1
|
Sørensen A, Jørgensen KJ, Munkholm K. Description of antidepressant withdrawal symptoms in clinical practice guidelines on depression: A systematic review. J Affect Disord 2022; 316:177-186. [PMID: 35964766 DOI: 10.1016/j.jad.2022.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/26/2022] [Accepted: 08/06/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Antidepressant withdrawal symptoms may mimic symptoms of depression relapse and can be challenging for patients when tapering or discontinuing antidepressants. We aimed to assess how withdrawal symptoms are described in major clinical practice guidelines on depression. METHODS Systematic review of major clinical practice guidelines on depression from the United Kingdom, the United States, Canada, Australia, Singapore, Ireland, and New Zealand. We searched PubMed, 14 guideline registries, and the websites of relevant organisations (last search 10 July 2022). The guidelines were assessed for information and descriptions of antidepressant withdrawal symptoms regarding their type, incidence, duration, severity, onset, and presumed mechanism. RESULTS We included 21 guidelines, 15 (71 %) of which stated that withdrawal or discontinuation symptoms can occur. None of the guidelines provided an exhaustive list of potential withdrawal symptoms; ten (48 %) guidelines mentioned at least one specific symptom, ranging between four and 39 symptoms. The symptomatic overlap between withdrawal and relapse was mentioned in four (19 %) guidelines. Withdrawal symptoms were generally described as mild, brief, and self-limiting; and severe in a minority of cases. Estimates of the duration, incidence, or expected onset were reported in five (24 %) guidelines, and were in all cases lower than those reported in systematic reviews. LIMITATIONS We included clinical practice guidelines from English-speaking countries only; our findings may not be generalizable to non-English-speaking countries. CONCLUSIONS Clinical practice guidelines provide scarce and inadequate information on antidepressant withdrawal symptoms and limited guidance for distinguishing withdrawal symptoms from symptoms of relapse.
Collapse
Affiliation(s)
- Anders Sørensen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Denmark.
| | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Klaus Munkholm
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| |
Collapse
|
2
|
Gilbody S, Brabyn S, Mitchell A, Ekers D, McMillan D, Bailey D, Hems D, Chew Graham CA, Keding A, Bosanquet K. Can We Prevent Depression in At-Risk Older Adults Using Self-Help? The UK SHARD Trial of Behavioral Activation. Am J Geriatr Psychiatry 2022; 30:197-207. [PMID: 34266750 DOI: 10.1016/j.jagp.2021.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Treatment of established depression is the dominant approach to care of older adults, but prevention holds much promise. Self-help interventions are a feasible preventive approach, since they are scalable and low cost. There are few trials in this area. Behavioral Activation (BA) is a credible candidate psychological approach, which has been shown to work in therapist led care but not been trialled in a self-help form. AIM To test the effectiveness of an unguided self-help intervention based on BA for older adults. METHODS We compared a self-help intervention based on BA for older people (n = 172) to usual care (n = 160) in a pragmatic randomized controlled trial. Outcomes were depression status and severity (PHQ9) and health related quality of life (SF12). The primary timepoint of the primary outcome was depression at 4 months, with longer term follow up at 12 months to test sustained impact of the primary outcome. RESULTS At 4 months adjusted PHQ-9 scores for BA self-help were 0.79 lower (95% CI: -1.70 to 0.13; p = 0.09) and the proportion of participants with case-level depression was significantly reduced (BA 31/137 (22.6%) versus usual care 41/141 (29.1%); Odds Ratio 0.48; 95% CI: 0.26-0.92; p = 0.03). There was no PHQ-9 difference at 12 months or for health related quality of life at any point (4 or 12 months). DISCUSSION Self-help using BA for older people at risk of depression is a feasible and scalable intervention with potential short-term benefits in preventing depression.
Collapse
Affiliation(s)
- Simon Gilbody
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK; Hull York Medical School (SG, DM), UK.
| | - Sally Brabyn
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK
| | - Alex Mitchell
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK; York Trials Unit (AM, AD), University of York, UK
| | - David Ekers
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK; Tees Esk and Wear Valleys NHS Foundation Trust (DE), North Yorkshire, UK
| | - Dean McMillan
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK; Hull York Medical School (SG, DM), UK
| | - Della Bailey
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK
| | - Deborah Hems
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK
| | | | - Ada Keding
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK; York Trials Unit (AM, AD), University of York, UK
| | - Kate Bosanquet
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK
| |
Collapse
|
3
|
Sørensen A, Juhl Jørgensen K, Munkholm K. Clinical practice guideline recommendations on tapering and discontinuing antidepressants for depression: a systematic review. Ther Adv Psychopharmacol 2022; 12:20451253211067656. [PMID: 35173954 PMCID: PMC8841913 DOI: 10.1177/20451253211067656] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/01/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Tapering and discontinuing antidepressants are important aspects of the management of patients with depression and should therefore be considered in clinical practice guidelines. OBJECTIVES We aimed to assess the extent and content, and appraise the quality, of guidance on tapering and discontinuing antidepressants in major clinical practice guidelines on depression. METHODS Systematic review of clinical practice guidelines on depression issued by national health authorities and major national or international professional organisations in the United Kingdom, the United States, Canada, Australia, Singapore, Ireland and New Zealand (PROSPERO CRD42020220682). We searched PubMed, 14 guideline registries and the websites of relevant organisations (last search 25 May 2021). The clinical practice guidelines were assessed for recommendations and information relevant to tapering and discontinuing antidepressants. The quality of the clinical practice guidelines as they pertained to tapering and discontinuation was assessed using the AGREE II tool. RESULTS Of the 21 included clinical practice guidelines, 15 (71%) recommended that antidepressants are tapered gradually or slowly, but none provided guidance on dose reductions, how to distinguish withdrawal symptoms from relapse or how to manage withdrawal symptoms. Psychological challenges were not addressed in any clinical practice guideline, and the treatment algorithms and flow charts did not include discontinuation. The quality of the clinical practice guidelines was overall low. CONCLUSION Current major clinical practice guidelines provide little support for clinicians wishing to help patients discontinue or taper antidepressants in terms of mitigating and managing withdrawal symptoms. Patients who have deteriorated upon following current guidance on tapering and discontinuing antidepressants thus cannot be concluded to have experienced a relapse. Better guidance requires better randomised trials investigating interventions for discontinuing or tapering antidepressants.
Collapse
Affiliation(s)
- Anders Sørensen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Klaus Munkholm
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
4
|
Rodrigues M, Sanger N, Dufort A, Sanger S, Panesar B, D'Elia A, Parpia S, Samaan Z, Thabane L. Outcomes reported in randomised controlled trials of major depressive disorder in older adults: protocol for a methodological review. BMJ Open 2021; 11:e054777. [PMID: 34725082 PMCID: PMC8562520 DOI: 10.1136/bmjopen-2021-054777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Major depressive disorder (MDD or depression) is prevalent among adults aged 65 years and older. The effectiveness and safety of interventions used to treat depression is often assessed through randomised controlled trials (RCTs). However, heterogeneity in the selection, measurement and reporting of outcomes in RCTs renders comparisons between trial results, interpretability and generalisability of findings challenging. There is presently no core outcome set (COS) for use in RCTs that assess interventions for older adults with MDD. We will conduct a methodological review of the literature for outcomes reported in trials for adults 65 years and older with depression to assess the heterogeneity of outcome measures. METHODS AND ANALYSIS RCTs evaluating pharmacotherapy, psychotherapy, or any other treatment intervention for older adults with MDD published in the last 10 years will be located using electronic database searches (MEDLINE, Embase, PsycINFO and the Cochrane Central Register of Controlled Trials). Reviewers will conduct title and abstract screening, full-text screening and data extraction of trials eligible for inclusion independently and in duplicate. Outcomes will be synthesised and mapped to core outcome-domain frameworks. We will summarise characteristics associated with trials and outcomes. ETHICS AND DISSEMINATION We hope that findings from our methodological review will reduce variability in outcome selection, measurement and reporting and facilitate the development of a COS for older adults with MDD. Our review will also inform evidence synthesis efforts in identifying the best treatment practices for this clinical population. Ethics approval is not required, as this study is a literature review. PROSPERO REGISTRATION NUMBER CRD42021244753.
Collapse
Affiliation(s)
- Myanca Rodrigues
- Health Research Methodology Graduate Program, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Nitika Sanger
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Alexander Dufort
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie Sanger
- Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
| | - Balpreet Panesar
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Alessia D'Elia
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Sameer Parpia
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Mood Disorders Program, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| |
Collapse
|
5
|
Strauss R, Kurdyak P, Glazier RH. Mood Disorders in Late Life: A Population-based Analysis of Prevalence, Risk Factors, and Consequences in Community-dwelling Older Adults in Ontario: Troubles de l'humeur en âge avancé : Une analyse dans la population de la prévalence, des facteurs de risque et des conséquences chez des adultes âgés vivant en milieu communautaire en Ontario. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:630-640. [PMID: 32436726 PMCID: PMC7457461 DOI: 10.1177/0706743720927812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Mental health issues in late life are a growing public health challenge as the population aged 65 and older rapidly increases worldwide. An updated understanding of the causes of mood disorders and their consequences in late life could guide interventions for this underrecognized and undertreated problem. We undertook a population-based analysis to quantify the prevalence of mood disorders in late life in Ontario, Canada, and to identify potential risk factors and consequences. METHOD Individuals aged 65 or older participating in 4 cycles of a nationally representative survey were included. Self-report of a diagnosed mood disorder was used as the outcome measure. Using linked administrative data, we quantified associations between mood disorder and potential risk factors such as demographic/socioeconomic factors, substance use, and comorbidity. We also determined associations between mood disorders and 5-year outcomes including health service utilization and mortality. RESULTS The prevalence of mood disorders was 6.1% (4.9% among males, 7.1% among females). Statistically significant associations with mood disorders included younger age, female sex, food insecurity, chronic opioid use, smoking, and morbidity. Individuals with mood disorders had increased odds of all consequences examined, including placement in long-term care (adjusted odds ratio [OR] =2.28; 95% confidence interval [CI], 1.71 to 3.02) and death (adjusted OR = 1.35; 95% CI, 1.13 to 1.63). CONCLUSIONS Mood disorders in late life were strongly correlated with demographic and social/behavioral factors, health care use, institutionalization, and mortality. Understanding these relationships provides a basis for potential interventions to reduce the occurrence of mood disorders in late life and their consequences.
