drapier, Batail, Robert); l'Université de Rennes, Inria Centre, Centre National de la Recherche Scientifique, IRISA, INSERM, Empenn U1228 ERL, Rennes, France (Roy, Dam, Bannier, Coloigner, Robert); the Service de Radiologie, CHU Rennes, Rennes, France (Bannier); the CHU de Tours, Tours, France (Desmidt, Barantin); the UMR 1253, iBrain, Université de Tours, INSERM, Tours, France (Desmidt, Barantin); the CIC 1415, CHU de Tours, INSERM, Tours, France (Desmidt); the CoBTeK (Cognition Behaviour Technology) Lab, University Côte d'Azur, Nice, France (David)
| | - Sébastien Dam
- From the Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, Rennes, France (Roy, Mirea-Grivel, Louise, Drapier, Batail, Robert); the Centre d'investigation clinique (CIC) de Rennes 1414, CHU de Rennes, Institut national de la santé et de la recherche médicale (INSERM), Rennes, France (Roy, Drapier, Batail, Robert); l'Université de Rennes, Inria Centre, Centre National de la Recherche Scientifique, IRISA, INSERM, Empenn U1228 ERL, Rennes, France (Roy, Dam, Bannier, Coloigner, Robert); the Service de Radiologie, CHU Rennes, Rennes, France (Bannier); the CHU de Tours, Tours, France (Desmidt, Barantin); the UMR 1253, iBrain, Université de Tours, INSERM, Tours, France (Desmidt, Barantin); the CIC 1415, CHU de Tours, INSERM, Tours, France (Desmidt); the CoBTeK (Cognition Behaviour Technology) Lab, University Côte d'Azur, Nice, France (David)
| | - Iris Mirea-Grivel
- From the Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, Rennes, France (Roy, Mirea-Grivel, Louise, Drapier, Batail, Robert); the Centre d'investigation clinique (CIC) de Rennes 1414, CHU de Rennes, Institut national de la santé et de la recherche médicale (INSERM), Rennes, France (Roy, Drapier, Batail, Robert); l'Université de Rennes, Inria Centre, Centre National de la Recherche Scientifique, IRISA, INSERM, Empenn U1228 ERL, Rennes, France (Roy, Dam, Bannier, Coloigner, Robert); the Service de Radiologie, CHU Rennes, Rennes, France (Bannier); the CHU de Tours, Tours, France (Desmidt, Barantin); the UMR 1253, iBrain, Université de Tours, INSERM, Tours, France (Desmidt, Barantin); the CIC 1415, CHU de Tours, INSERM, Tours, France (Desmidt); the CoBTeK (Cognition Behaviour Technology) Lab, University Côte d'Azur, Nice, France (David)
| | - Louise Weyl
- From the Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, Rennes, France (Roy, Mirea-Grivel, Louise, Drapier, Batail, Robert); the Centre d'investigation clinique (CIC) de Rennes 1414, CHU de Rennes, Institut national de la santé et de la recherche médicale (INSERM), Rennes, France (Roy, Drapier, Batail, Robert); l'Université de Rennes, Inria Centre, Centre National de la Recherche Scientifique, IRISA, INSERM, Empenn U1228 ERL, Rennes, France (Roy, Dam, Bannier, Coloigner, Robert); the Service de Radiologie, CHU Rennes, Rennes, France (Bannier); the CHU de Tours, Tours, France (Desmidt, Barantin); the UMR 1253, iBrain, Université de Tours, INSERM, Tours, France (Desmidt, Barantin); the CIC 1415, CHU de Tours, INSERM, Tours, France (Desmidt); the CoBTeK (Cognition Behaviour Technology) Lab, University Côte d'Azur, Nice, France (David)
| | - Elise Bannier
- From the Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, Rennes, France (Roy, Mirea-Grivel, Louise, Drapier, Batail, Robert); the Centre d'investigation clinique (CIC) de Rennes 1414, CHU de Rennes, Institut national de la santé et de la recherche médicale (INSERM), Rennes, France (Roy, Drapier, Batail, Robert); l'Université de Rennes, Inria Centre, Centre National de la Recherche Scientifique, IRISA, INSERM, Empenn U1228 ERL, Rennes, France (Roy, Dam, Bannier, Coloigner, Robert); the Service de Radiologie, CHU Rennes, Rennes, France (Bannier); the CHU de Tours, Tours, France (Desmidt, Barantin); the UMR 1253, iBrain, Université de Tours, INSERM, Tours, France (Desmidt, Barantin); the CIC 1415, CHU de Tours, INSERM, Tours, France (Desmidt); the CoBTeK (Cognition Behaviour Technology) Lab, University Côte d'Azur, Nice, France (David)
| | - Laurent Barantin
- From the Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, Rennes, France (Roy, Mirea-Grivel, Louise, Drapier, Batail, Robert); the Centre d'investigation clinique (CIC) de Rennes 1414, CHU de Rennes, Institut national de la santé et de la recherche médicale (INSERM), Rennes, France (Roy, Drapier, Batail, Robert); l'Université de Rennes, Inria Centre, Centre National de la Recherche Scientifique, IRISA, INSERM, Empenn U1228 ERL, Rennes, France (Roy, Dam, Bannier, Coloigner, Robert); the Service de Radiologie, CHU Rennes, Rennes, France (Bannier); the CHU de Tours, Tours, France (Desmidt, Barantin); the UMR 1253, iBrain, Université de Tours, INSERM, Tours, France (Desmidt, Barantin); the CIC 1415, CHU de Tours, INSERM, Tours, France (Desmidt); the CoBTeK (Cognition Behaviour Technology) Lab, University Côte d'Azur, Nice, France (David)