Collapse
Affiliation(s)
- Rachel Strauss
- Dalla Lana School of Public Health, 7938University of Toronto, Ontario, Canada
| | - Paul Kurdyak
- Institute for Clinical Evaluative Sciences (50010ICES), Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Richard H Glazier
- Dalla Lana School of Public Health, 7938University of Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences (50010ICES), Toronto, Ontario, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Family and Community Medicine, 7938University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
6
|
Christensen LF, Moller AM, Hansen JP, Nielsen CT, Gildberg FA. Patients' and providers' experiences with video consultations used in the treatment of older patients with unipolar depression: A systematic review. J Psychiatr Ment Health Nurs 2020; 27:258-271. [PMID: 31677331 DOI: 10.1111/jpm.12574] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 10/23/2019] [Accepted: 10/30/2019] [Indexed: 12/11/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Depression is the most common cause of mental illness amongst older people. As a result of the growth of the older population, it is expected that an increasing number of older people will need treatment. Depression can be effectively treated-but fewer than half of those who are affected receive treatment. Barriers to receiving treatment are lack of resources and trained healthcare providers, social stigma, incorrect diagnoses and long distances to treatment facilities. There is an increased need for alternative ways of treating patients with depression. The use of video consultations has shown to be a viable option for delivering mental health care to older patients. Use of video consultations allows patients to receive treatment in their own homes. None of the existing reviews have focused on satisfaction with the use of video consultations amongst older people with depression. This paper provides knowledge regarding the use of video consultations, especially for older people with depression. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: No previous review has sought to understand the use of video consultations in mental health care to older patients with depression. The results show that video consultations support mental health practice, especially as a useful alternative when face-to-face therapy is not possible. An initial scepticism from participants quickly disappeared when video consultations were experienced in action. The challenges associated with the use of video consultations seem to consist of technical problems and lack of support from staff. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health practitioners should consider the use of video consultations because it can support mental health practice, especially as a useful alternative when face-to-face therapy is not possible. ABSTRACT: Introduction Depression is the leading cause of mental illness amongst an ageing population and fewer than half of those who are affected receive treatment. There is an increased need for alternative ways of treating patients; the use of video consultations has been shown to be a viable option for delivering mental health care. However, none of the existing reviews have focused on satisfaction with the use of video consultations amongst older people with depression and providers. Aim To conduct a systematic review of the existing literature focusing on patients' and providers' experiences of video consultations for depression. Method Eight scientific databases were searched. In all, 3,537 articles were identified and, of these, 21 peer-reviewed articles were included in this review. Results The results show that video consultations support mental health practice, especially as a useful alternative when face-to-face therapy is not possible. Any initial scepticism quickly disappeared when video consultations were experienced in action. The challenges seem to consist of technical problems and lack of support from staff. Discussion The experiences and satisfaction of older people with depression seem to be positive, although methodological limitations and deficiencies of the reviewed articles should be considered. More qualitative research is needed, and future studies should focus on specific diagnoses and providers' experiences. Implications for practice Video consultations support mental health practice, especially as a useful alternative when face-to-face therapy is not possible.
Collapse
Affiliation(s)
- Lone Fisker Christensen
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Research Unit for Telepsychiatry and E-mental Health, University of Southern Denmark, Odense, Denmark.,Research Unit, Department of Mental Health, Esbjerg, Region of Southern Denmark, Esbjerg, Denmark
| | - Anne Marie Moller
- Research Unit for Telepsychiatry and E-mental Health, University of Southern Denmark, Odense, Denmark.,Health Promotion Research, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Peter Hansen
- Research Unit, Department of Mental Health, Esbjerg, Region of Southern Denmark, Esbjerg, Denmark.,Center for Psychiatric Nursing and Health Research, Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Connie Thuroe Nielsen
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Mental Health, Vejle, Region of Southern Denmark, Vejle, Denmark
| | - Frederik Alkier Gildberg
- Center for Psychiatric Nursing and Health Research, Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
7
|
Verdaguer ES, Stafford J, Tuijt R, Orgeta V. Minor and subthreshold depressive disorders in Alzheimer's disease: A systematic review and meta-analysis of prevalence studies. J Affect Disord 2020; 263:728-734. [PMID: 31787425 DOI: 10.1016/j.jad.2019.11.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 10/02/2019] [Accepted: 11/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Depressive symptoms are common in Alzheimer's disease (AD) and negatively impact patient well-being. The main aim of the present study was to establish summary estimates for the prevalence of minor depressive disorder (MinD) and subthreshold depression in AD and synthesise evidence on prognosis and management of these symptoms in order to inform clinical guidelines. METHODS Systematic review and meta-analysis of cross-sectional and longitudinal studies of prevalence, prognosis, and treatments for minor and subthreshold depression in AD. We searched MEDLINE, Embase, PsycINFO and CINAHL. We included studies that reported prevalence of subthreshold depressive disorders and those reporting data on validity of diagnostic criteria, mechanisms, or randomised controlled clinical trials (RCTs) testing effectiveness of interventions. Estimates of prevalence were pooled using random-effects meta-analyses. Two authors screened articles and independently extracted data on study characteristics. RESULTS We reviewed 5671 abstracts, retrieved 621 full text articles and included a total of 15 studies. Pooling data from 10 studies showed that prevalence for MinD in AD was 22.0% (95% CI 16.0 to 28.0). Prevalence for a clinical diagnosis of MinD (DSM-III-R and DSM-IV) was 26.0% (95% CI 20.0 to 32.0; 6 studies). People with MinD experienced higher levels of neuropsychiatric symptoms, functional and cognitive decline, although studies remain cross-sectional. Neither sertraline nor a carer intervention were effective in reducing symptoms. CONCLUSION This review finds that MinD is prevalent in people with a diagnosis of AD and requires clinical attention. Research is warranted to develop effective interventions to treat and prevent these symptoms.
Collapse
|
8
|
Kenning C, Blakemore A, Bower P, Safari M, Cuijpers P, Brown JS, Hann M, Lidbetter N, Muñoz RF, Waheed W. Preventing depression in the community by voluntary sector providers (PERSUADE): intervention development and protocol for a parallel randomised controlled feasibility trial. BMJ Open 2019; 9:e023791. [PMID: 31585966 PMCID: PMC6797240 DOI: 10.1136/bmjopen-2018-023791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Depression is now the most common illness worldwide affecting more than 300 million people. Studies modelling the impact of depression interventions have shown that the burden of depression cannot be minimised by more than 35% with existing treatments. There is a need to develop better preventative interventions. The overall aim of this programme of work is to develop interventions to reduce depression symptom scores and prevent development of depression in people with subthreshold depression. The objectives are to adapt a low intensity community-based depression prevention intervention, establish the acceptability and uptake of this model and conduct a parallel randomised controlled feasibility trial to inform a full-scale trial. METHODS AND ANALYSIS Focus groups will be run with members of the public, voluntary sector providers and researchers to inform the adaptation of an existing depression prevention course. Sixty-four people with subthreshold depression, as represented by a score of between 5 and 9 on the Patient Health Questionnaire-9 depression measure, will be recruited to take part in the feasibility trial. Participants will be randomised equally to the intervention or usual care control groups. Participants in the intervention group will receive the new revised manual and attend a 1-day workshop delivered by voluntary sector service providers. Outcome measures will be completed 3 months after baseline. Quantitative data on recruitment, randomisation, attendance, retention, questionnaire completion rates will be collected. Primary analyses will be descriptive and a process evaluation will be conducted to assess the processes involved in implementing the intervention. Interviews will be conducted to explore acceptability and framework analysis will be used to analyse the data. ETHICS AND DISSEMINATION The study has been reviewed and approved by NHS Research and Ethics Committee: NW-Greater Manchester East. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media, the internet and community engagement activities. TRIAL REGISTRATION NUMBER ISRCTN23278208;Pre-results.
Collapse
Affiliation(s)
- Cassandra Kenning
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, Greater Manchester, UK
| | - Amy Blakemore
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, Manchester, UK
| | - Peter Bower
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, Greater Manchester, UK
| | - Melina Safari
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, Greater Manchester, UK
| | - Pim Cuijpers
- Faculty of Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - June Sl Brown
- Department of Psychology, Kings College London, London, UK
| | - Mark Hann
- Centre for Biostatistics and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Ricardo F Muñoz
- Institute for International Internet Interventions for Health, Palo Alto University, Palo Alto, California, USA
| | - Waquas Waheed
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, Greater Manchester, UK
| |
Collapse
|
9
|
Burroughs H, Bartlam B, Bullock P, Lovell K, Ogollah R, Ray M, Bower P, Waheed W, Gilbody S, Kingstone T, Nicholls E, Chew-Graham CA. Non-traditional support workers delivering a brief psychosocial intervention for older people with anxiety and depression: the NOTEPAD feasibility study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundAnxiety and depression often coexist in older people. These disorders are often underdiagnosed and undertreated, and are associated with increased use of health and social care services, and raised mortality. Barriers to diagnosis include the reluctance of older people to present to their general practitioner (GP) with mood symptoms because of the stigma they perceive about mental health problems, and because the treatments offered are not acceptable to them.ObjectivesTo refine a community-based psychosocial intervention for older people with anxiety and/or depression so that it can be delivered by non-traditional providers such, as support workers (SWs), in the third sector. To determine whether or not SWs can be trained to deliver this intervention to older people with anxiety and/or depression. To test procedures and determine if it is feasible to recruit and randomise patients, and to conduct a process evaluation to provide essential information to inform a randomised trial.DesignThree phases, all informed by a patient and public involvement and engagement group. Qualitative work with older people and third-sector providers, plus a consensus group to refine the intervention, training, SW manuals and patient participant materials (phase 1). Recruitment and training of SWs (phase 2). Feasibility study to test recruitment procedures and assess fidelity of delivery of the intervention; and interviews with study participants, SWs and GPs to assess acceptability of the intervention and impact on routine care (phase 3).SettingNorth Staffordshire, in collaboration with Age UK North Staffordshire.InterventionA psychosocial intervention, comprising one-to-one contact between older people with anxiety and/or depression and a SW employed by Age UK North Staffordshire, based on the principles of behavioural activation (BA), with encouragement to participate in a group activity.ResultsInitial qualitative work contributed to refinement of the psychosocial intervention. Recruitment (and retention) of the SWs was possible; the training, support materials and manual were acceptable to them, and they delivered the intervention as intended. Recruitment of practices from which to recruit patients was possible, but the recruitment target (100 patients) was not achieved, with 38 older adults randomised. Retention at 4 months was 86%. The study was not powered to demonstrate differences in outcomes. Older people in the intervention arm found the sessions with SWs acceptable, although signposting to, and attending, groups was not valued by all participants. GPs recognised the need for additional care for older people with anxiety and depression, which they could not provide. Participation in the study did not have an impact on routine care, other than responding to the calls from the study team about risk of self-harm. GPs were not aware of the work done by SWs with patients.LimitationsTarget recruitment was not achieved.ConclusionsSupport workers recruited from Age UK employees can be recruited and trained to deliver an intervention, based on the principles of BA, to older people with anxiety and/or depression. The training and supervision model used in the study was acceptable to SWs, and the intervention was acceptable to older people.Future workFurther development of recruitment strategies is needed before this intervention can be tested in a fully powered randomised controlled trial.Trial registrationCurrent Controlled Trials ISRCTN16318986.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 7, No. 25. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Heather Burroughs
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
| | - Bernadette Bartlam
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
| | | | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Reuben Ogollah
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Mo Ray
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population of Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Waquas Waheed
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population of Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Simon Gilbody
- Mental Health and Addictions Research Group, University of York, York, UK
- Centre for Health and Population Sciences, Hull York Medical School, York, UK
| | - Tom Kingstone
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
- Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Elaine Nicholls
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
| | - Carolyn A Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
- Midlands Partnership NHS Foundation Trust, Stafford, UK
- Collaboration for Leadership in Applied Health Research and Care West Midlands, Warwick, UK
| |
Collapse
|
10
|
Zou C, Chen S, Shen J, Zheng X, Wang L, Guan L, Liu Q, Yang Y. Prevalence and associated factors of depressive symptoms among elderly inpatients of a Chinese tertiary hospital. Clin Interv Aging 2018; 13:1755-1762. [PMID: 30271130 PMCID: PMC6145362 DOI: 10.2147/cia.s170346] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Depression in the elderly is a serious and often underdiagnosed psychiatric disorder that has been linked to adverse outcomes in the hospital setting. This study aims to evaluate the prevalence of depressive symptoms and associated factors among elderly hospital inpatients. METHODS The cross-sectional study included 411 consecutively hospitalized patients aged 60 years and older. Participants were evaluated within 48 hours of admission using an interviewer-administered questionnaire including the Geriatric Depression Scale and comprehensive geriatric assessment to provide basic demographic and clinical information. RESULTS Most of the participants were male (64.5%), with a mean (SD) age of 75.9 (8.1) years between 60 and 97 years. The prevalence of depressive symptoms was 32.8%. Univariate analysis showed significant associations between depressive symptoms and older age, female gender, lower body mass index, number of chronic diseases, impaired family function, impaired cognition, malnutrition, increased frailty, and decreased ability to perform activities of daily living. After logistic regression, variables that remained significantly associated with depression were cognitive decline (odds ratio =1.97, 95% CI: 1.09-3.55), poor family function (odds ratio =2.01, 95% CI: 1.10-3.66), and frailty (odds ratio =5.07, 95% CI: 1.95-13.20). Depressive symptoms were independently associated with prolonged hospital length. CONCLUSION Depressive symptoms were prevalent among hospitalized elderly and independently associated with cognitive decline, poor family function, and frailty. Therefore, it is essential to screen for depression and perform a comprehensive geriatric assessment in these patients to identify and manage depressive symptoms.
Collapse
Affiliation(s)
- Chuan Zou
- Department of Gerontology and Geriatrics, Chengdu Fifth People's Hospital, Chengdu-Montpellier Geriatric Research Center, Chengdu, China,
| | - Shanping Chen
- Department of Gerontology and Geriatrics, Chengdu Fifth People's Hospital, Chengdu-Montpellier Geriatric Research Center, Chengdu, China,
| | - Jing Shen
- Department of Gerontology and Geriatrics, Chengdu Fifth People's Hospital, Chengdu-Montpellier Geriatric Research Center, Chengdu, China,
| | - Xiaomei Zheng
- Department of Gerontology and Geriatrics, Chengdu Fifth People's Hospital, Chengdu-Montpellier Geriatric Research Center, Chengdu, China,
| | - Lingxiao Wang
- Department of Gerontology and Geriatrics, Chengdu Fifth People's Hospital, Chengdu-Montpellier Geriatric Research Center, Chengdu, China,
| | - Lijuan Guan
- Department of Gerontology and Geriatrics, Chengdu Fifth People's Hospital, Chengdu-Montpellier Geriatric Research Center, Chengdu, China,
| | - Qian Liu
- Department of Gerontology and Geriatrics, Chengdu Fifth People's Hospital, Chengdu-Montpellier Geriatric Research Center, Chengdu, China,
| | - Yongxue Yang
- Department of Gerontology and Geriatrics, Chengdu Fifth People's Hospital, Chengdu-Montpellier Geriatric Research Center, Chengdu, China,
| |
Collapse
|
11
|
Bosanquet K, Adamson J, Atherton K, Bailey D, Baxter C, Beresford-Dent J, Birtwistle J, Chew-Graham C, Clare E, Delgadillo J, Ekers D, Foster D, Gabe R, Gascoyne S, Haley L, Hamilton J, Hargate R, Hewitt C, Holmes J, Keding A, Lewis H, McMillan D, Meer S, Mitchell N, Nutbrown S, Overend K, Parrott S, Pervin J, Richards DA, Spilsbury K, Torgerson D, Traviss-Turner G, Trépel D, Woodhouse R, Gilbody S. CollAborative care for Screen-Positive EldeRs with major depression (CASPER plus): a multicentred randomised controlled trial of clinical effectiveness and cost-effectiveness. Health Technol Assess 2018; 21:1-252. [PMID: 29171379 DOI: 10.3310/hta21670] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Depression in older adults is common and is associated with poor quality of life, increased morbidity and early mortality, and increased health and social care use. Collaborative care, a low-intensity intervention for depression that is shown to be effective in working-age adults, has not yet been evaluated in older people with depression who are managed in UK primary care. The CollAborative care for Screen-Positive EldeRs (CASPER) plus trial fills the evidence gap identified by the most recent guidelines on depression management. OBJECTIVES To establish the clinical effectiveness and cost-effectiveness of collaborative care for older adults with major depressive disorder in primary care. DESIGN A pragmatic, multicentred, two-arm, parallel, individually randomised controlled trial with embedded qualitative study. Participants were automatically randomised by computer, by the York Trials Unit Randomisation Service, on a 1 : 1 basis using simple unstratified randomisation after informed consent and baseline measures were collected. Blinding was not possible. SETTING Sixty-nine general practices in the north of England. PARTICIPANTS A total of 485 participants aged ≥ 65 years with major depressive disorder. INTERVENTIONS A low-intensity intervention of collaborative care, including behavioural activation, delivered by a case manager for an average of six sessions over 7-8 weeks, alongside usual general practitioner (GP) care. The control arm received only usual GP care. MAIN OUTCOME MEASURES The primary outcome measure was Patient Health Questionnaire-9 items score at 4 months post randomisation. Secondary outcome measures included depression severity and caseness at 12 and 18 months, the EuroQol-5 Dimensions, Short Form questionnaire-12 items, Patient Health Questionnaire-15 items, Generalised Anxiety Disorder-7 items, Connor-Davidson Resilience Scale-2 items, a medication questionnaire, objective data and adverse events. Participants were followed up at 12 and 18 months. RESULTS In total, 485 participants were randomised (collaborative care, n = 249; usual care, n = 236), with 390 participants (80%: collaborative care, 75%; usual care, 86%) followed up at 4 months, 358 participants (74%: collaborative care, 70%; usual care, 78%) followed up at 12 months and 344 participants (71%: collaborative care, 67%; usual care, 75%) followed up at 18 months. A total of 415 participants were included in primary analysis (collaborative care, n = 198; usual care, n = 217), which revealed a statistically significant effect in favour of collaborative care at the primary end point at 4 months [8.98 vs. 