| | - Dominique Drapier
- From the Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, Rennes, France (Roy, Mirea-Grivel, Louise, Drapier, Batail, Robert); the Centre d'investigation clinique (CIC) de Rennes 1414, CHU de Rennes, Institut national de la santé et de la recherche médicale (INSERM), Rennes, France (Roy, Drapier, Batail, Robert); l'Université de Rennes, Inria Centre, Centre National de la Recherche Scientifique, IRISA, INSERM, Empenn U1228 ERL, Rennes, France (Roy, Dam, Bannier, Coloigner, Robert); the Service de Radiologie, CHU Rennes, Rennes, France (Bannier); the CHU de Tours, Tours, France (Desmidt, Barantin); the UMR 1253, iBrain, Université de Tours, INSERM, Tours, France (Desmidt, Barantin); the CIC 1415, CHU de Tours, INSERM, Tours, France (Desmidt); the CoBTeK (Cognition Behaviour Technology) Lab, University Côte d'Azur, Nice, France (David)
| | - Jean-Marie Batail
- From the Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, Rennes, France (Roy, Mirea-Grivel, Louise, Drapier, Batail, Robert); the Centre d'investigation clinique (CIC) de Rennes 1414, CHU de Rennes, Institut national de la santé et de la recherche médicale (INSERM), Rennes, France (Roy, Drapier, Batail, Robert); l'Université de Rennes, Inria Centre, Centre National de la Recherche Scientifique, IRISA, INSERM, Empenn U1228 ERL, Rennes, France (Roy, Dam, Bannier, Coloigner, Robert); the Service de Radiologie, CHU Rennes, Rennes, France (Bannier); the CHU de Tours, Tours, France (Desmidt, Barantin); the UMR 1253, iBrain, Université de Tours, INSERM, Tours, France (Desmidt, Barantin); the CIC 1415, CHU de Tours, INSERM, Tours, France (Desmidt); the CoBTeK (Cognition Behaviour Technology) Lab, University Côte d'Azur, Nice, France (David)
| | - Renaud David
- From the Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, Rennes, France (Roy, Mirea-Grivel, Louise, Drapier, Batail, Robert); the Centre d'investigation clinique (CIC) de Rennes 1414, CHU de Rennes, Institut national de la santé et de la recherche médicale (INSERM), Rennes, France (Roy, Drapier, Batail, Robert); l'Université de Rennes, Inria Centre, Centre National de la Recherche Scientifique, IRISA, INSERM, Empenn U1228 ERL, Rennes, France (Roy, Dam, Bannier, Coloigner, Robert); the Service de Radiologie, CHU Rennes, Rennes, France (Bannier); the CHU de Tours, Tours, France (Desmidt, Barantin); the UMR 1253, iBrain, Université de Tours, INSERM, Tours, France (Desmidt, Barantin); the CIC 1415, CHU de Tours, INSERM, Tours, France (Desmidt); the CoBTeK (Cognition Behaviour Technology) Lab, University Côte d'Azur, Nice, France (David)
| | - Julie Coloigner
- From the Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, Rennes, France (Roy, Mirea-Grivel, Louise, Drapier, Batail, Robert); the Centre d'investigation clinique (CIC) de Rennes 1414, CHU de Rennes, Institut national de la santé et de la recherche médicale (INSERM), Rennes, France (Roy, Drapier, Batail, Robert); l'Université de Rennes, Inria Centre, Centre National de la Recherche Scientifique, IRISA, INSERM, Empenn U1228 ERL, Rennes, France (Roy, Dam, Bannier, Coloigner, Robert); the Service de Radiologie, CHU Rennes, Rennes, France (Bannier); the CHU de Tours, Tours, France (Desmidt, Barantin); the UMR 1253, iBrain, Université de Tours, INSERM, Tours, France (Desmidt, Barantin); the CIC 1415, CHU de Tours, INSERM, Tours, France (Desmidt); the CoBTeK (Cognition Behaviour Technology) Lab, University Côte d'Azur, Nice, France (David)
| | - Gabriel H Robert
- From the Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, Rennes, France (Roy, Mirea-Grivel, Louise, Drapier, Batail, Robert); the Centre d'investigation clinique (CIC) de Rennes 1414, CHU de Rennes, Institut national de la santé et de la recherche médicale (INSERM), Rennes, France (Roy, Drapier, Batail, Robert); l'Université de Rennes, Inria Centre, Centre National de la Recherche Scientifique, IRISA, INSERM, Empenn U1228 ERL, Rennes, France (Roy, Dam, Bannier, Coloigner, Robert); the Service de Radiologie, CHU Rennes, Rennes, France (Bannier); the CHU de Tours, Tours, France (Desmidt, Barantin); the UMR 1253, iBrain, Université de Tours, INSERM, Tours, France (Desmidt, Barantin); the CIC 1415, CHU de Tours, INSERM, Tours, France (Desmidt); the CoBTeK (Cognition Behaviour Technology) Lab, University Côte d'Azur, Nice, France (David)
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