10.90 score points, mean difference 1.92 score points, 95% confidence interval (CI) 0.85 to 2.99 score points; p < 0.001], equivalent to a standard effect size of 0.34. However, treatment differences were not maintained in the longer term (at 12 months: 0.19 score points, 95% CI -0.92 to 1.29 score points; p = 0.741; at 18 months: < 0.01 score points, 95% CI -1.12 to 1.12 score points; p = 0.997). The study recorded details of all serious adverse events (SAEs), which consisted of 'unscheduled hospitalisation', 'other medically important condition' and 'death'. No SAEs were related to the intervention. Collaborative care showed a small but non-significant increase in quality-adjusted life-years (QALYs) over the 18-month period, with a higher cost. Overall, the mean cost per incremental QALY for collaborative care compared with usual care was £26,016; however, for participants attending six or more sessions, collaborative care appears to represent better value for money (£9876/QALY). LIMITATIONS Study limitations are identified at different stages: design (blinding unfeasible, potential contamination), process (relatively low overall consent rate, differential attrition/retention rates) and analysis (no baseline health-care resource cost or secondary/social care data). CONCLUSION Collaborative care was effective for older people with case-level depression across a range of outcomes in the short term though the reduction in depression severity was not maintained over the longer term of 12 or 18 months. Participants who received six or more sessions of collaborative care did benefit substantially more than those who received fewer treatment sessions but this difference was not statistically significant. FUTURE WORK RECOMMENDATIONS Recommendations for future research include investigating the longer-term effect of the intervention. Depression is a recurrent disorder and it would be useful to assess its impact on relapse and the prevention of future case-level depression. TRIAL REGISTRATION Current Controlled Trials ISRCTN45842879. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 67. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
| | - Joy Adamson
- Department of Health Sciences, University of York, York, UK
| | - Katie Atherton
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Della Bailey
- Department of Health Sciences, University of York, York, UK
| | | | | | | | - Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Emily Clare
- Northumberland, Tyne and Wear NHS Foundation Trust, National Institute for Health Research Clinical Research Network (Mental Health) North East and North Cumbria, Newcastle upon Tyne, UK
| | - Jaime Delgadillo
- Department of Health Sciences, University of York, York, UK.,Primary Care Mental Health Service, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - David Ekers
- Mental Health Research Group, Durham University, Durham, UK.,Research and Development Department, Tees, Esk & Wear Valleys NHS Foundation Trust, Middlesbrough, UK
| | - Deborah Foster
- Department of Health Sciences, University of York, York, UK
| | - Rhian Gabe
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | | | - Lesley Haley
- Research and Development Department, Tees, Esk & Wear Valleys NHS Foundation Trust, Middlesbrough, UK
| | - Jahnese Hamilton
- Northumberland, Tyne and Wear NHS Foundation Trust, National Institute for Health Research Clinical Research Network (Mental Health) North East and North Cumbria, Newcastle upon Tyne, UK
| | | | | | - John Holmes
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ada Keding
- Department of Health Sciences, University of York, York, UK
| | - Helen Lewis
- Department of Health Sciences, University of York, York, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | - Shaista Meer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Sarah Nutbrown
- Department of Health Sciences, University of York, York, UK
| | - Karen Overend
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Jodi Pervin
- Department of Health Sciences, University of York, York, UK
| | - David A Richards
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | | | | | - Dominic Trépel
- Department of Health Sciences, University of York, York, UK
| | | | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| |
Collapse
|
12
|
Lewis H, Adamson J, Atherton K, Bailey D, Birtwistle J, Bosanquet K, Clare E, Delgadillo J, Ekers D, Foster D, Gabe R, Gascoyne S, Haley L, Hargate R, Hewitt C, Holmes J, Keding A, Lilley-Kelly A, Maya J, McMillan D, Meer S, Meredith J, Mitchell N, Nutbrown S, Overend K, Pasterfield M, Richards D, Spilsbury K, Torgerson D, Traviss-Turner G, Trépel D, Woodhouse R, Ziegler F, Gilbody S. CollAborative care and active surveillance for Screen-Positive EldeRs with subthreshold depression (CASPER): a multicentred randomised controlled trial of clinical effectiveness and cost-effectiveness. Health Technol Assess 2018; 21:1-196. [PMID: 28248154 DOI: 10.3310/hta21080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Efforts to reduce the burden of illness and personal suffering associated with depression in older adults have focused on those with more severe depressive syndromes. Less attention has been paid to those with mild disorders/subthreshold depression, but these patients also suffer significant impairments in their quality of life and level of functioning. There is currently no clear evidence-based guidance regarding treatment for this patient group. OBJECTIVES To establish the clinical effectiveness and cost-effectiveness of a low-intensity intervention of collaborative care for primary care older adults who screened positive for subthreshold depression. DESIGN A pragmatic, multicentred, two-arm, parallel, individually randomised controlled trial with a qualitative study embedded within the pilot. Randomisation occurred after informed consent and baseline measures were collected. SETTING Thirty-two general practitioner (GP) practices in the north of England. PARTICIPANTS A total of 705 participants aged ≥ 75 years during the pilot phase and ≥ 65 years during the main trial with subthreshold depression. INTERVENTIONS Participants in the intervention group received a low-intensity intervention of collaborative care, which included behavioural activation delivered by a case manager for an average of six sessions over 7-8 weeks, alongside usual GP care. Control-arm participants received only usual GP care. MAIN OUTCOME MEASURES The primary outcome measure was a self-reported measure of depression severity, the Patient Health Questionnaire-9 items PHQ-9 score at 4 months post randomisation. Secondary outcome measures included the European Quality of Life-5 Dimensions, Short Form questionnaire-12 items, Patient Health Questionnaire-15 items, Generalised Anxiety Disorder seven-item scale, Connor-Davidson Resilience Scale two-item version, a medication questionnaire and objective data. Participants were followed up for 12 months. RESULTS In total, 705 participants were randomised (collaborative care n = 344, usual care n = 361), with 586 participants (83%; collaborative care 76%, usual care 90%) followed up at 4 months and 519 participants (74%; collaborative care 68%, usual care 79%) followed up at 12 months. Attrition was markedly greater in the collaborative care arm. Model estimates at the primary end point of 4 months revealed a statistically significant effect in favour of collaborative care compared with usual care [mean difference 1.31 score points, 95% confidence interval (CI) 0.67 to 1.95 score points; p < 0.001]. The difference equates to a standard effect size of 0.30, for which the trial was powered. Treatment differences measured by the PHQ-9 were maintained at 12 months' follow-up (mean difference 1.33 score points, 95% CI 0.55 to 2.10 score points; p = 0.001). Base-case cost-effectiveness analysis found that the incremental cost-effectiveness ratio was £9633 per quality-adjusted life-year (QALY). On average, participants allocated to collaborative care displayed significantly higher QALYs than those allocated to the control group (annual difference in adjusted QALYs of 0.044, 95% bias-corrected CI 0.015 to 0.072; p = 0.003). CONCLUSIONS Collaborative care has been shown to be clinically effective and cost-effective for older adults with subthreshold depression and to reduce the proportion of people who go on to develop case-level depression at 12 months. This intervention could feasibly be delivered in the NHS at an acceptable cost-benefit ratio. Important future work would include investigating the longer-term effect of collaborative care on the CASPER population, which could be conducted by introducing an extension to follow-up, and investigating the impact of collaborative care on managing multimorbidities in people with subthreshold depression. TRIAL REGISTRATION Current Controlled Trials ISRCTN02202951. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 8. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Helen Lewis
- Department of Health Sciences, University of York, York, UK
| | - Joy Adamson
- Department of Health Sciences, University of York, York, UK
| | - Katie Atherton
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Della Bailey
- Department of Health Sciences, University of York, York, UK
| | | | | | - Emily Clare
- Northumberland, Tyne and Wear NHS Foundation Trust, NIHR Clinical Research Network (Mental Health) North East and North Cumbria, Newcastle upon Tyne, UK
| | - Jaime Delgadillo
- Primary Care Mental Health Service, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - David Ekers
- Mental Health Research Group, University of Durham, Durham, UK
| | - Deborah Foster
- Department of Health Sciences, University of York, York, UK
| | - Rhian Gabe
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | | | - Lesley Haley
- Tees, Esk and Wear Valleys NHS Foundation Trust, NIHR Clinical Research Network North East and North Cumbria, Research and Development Department, Middlesbrough, UK
| | | | | | - John Holmes
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ada Keding
- Department of Health Sciences, University of York, York, UK
| | | | - Jahnese Maya
- Northumberland, Tyne and Wear NHS Foundation Trust, NIHR Clinical Research Network (Mental Health) North East and North Cumbria, Newcastle upon Tyne, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | - Shaista Meer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Jodi Meredith
- Department of Health Sciences, University of York, York, UK
| | | | - Sarah Nutbrown
- Department of Health Sciences, University of York, York, UK
| | - Karen Overend
- Department of Health Sciences, University of York, York, UK
| | | | - David Richards
- Department of Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | | | | | | | - Dominic Trépel
- Department of Health Sciences, University of York, York, UK
| | | | | | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| |
Collapse
|
13
|
Scott AIF. College guidelines on electroconvulsive therapy: an update for prescribers. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.11.2.150] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This article is intended to update prescribers of electroconvulsive therapy (ECT) on the key points of the revised edition of the Royal College of Psychiatrist's ECT Handbook (due to be published in 2005). The two most important tenets that influenced the revision were that evidence from systematic reviews and appraisals was balanced with expert judgement based on clinical experience, and that both prescribers and practitioners should strive to reduce further the cognitive adverse effects of treatment. The article concentrates on revised guidance regarding the indications for ECT, important elements of the process of informed consent, and the prescription of treatment, i.e. choice of electrode placement and the frequency and total number of treatments.
Collapse
|
14
|
Abstract
The population is rapidly aging worldwide and the burden of chronic disease follows along. Frequently, diseases go hand in hand and cardiovascular disease and mental health problems are no exception. Symptoms of depression in the elderly are often overlooked and untreated because they coincide with other problems encountered by the elderly. Older adults with depressive symptoms have poorer functioning compared to those with chronic medical conditions. The burden of cardiovascular disease also remains a leading cause of morbidity and mortality. Bidirectional associations between depression and cardiovascular diseases are described with a focus on psychosocial factors affecting cardiac functioning and disease outcome.
Collapse
|
15
|
Donoghue HM, Traviss-Turner GD, House AO, Lewis H, Gilbody S. Life adversity in depressed and non-depressed older adults: A cross-sectional comparison of the brief LTE-Q questionnaire and life events and difficulties interview as part of the CASPER study. J Affect Disord 2016; 193:31-8. [PMID: 26766034 DOI: 10.1016/j.jad.2015.12.070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 12/06/2015] [Accepted: 12/26/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a paucity of research on the nature of life adversity in depressed and non-depressed older adults. Early life events work used in-depth interviews; however, larger epidemiological trials investigate life adversity using brief questionnaires. This study investigates the type of life adversity experienced in later life and its association with depression and compares adversity captured using a brief (LTE-Q) and in-depth (LEDS) measure. METHODS 960 participants over 65 years were recruited in UK primary care to complete the PHQ-9 and LTE-Q. A sub-sample (n=19) completed the LEDS and a question exploring the subjective experience of the LTE-Q and LEDS. RESULTS Important life adversity was reported on the LTE-Q in 48% of the sample. In the LTE-Q sample the prevalence of depression (PHQ-9≥10) was 12%. Exposure to recent adversity was associated with doubling of the odds of depression. The LTE-Q only captured a proportion of adversity measured by the LEDS (42% vs 84%). Both measures showed health, bereavement and relationship events were most common. LIMITATIONS The cross-sectional design limits the extent to which inferences can be drawn around the direction of causality between adversity and depression. Recall in older adults is questionable. CONCLUSIONS UK older adults face adversity in areas of health, bereavement and relationships which are associated with depression. This has clinical relevance for psychological interventions for older adults to consider social context and social support. It helps identify the strengths and weaknesses of a brief adversity measure in large scale research. Further research is needed to explore the mechanisms of onset and direction of causality.
Collapse
Affiliation(s)
- Hjördis M Donoghue
- Leeds Institute of Health Sciences, Academic Unit of Psychiatry & Behavioural Sciences, University of Leeds, UK
| | - Gemma D Traviss-Turner
- Leeds Institute of Health Sciences, Academic Unit of Psychiatry & Behavioural Sciences, University of Leeds, UK.
| | - Allan O House
- Leeds Institute of Health Sciences, Academic Unit of Psychiatry & Behavioural Sciences, University of Leeds, UK
| | - Helen Lewis
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York YO10 5DD, UK
| | - Simon Gilbody
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York YO10 5DD, UK
| |
Collapse
|
16
|
Lu Y, Arthur D, Hu L, Cheng G, An F, Li Z. Beliefs about antidepressant medication and associated adherence among older Chinese patients with major depression: A cross-sectional survey. Int J Ment Health Nurs 2016; 25:71-9. [PMID: 26692425 DOI: 10.1111/inm.12181] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 08/18/2015] [Accepted: 08/25/2015] [Indexed: 11/27/2022]
Abstract
Antidepressant non-adherence among people with depressive disorder is a major, ongoing public health issue, yet few studies have focused on older adults and their medication adherence. Although treatment adherence is determined by multiple factors, one of the important and modifiable predictors are patients' attitudes and beliefs about medication. We explored a sample of 135 older Chinese people with major depression, and the relationship between beliefs about antidepressants and medication adherence. Sociodemographic and illness variables were also examined. In all, high antidepressant adherence was reported in 37.8%, moderate adherence in 39.2%, and low adherence in 23%. Ordinal regression analysis showed perceived necessity (P < 0.01) and concern (P < 0.01) about antidepressants were significant influencing factors. Other variables with a positive association with higher adherence were lower average income (P < 0.05), fewer number of prior episodes of depression (P < 0.01), and comorbid anxiety (P < 0.05). The present study highlights low adherence in a sample of older depressed Chinese people, and highlights how beliefs about medication affect adherence. Therefore, more attention should be focused on non-adherence in older patients, and there is a need to establish accessible and systematic education programmes to correct misconceptions to improve their adherence.
Collapse
Affiliation(s)
- Yang Lu
- Department of Respiratory and Critical Care Medicine, Beijing Chao Yang Hospital, Peking Union Medical College, Beijing, China
| | - David Arthur
- School of Health, Charles Darwin University, Melbourne, Victoria, Australia
| | - Lili Hu
- Beijing An Ding Hospital, Capital Medical University, Peking Union Medical College, Beijing, China
| | - Gen Cheng
- School of Nursing, Peking Union Medical College, Beijing, China
| | - Fengrong An
- School of Nursing, Peking Union Medical College, Beijing, China
| | - Zheng Li
- School of Nursing, Peking Union Medical College, Beijing, China
| |
Collapse
|
17
|
Overend K, Lewis H, Bailey D, Bosanquet K, Chew-Graham C, Ekers D, Gascoyne S, Hems D, Holmes J, Keding A, McMillan D, Meer S, Meredith J, Mitchell N, Nutbrown S, Parrott S, Richards D, Traviss G, Trépel D, Woodhouse R, Gilbody S. CASPER plus (CollAborative care in Screen-Positive EldeRs with major depressive disorder): study protocol for a randomised controlled trial. Trials 2014; 15:451. [PMID: 25409776 PMCID: PMC4247639 DOI: 10.1186/1745-6215-15-451] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 10/14/2014] [Indexed: 11/25/2022] Open
Abstract
Background Depression accounts for the greatest disease burden of all mental health disorders, contributes heavily to healthcare costs, and by 2020 is set to become the second largest cause of global disability. Although 10% to 16% of people aged 65 years and over are likely to experience depressive symptoms, the condition is under-diagnosed and often inadequately treated in primary care. Later-life depression is associated with chronic illness and disability, cognitive impairment and social isolation. With a progressively ageing population it becomes increasingly important to refine strategies to identity and manage depression in older people. Currently, management may be limited to the prescription of antidepressants where there may be poor concordance; older people may lack awareness of psychosocial interventions and general practitioners may neglect to offer this treatment option. Methods/design CASPER Plus is a multi-centre, randomised controlled trial of a collaborative care intervention for individuals aged 65 years and over experiencing moderate to severe depression. Selected practices in the North of England identify potentially eligible patients and invite them to participate in the study. A diagnostic interview is carried out and participants with major depressive disorder are randomised to either collaborative care or usual care. The recruitment target is 450 participants. The intervention, behavioural activation and medication management in a collaborative care framework, has been adapted to meet the complex needs of older people. It is delivered over eight to 10 weekly sessions by a case manager liaising with general practitioners. The trial aims to evaluate the clinical and cost effectiveness of collaborative care in addition to usual GP care versus usual GP care alone. The primary clinical outcome, depression severity, will be measured with the Patient Health Questionnaire-9 (PHQ-9) at baseline, 4, 12 and 18 months. Cost effectiveness analysis will assess health-related quality of life using the SF-12 and EQ-5D and will examine cost-consequences of collaborative care. A qualitative process evaluation will be undertaken to explore acceptability, gauge the extent to which the intervention is implemented and to explore sustainability beyond the clinical trial. Discussion Results will add to existing evidence and a positive outcome may lead to the commissioning of this model of service in primary care. Trial registration ISRCTN45842879 (24 July 2012).
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Simon Gilbody
- Department of Health Sciences, University of York, Seebohm Rowntree, Building, Heslington, York YO10 5DD, UK.
| |
Collapse
|
18
|
Bauer M, Pfennig A, Severus E, Whybrow PC, Angst J, Möller HJ. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders, part 1: update 2013 on the acute and continuation treatment of unipolar depressive disorders. World J Biol Psychiatry 2013; 14:334-85. [PMID: 23879318 DOI: 10.3109/15622975.2013.804195] [Citation(s) in RCA: 381] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This 2013 update of the practice guidelines for the biological treatment of unipolar depressive disorders was developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal has been to systematically review all available evidence pertaining to the treatment of unipolar depressive disorders, and to produce a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. The guidelines are intended for use by all physicians seeing and treating patients with these conditions. METHODS The 2013 update was conducted by a systematic update literature search and appraisal. All recommendations were approved by the Guidelines Task Force. RESULTS This first part of the guidelines (Part 1) covers disease definition, classification, epidemiology, and course of unipolar depressive disorders, as well as the management of the acute and continuation phase treatment. It is primarily concerned with the biological treatment (including antidepressants, other psychopharmacological medications, electroconvulsive therapy, light therapy, adjunctive and novel therapeutic strategies) of adults. CONCLUSIONS To date, there is a variety of evidence-based antidepressant treatment options available. Nevertheless there is still a substantial proportion of patients not achieving full remission. In addition, somatic and psychiatric comorbidities and other special circumstances need to be more thoroughly investigated. Therefore, further high-quality informative randomized controlled trials are urgently needed.
Collapse
Affiliation(s)
- Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.
| | | | | | | | | | | | | |
Collapse
|
19
|
Messinger-Rapport BJ, Cruz-Oliver DM, Thomas DR, Morley JE. Clinical Update on Nursing Home Medicine: 2012. J Am Med Dir Assoc 2012; 13:581-94. [DOI: 10.1016/j.jamda.2012.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 06/08/2012] [Indexed: 01/24/2023]
|
20
|
Abstract
Depression is the most frequent mental disorder in older people, often causing emotional distress and reduced quality of life. Despite its clinical significance, depression remains underdiagnosed and inadequately treated in older patients. Regarding prognosis, data suggest that almost 70% of patients, treated long enough and with appropriate doses, recover from an index episode of depression. Antidepressants are efficient for treating depressed outpatients with several comorbid physical diseases as well as hospitalized patients, with selective serotonin reuptake inhibitors being the antidepressants of choice for older patients. Available data can guide pharmacological treatment in both the acute and maintenance stages, but further research is required to guide clinical strategies when remission is not achieved. Approaches for the management of resistance to treatment are summarized, including optimization strategies, drug changes, algorithms, and combined and augmentation pharmacological treatments. Finally, additional therapeutic choices such as electroconvulsive therapy, transcranial magnetic stimulation, and integrated psychotherapy are presented.
Collapse
Affiliation(s)
- Cássio M C Bottino
- Old Age Research Group (PROTER), Institute of Psychiatry, University of São Paulo Medical School, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP, Brazil.
| | | | | |
Collapse
|
21
|
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.
Collapse
Affiliation(s)
- Jane R Mort
- South Dakota State University College of Pharmacy, Brookings, SD, USA.
| | | | | |
Collapse
|
22
|
Bosmans JE, Adriaanse MC. Outpatient costs in pharmaceutically treated diabetes patients with and without a diagnosis of depression in a Dutch primary care setting. BMC Health Serv Res 2012; 12:46. [PMID: 22361361 PMCID: PMC3542589 DOI: 10.1186/1472-6963-12-46] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 02/23/2012] [Indexed: 11/25/2022] Open
Abstract
Background To assess differences in outpatient costs among pharmaceutically treated diabetes patients with and without a diagnosis of depression in a Dutch primary care setting. Methods A retrospective case control study over 3 years (2002-2004). Data on 7128 depressed patients and 23772 non-depressed matched controls were available from the electronic medical record system of 20 general practices organized in one large primary care organization in the Netherlands. A total of 393 depressed patients with diabetes and 494 non-depressed patients with diabetes were identified in these records. The data that were extracted from the medical record system concerned only outpatient costs, which included GP care, referrals, and medication. Results Mean total outpatient costs per year in depressed diabetes patients were €1039 (SD 743) in the period 2002-2004, which was more than two times as high as in non-depressed diabetes patients (€492, SD 434). After correction for age, sex, type of insurance, diabetes treatment, and comorbidity, the difference in total annual costs between depressed and non-depressed diabetes patients changed from €408 (uncorrected) to €463 (corrected) in multilevel analyses. Correction for comorbidity had the largest impact on the difference in costs between both groups. Conclusions Outpatient costs in depressed patients with diabetes are substantially higher than in non-depressed patients with diabetes even after adjusting for confounders. Future research should investigate whether effective treatment of depression among diabetes patients can reduce health care costs in the long term.
Collapse
Affiliation(s)
- Judith E Bosmans
- Section of Health Economics & Health Technology Assessment, Department of Health Sciences, VU University Amsterdam, the Netherlands.
| | | |
Collapse
|
23
|
Hegerl U, Holtzheimer P, Mergl R, McDonald W. The neurobiology and treatment of late-life depression. HANDBOOK OF CLINICAL NEUROLOGY 2012; 106:265-278. [PMID: 22608627 DOI: 10.1016/b978-0-444-52002-9.00016-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Ulrich Hegerl
- Department of Psychiatry, University of Leipzig, Leipzig, Germany.
| | | | | | | |
Collapse
|
24
|
Mitchell N, Hewitt C, Adamson J, Parrott S, Torgerson D, Ekers D, Holmes J, Lester H, McMillan D, Richards D, Spilsbury K, Godfrey C, Gilbody S. A randomised evaluation of CollAborative care and active surveillance for Screen-Positive EldeRs with sub-threshold depression (CASPER): study protocol for a randomized controlled trial. Trials 2011; 12:225. [PMID: 21988800 PMCID: PMC3204244 DOI: 10.1186/1745-6215-12-225] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 10/11/2011] [Indexed: 11/16/2022] Open
Abstract
Background Depression accounts for the greatest burden of disease among all mental health problems, and is expected to become the second-highest amongst all general health problems by 2020. By the age of 75, 1 in 7 older people meet formal diagnostic criteria for depression. Efforts to ameliorate the burden of illness and personal suffering associated with depression in older people have focussed on those with more severe depressive syndromes. Less attention has been paid to those with mild disorders/sub-threshold depressive syndromes but these patients also suffer impairments in their quality of life and level of functioning. Methods/Design The CASPER study has been designed to assemble an epidemiological cohort of people over 75 years of age (the CASPER cohort), from which we will identify those eligible to participate in a trial of collaborative care for sub-threshold depression (the CASPER trial). We aim to undertake a pragmatic randomised controlled multi-centre trial evaluating the effectiveness and cost-effectiveness of collaborative care; a low intensity psychological intervention in addition to usual general practitioner care versus usual general practitioner care alone. General practitioners from practices based in the North of England will be asked to identify potentially eligible patients over the age of 75 years. Patients will be sent a letter inviting them to participate in the study. We aim to recruit approximately 540 participants for the CASPER trial. A diagnostic interview will be carried out to ascertain trial eligibility with the major depressive episode module of the Mini International Neuropsychiatric Interview (M.I.N.I.), eligible participants randomised to either the intervention or usual care. The primary outcome will be measured with the Patient Health Questionnaire-9 (PHQ-9) and additional quality of life measures will be collected. Data will be collected at baseline, 4 and 12 months for both trial and cohort participants. Trial Registration ISRCTN: ISRCTN02202951
Collapse
Affiliation(s)
- Natasha Mitchell
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, YO10 5DD, UK
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Hanlon JT, Wang X, Castle NG, Stone RA, Handler SM, Semla TP, Pugh MJ, Berlowitz DR, Dysken MW. Potential underuse, overuse, and inappropriate use of antidepressants in older veteran nursing home residents. J Am Geriatr Soc 2011; 59:1412-20. [PMID: 21824120 DOI: 10.1111/j.1532-5415.2011.03522.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To examine prevalence and resident- and site-level factors associated with potential underuse, overuse, and inappropriate use of antidepressants in older Veterans Affairs (VA) Community Living Center (CLC) residents. DESIGN Longitudinal study. SETTING One hundred thirty-three VA CLCs. PARTICIPANTS Three thousand six hundred ninety-two veterans aged 65 and older admitted between January 1, 2004, and June 3, 2005, with long stays (≥ 90 days). MEASUREMENTS Prevalence of potential underuse, inappropriate use, and overuse of antidepressants in residents with and without depression (as documented according to International Classification of Diseases, Ninth Revision, Clinical Modification, codes or Depression Rating Scale). RESULTS Selective serotonin reuptake inhibitors were the most commonly prescribed antidepressant. Of the 877 residents with depression, 25.4% did not receive an antidepressant, suggesting potential underuse. Of residents with depression who received antidepressants, 57.5% had potential inappropriate use due primarily to problems seen with drug-drug and drug-disease interactions. Of the 2,815 residents who did not have depression, 1,190 (42.3%) were prescribed one or more antidepressants; only 48 (4.0%) of these had a Food and Drug Administration-approved labeled indication, suggesting potential overuse. Overall, only 17.6% of antidepressant use was appropriate (324/1,844). The only consistent resident factor associated with potential underuse and overuse use was taking an antipsychotic without evidence of schizophrenia (underuse: adjusted relative risk ratio (ARRR)=0.56, 95% confidence interval (CI)=0.33-0.94; overuse: adjusted odds ratio=1.52, 95% CI=1.21-1.91). Having moderate to severe pain (ARRR=1.54, 95% CI=1.08-2.20) and the prescribing of an anxiolytic or hypnotic (ARRR=1.33, 95% CI=1.02-1.74) increased the risk of potential inappropriate antidepressant use. CONCLUSION Potential problems with the use of antidepressants were frequently observed in older U.S. veteran CLC residents. Future studies are needed to examine the true risks and benefits of antidepressant use in CLC and non-VA nursing homes.
Collapse
Affiliation(s)
- Joseph T Hanlon
- Geriatric Research, Education and Clinical Center, and Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Health System, Pittsburgh, Pennsylvania, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Sanglier T, Saragoussi D, Milea D, Auray JP, Valuck RJ, Tournier M. Comparing Antidepressant Treatment Patterns in Older and Younger Adults: A Claims Database Analysis. J Am Geriatr Soc 2011; 59:1197-205. [DOI: 10.1111/j.1532-5415.2011.03457.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
27
|
Wilkins VM, Kiosses D, Ravdin LD. Late-life depression with comorbid cognitive impairment and disability: nonpharmacological interventions. Clin Interv Aging 2010; 5:323-31. [PMID: 21228897 PMCID: PMC3010167 DOI: 10.2147/cia.s9088] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Indexed: 11/23/2022] Open
Abstract
Less than half of older adults with depression achieve remission with antidepressant medications, and rates of remission are even poorer for those with comorbid conditions. Psychosocial interventions have been effective in treating geriatric depression, either alone or better yet, in combination with antidepressant medications. Traditional strategies for nonpharmacological treatment of late-life depression do not specifically address the co-occurring cognitive impairment and disability that is prevalent in this population. Newer therapies are recognizing the need to simultaneously direct treatment efforts in late-life depression towards the triad of depressive symptoms, cognitive dysfunction, and functional disability that is so often found in geriatric depression, and this comprehensive approach holds promise for improved treatment outcomes.
Collapse
Affiliation(s)
- Victoria M Wilkins
- Department of Psychiatry, Weill Medical College of Cornell University, White Plains, NY, USA
| | | | | |
Collapse
|
28
|
Harris T, Carey IM, Shah SM, DeWilde S, Cook DG. Antidepressant prescribing in older primary care patients in community and care home settings in England and Wales. J Am Med Dir Assoc 2010; 13:41-7. [PMID: 21450211 DOI: 10.1016/j.jamda.2010.09.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Revised: 09/16/2010] [Accepted: 09/16/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare the prevalence and predictors of antidepressant prescribing in older care home and community residents in England and Wales. DESIGN Retrospective analysis of primary care consultation and antidepressant prescribing data. SETTING The setting included 326 general (family) practices in England and Wales supplying data to The Health Improvement Network database between 2008 and 2009. PARTICIPANTS Participants were 10,387 care home and 403,259 community residents aged 65 to 104. MAIN OUTCOME MEASURE Antidepressant prescription in the last 3 months of recorded data for each patient. RESULTS Prevalence rates for antidepressant prescribing were 10.3% (95% confidence interval 10%-10.6%) for community and 37.5% (36.2%-38.9%) for care home residents. After excluding low-dose tricyclics (often used for other indications) prevalences were 7.3% (7.1%-7.5%) and 33.6% (32.3%-34.9%) respectively; of these, 21.7% (20.8%-22.6%) of community and 4.8% (3.9%-5.6%) of care home prescriptions were for antidepressants advised as best avoided in this age group. After indirect standardization for age, sex, and chronic disease prevalence, the ratio for prescribing was 2.4 (2.3-2.5) in care homes compared with the community; 28.3% (26.6%-30.1%) of community and 42.5% (39.4%-45.7%) of care home residents prescribed antidepressants had no appropriate recorded indication. CONCLUSIONS This national sample confirms the high prevalence of antidepressant prescribing to older people, particularly in care homes, frequently without a documented indication. The strong association found between chronic disease and antidepressant prescribing did not explain the higher care home prescribing rate. Widespread community use of nonrecommended antidepressants is also a concern.
Collapse
Affiliation(s)
- Tess Harris
- Division of Population Health Sciences & Education, St George's University of London, Cranmer Terrace, Tooting, London SW17 0RE, UK.
| | | | | | | | | |
Collapse
|
29
|
Engin S, Ozturk M, Engin N, Kulaksizoglu IB. Dark side of the town: depressive symptoms in disadvantaged senior citizens. J Nutr Health Aging 2010; 14:483-7. [PMID: 20617293 DOI: 10.1007/s12603-010-0035-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Depression is frequently overlooked in older adults. Detection of depressive symptoms (DS) is important in primary care. This study aimed to detect the rate, risk factors and effects of DS in a disadvantaged older population. DESIGN Descriptive study. SETTING Community based rehabilitation centers and Sehzadebasi medical center of Istanbul Metropolitan Municipality (IMM). PARTICIPANTS 1163 Consecutive patients at least 60 years old, and applied to IMM; mostly poor and/or without health insurance. MEASUREMENTS Detailed history and geriatric scales were obtained. Depressive symptoms (DS) were defined as 14 or more points in 30 item Geriatric Depression Scale. Relations of DS and ordinal variables were tested by Chi-square; DS and numeric variables by T-test. Multiple regressions followed. RESULTS Younger old and women subjects were in majority. The rate of DS was 52%, while 9.1% have depression diagnosis in their history. After multiple regressions, lack of health insurance was found to be the strongest independent risk factor for DS (p < 0.0001). Other variables that remained significant were: Limited mobility, lower Instrumental Activities of Daily Living and Tinetti Balance scores, onset insomnia, nightly awakenings and reported dizziness (p values = 0.008; 0.021; 0.005; 0.022; 0.04 and 0.03 respectively). CONCLUSION These results indicate the need for comprehensive geriatric assessment in primary care to detect DS, in addition to negative effect of DS on sleep and independency. Health insurance coverage of the senior citizens also is an important challenge.
Collapse
Affiliation(s)
- S Engin
- Istanbul Metropolitan Municipality Department of Health Services, Kayisdagi nursing home, Kayisdagi street No: 65 Kucukbakkalkoy, Kadikoy/Istanbul, Turkey.
| | | | | | | |
Collapse
|
30
|
Abstract
Depression is the most common mental illness in the elderly, with an estimated 15% of the elderly population living in the community having clinically significant depressive symptoms. It is of medical and social importance as it is associated with increased morbidity and mortality, poor quality of life and increased social dependence. Recognition of depression in this age group has been found to be poor, with more patients presenting with somatic physical symptoms. Treatment can also be difficult compared with younger patients, with increased prevalence of side effects of medication, polypharmacy and poor compliance. Primary care practitioners are therefore crucial in the detection and early instigation of appropriate treatment. This article looks at the risk factors, presentation and treatment options for depression in the elderly age group.
Collapse
Affiliation(s)
- Emma Funnell
- Academic GP Registrar, Department of Primary Care, University of Liverpool
| |
Collapse
|
31
|
Peng XD, Huang CQ, Chen LJ, Lu ZC. Cognitive behavioural therapy and reminiscence techniques for the treatment of depression in the elderly: a systematic review. J Int Med Res 2009; 37:975-82. [PMID: 19761679 DOI: 10.1177/147323000903700401] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Psychotherapy, including cognitive behavioural therapy (CBT), reminiscence and general psychotherapy (GPT), is viewed as effective treatment for depression, but its efficacy in older people is not well defined. This systematic review included 14 randomized controlled trials that assessed the efficacy of psychotherapy for treating depression in elderly people (> or = 55 years). The results of this meta-analysis showed that, compared with placebo, psychotherapy was more effective in reducing depression scores (standardized mean difference -0.92; 95% confidence interval -1.21, -0.36). Subgroup analysis showed that CBT, reminiscence and GPT were all more effective than placebo; psychotherapy as an adjunct to antidepressant medication did not increase effectiveness. There was no significant difference between CBT and reminiscence in improving depression. A higher drop-out rate was observed in studies that did not include psychotherapy versus those that did, although this difference was not statistically significant. Thus, various general formats of psychotherapy are effective for treating depression in older people, although psychotherapy does not significantly increase the effectiveness of anti-depressant medication.
Collapse
Affiliation(s)
- X-D Peng
- State Key Laboratory of Biotherapy and Cancer Centre, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | | | | | | |
Collapse
|
32
|
Clarkson P, Abendstern M, Sutcliffe C, Hughes J, Challis D. Reliability of needs assessments in the community care of older people: impact of the single assessment process in England. J Public Health (Oxf) 2009; 31:521-9. [DOI: 10.1093/pubmed/fdp035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
33
|
|
34
|
Depressive symptoms among elderly inpatients of a Brazilian university hospital: prevalence and associated factors. Int Psychogeriatr 2008; 20:1028-40. [PMID: 18416877 DOI: 10.1017/s1041610208007278] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study aims to evaluate the prevalence of depressive symptoms and associated factors among elderly hospital inpatients. METHODS A cross-sectional study evaluated 189 participants using the Geriatric Depression Scale, the Mini-mental State Examination and the Katz and Lawton Index, to assess dependence regarding activities of daily living (ADL). RESULTS Most of the participants were women, aged between 60 and 92 years, with low levels of educational attainment and personal income, and non-qualified occupations. The prevalence of depressive symptoms was 56%, but only 3% had a psychiatric diagnosis registered in their medical records. Univariate analysis showed significant associations between depressive symptoms and low educational level and income, marital status, number of hospitalizations in the previous year, cognitive decline, dependence regarding basic and instrumental ADL, and death. After logistic regression, the only variables that remained significantly associated with depression were low educational level, dependence regarding basic ADL, and death. CONCLUSIONS Depressive symptoms were independently associated with low educational level and dependence regarding basic ADL. Hospitalized elderly people with depressive symptoms were more likely to die. It is essential to diagnose and treat depression properly in this population to minimize its negative impacts.
Collapse
|
35
|
Chew-Graham C, Shiers D, Beeston D. Is personal care important in the diagnosis of depression in older people? Br J Gen Pract 2008; 58:675-6. [PMID: 18826776 PMCID: PMC2553524 DOI: 10.3399/bjgp08x342200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
|
36
|
Féart C, Peuchant E, Letenneur L, Samieri C, Montagnier D, Fourrier-Reglat A, Barberger-Gateau P. Plasma eicosapentaenoic acid is inversely associated with severity of depressive symptomatology in the elderly: data from the Bordeaux sample of the Three-City Study. Am J Clin Nutr 2008; 87:1156-62. [PMID: 18469234 DOI: 10.1093/ajcn/87.5.1156] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Depressive symptoms are commonly observed in elderly people, and nutritional factors such as polyunsaturated fatty acids (PUFAs) have been proposed as potential protective determinants of depressive disorders. OBJECTIVE The objective was to analyze the relation between plasma fatty acids and severity of depressive symptomatology (DS) in French elderly community dwellers. DESIGN The study population (mean age: 74.6 y) consisted of 1390 subjects from Bordeaux (France) included in the Three-City Study cohort. DS was evaluated by using the Center for Epidemiologic Studies Depression scale. The use of antidepressant drugs was recorded. The proportion of each plasma fatty acid was determined. Cross-sectional analysis of the association between plasma fatty acids and severity of DS was performed by multilinear regression. RESULTS Compared with control subjects, subjects with DS were older, were more often women, were more often widowed or single, were of lower income, were receiving antidepressant treatment more frequently, had a lower incidence of hypercholesterolemia, and had lower Mini-Mental State Examination scores (mean: -1.1 point; P < 0.0001). Plasma eicosapentaenoic acid (EPA) was lower in the subjects with DS than in the control subjects (0.85% compared with 1.01%; P = 0.001). There were no significant differences in any other fatty acid. When adjusted for potential confounders, such as sociodemographic characteristics and health indicators, plasma EPA was inversely associated with the severity of DS (beta = -0.170, P = 0.040) in subjects taking antidepressants. CONCLUSION Higher plasma EPA was associated with a lower severity of DS in elderly subjects, especially those taking antidepressants.
Collapse
Affiliation(s)
- Catherine Féart
- INSERM U593, Equipe Epidémiologie de la Nutrition et des Comportements Alimentaires, Bordeaux, France.
| | | | | | | | | | | | | |
Collapse
|
37
|
|
38
|
|
39
|
Beier MT, Martin CM. Gradual dose reduction and medication tapering: a clinical perspective. ACTA ACUST UNITED AC 2008; 22:628-44. [PMID: 18198962 DOI: 10.4140/tcp.n.2007.628] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Recent changes in the State Operations Manual put new emphasis on attempts to gradually reduce the dose of certain medications -- namely psychotropic medications -- as a component of medication management in nursing facilities. Applying these federal guidelines to caring for elderly patients is often highly complex. It requires an understanding of existing clinical evidence, the current standards of practice for using these medications, and the appropriate rationale for attempting to reduce drug dosages.
Collapse
|
40
|
|
41
|
Abstract
BACKGROUND Despite a number of reviews advocating psychotherapy for the treatment of depression, there is relatively little evidence based on randomised controlled trials that specifically examines its efficacy in older people. OBJECTIVES To examine the efficacy of psychotherapeutic treatments for depression in older people. SEARCH STRATEGY CCDANCTR-Studies and CCDANCTR-References were searched on 11/9/2006. The International Journal of Geriatric Psychiatry and Irish Journal of Psychiatry were handsearched. Reference lists of previous published systematic reviews, included/excluded trial articles and bibliographies were scrutinised. Experts in the field were contacted.. SELECTION CRITERIA All randomised controlled trials that included older adults diagnosed as suffering from depression (ICD or DSM criteria) were included. All types of psychotherapeutic treatments were included, categorised into cognitive behavioural therapies (CBT), psychodynamic therapy, interpersonal therapy and supportive therapies. DATA COLLECTION AND ANALYSIS Meta-analysis was performed, using odds ratios for dichotomous outcomes and weighted mean differences (WMD) for continuous outcomes, with 95% confidence intervals. Primary outcomes were a reduction in severity of depression, usually measured by clinician rated rating scales. Secondary outcomes, including dropout and life satisfaction, were also analysed. MAIN RESULTS The search identified nine trials of cognitive behavioural and psychodynamic therapy approaches, together with a small group of 'active control' interventions. No trials relating to other psychotherapeutic approaches and techniques were found. A total of seven trials provided sufficient data for inclusion in the comparison between CBT and controls. No trials compared psychodynamic psychotherapy with controls. Based on five trials (153 participants), cognitive behavioural therapy was more effective than waiting list controls (WMD -9.85, 95% CI -11.97 to -7.73). Only three small trials compared psychodynamic therapy with CBT, with no significant difference in treatment effect indicated between the two types of psychotherapeutic treatment. Based on three trials with usable data, CBT was superior to active control interventions when using the Hamilton Depression Rating Scale (WMD -5.69, 95% CI -11.04 to -0.35), but equivalent when using the Geriatric Depression Scale (WMD -2.00, 95% CI -5.31 to 1.32). AUTHORS' CONCLUSIONS Only a small number of studies and patients were included in the meta-analysis. If taken on their own merit, the findings do not provide strong support for psychotherapeutic treatments in the management of depression in older people. However, the findings do reflect those of a larger meta-analysis that included patients with broader age ranges, suggesting that CBT may be of potential benefit.
Collapse
Affiliation(s)
- K C M Wilson
- Psychiatry, EMI Academic Unit, Univ of Liverpool, St Catherine's Hospital, Church Road, Birkenhead, Wirral, UK, L42 0LQ.
| | | | | |
Collapse
|
42
|
Affiliation(s)
- Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA.
| |
Collapse
|
43
|
de Vasconcelos Cunha UG, Lopes Rocha F, Avila de Melo R, Alves Valle E, de Souza Neto JJ, Mendes Brega R, Magalhães Scoralick F, Araújo Silva S, Martins de Oliveira F, da Costa Júnior AL, Faria Alves VX, Sakurai E. A placebo-controlled double-blind randomized study of venlafaxine in the treatment of depression in dementia. Dement Geriatr Cogn Disord 2007; 24:36-41. [PMID: 17495474 DOI: 10.1159/000102570] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To evaluate the efficacy and safety of venlafaxine in the treatment of major depression in dementia. METHODS Thirty-one outpatients who had dementia and major depression participated in this randomized, double-blind, placebo-controlled, 6-week, flexible dose clinical trial. The screening measures were Cornell Scale for depression in dementia, DSM-IV for depression and dementia and Mini-Mental State Examination. The outcome measures were response rate, Montgomery-Asberg Depression Rating scale and Clinical Global Impressions. RESULTS The percentage of patients defined as Montgomery-Asberg Depression Rating scale responders was approximately the same in the placebo and in the venlafaxine groups. Clinical Global Impressions showed no significant difference between the groups. The reasons for dropouts show borderline significance between the two groups. There was no statistically significant difference in the incidence of adverse events between the venlafaxine and placebo-treated groups. CONCLUSIONS Our data do not support the hypothesis that venlafaxine improves mood in elderly demented patients.
Collapse
|
44
|
van Schaik DJF, van Marwijk HWJ, Beekman ATF, de Haan M, van Dyck R. Interpersonal psychotherapy (IPT) for late-life depression in general practice: uptake and satisfaction by patients, therapists and physicians. BMC FAMILY PRACTICE 2007; 8:52. [PMID: 17854480 PMCID: PMC2077866 DOI: 10.1186/1471-2296-8-52] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Accepted: 09/13/2007] [Indexed: 11/10/2022]
Abstract
BACKGROUND Interpersonal Psychotherapy (IPT) is recommended in most depression treatment guidelines and proved to be a suitable treatment for elderly depressed patients. Despite the favorable results of IPT in research populations, the dissemination to general practice is surprisingly limited. Little is known about uptake and satisfaction when this therapy is introduced into real-life general practice. METHODS Motivation and evaluation of patients, GPs and therapists were recorded and organizational barriers described alongside a randomized controlled trial. IPT, given by mental health workers, was compared with usual general practitioner (GP) care. Included were patients (> or =55 years) who met the DSM-IV criteria for major depressive disorder. RESULTS Patients were motivated for the psychotherapy intervention: of the 205 eligible patients, 143 (70%) entered the study, and of the 69 patients who were offered IPT, 77% complied with the treatment. IPT proved to be an attractive therapy for patients as well as for therapists from mental health organizations. General practitioners evaluated the intervention positively afterwards, mainly because of the time-limited and structured approach. Organizational barriers: no IPT therapists were available; an IPT trainer and supervisor had to be trained and training materials had to be developed and translated. Additionally, there was a lack of office space in some general practices; for therapists from private practices it was not feasible to participate because of financial reasons. IPT was superior to usual care in patients with moderate to severe depression. CONCLUSION As we succeeded in delivering IPT in primary care practice, and as IPT was superior to usual care, there are grounds to support the implementation of IPT for depressed elderly patients within general practice, as long as the practices have room for the therapists and financial barriers can be overcome. Consolidation may be achieved by making this intervention available through practice nurses or community psychiatric nurses who deliver IPT as part of a more comprehensive depression management program.
Collapse
Affiliation(s)
- Digna JF van Schaik
- GGZ Buitenamstel and Department of Psychiatry, Institute for Research in Extramural Medicine (EMGO), VU University Medical Center, Amsterdam, the Netherlands
- Department of General Practice, Institute for Research in Extramural Medicine (EMGO), VU University Medical Center, Amsterdam, the Netherlands
| | - Harm WJ van Marwijk
- Department of General Practice, Institute for Research in Extramural Medicine (EMGO), VU University Medical Center, Amsterdam, the Netherlands
| | - Aartjan TF Beekman
- GGZ Buitenamstel and Department of Psychiatry, Institute for Research in Extramural Medicine (EMGO), VU University Medical Center, Amsterdam, the Netherlands
| | - Marten de Haan
- Department of General Practice, Institute for Research in Extramural Medicine (EMGO), VU University Medical Center, Amsterdam, the Netherlands
| | - Richard van Dyck
- GGZ Buitenamstel and Department of Psychiatry, Institute for Research in Extramural Medicine (EMGO), VU University Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
45
|
Bauer M, Bschor T, Pfennig A, Whybrow PC, Angst J, Versiani M, Möller HJ. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders in Primary Care. World J Biol Psychiatry 2007; 8:67-104. [PMID: 17455102 DOI: 10.1080/15622970701227829] [Citation(s) in RCA: 238] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
These practical guidelines for the biological treatment of unipolar depressive disorders in primary care settings were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). They embody the results of a systematic review of all available clinical and scientific evidence pertaining to the treatment of unipolar depressive disorders and offer practical recommendations for general practitioners encountering patients with these conditions. The guidelines cover disease definition, classification, epidemiology and course of unipolar depressive disorders, and the principles of management in the acute, continuation and maintenance phase. They deal primarily with biological treatment (including antidepressants, other psychopharmacological and hormonal medications, electroconvulsive therapy, light therapy).
Collapse
Affiliation(s)
- Michael Bauer
- University Hospital Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
| | | | | | | | | | | | | |
Collapse
|
46
|
Gorwood P, Weiller E, Lemming O, Katona C. Escitalopram prevents relapse in older patients with major depressive disorder. Am J Geriatr Psychiatry 2007; 15:581-93. [PMID: 17586783 DOI: 10.1097/01.jgp.0000240823.94522.4c] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The present study investigated the efficacy and tolerability of escitalopram in the prevention of relapse of major depressive disorder (MDD) in older patients who had responded to acute treatment with escitalopram. METHOD A total of 405 patients who were aged 65 years or older with a primary diagnosis of MDD (according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) and a Montgomery-Asberg Depression Rating Scale (MADRS) total score of 22 or more received 12-week, open-label escitalopram 10 or 20 mg per day treatment. Remitters (MADRS </=12) were randomized to 24-week double-blind treatment with escitalopram or placebo. The primary efficacy parameter was the time to relapse, defined as either an increase in MADRS total score to 22 or more or lack of efficacy as judged by the investigator. RESULTS Three hundred five patients achieved remission and were randomly assigned to treatment with escitalopram (N = 152) or placebo (N = 153). The primary analysis showed a clear beneficial effect of escitalopram relative to placebo on the time to relapse (log-rank test, chi(2) = 27.6, df = 1, p <0.001). The risk of relapse was 4.4 times higher for placebo- than for escitalopram-treated patients (chi(2) test, chi(2) = 22.9, df = 1, p <0.001). Significantly fewer escitalopram-treated patients relapsed (9%) compared with placebo (33%) (chi(2) test, chi(2) = 27.1, df = 1, p <0.001). Escitalopram was well tolerated with 53 patients (13%) withdrawn as a result of adverse events during the open-label period and three (2%) escitalopram-treated patients and six (4%) placebo-treated patients during double-blind treatment (not significant). The overall withdrawal rate, excluding relapses, was 7.2% for escitalopram and 8.5% for placebo during the double-blind period (not significant). CONCLUSION Escitalopram was effective in preventing relapse of MDD in older patients and was well tolerated as continuation treatment.
Collapse
|
47
|
Abstract
Psychotherapeutic treatments are known to be effective in older adults with mental illnesses. Depression, anxiety, and complicated bereavement must be considered psychiatric illnesses, rather than normal consequences of aging. To improve the rate of psychotherapy use among older adults, stigma surrounding psychiatric treatment, as well as misconceptions that older adults are incapable of change, must be unlearned and eliminated.
Collapse
|
48
|
Abstract
Neuropsychiatric syndromes are common in the setting of cerebrovascular disease. The most frequent psychiatric syndrome after stroke is depression. Emotionalism and apathy after stroke are also frequent and under-detected symptoms. Treatment principles are broadly similar to those currently used to treat non-organically ill patients. The evidence for pharmacological and psychological treatment for depression after stroke is scant, and of variable quality. Currently there is evidence of efficacy for both tricyclic antidepressants and SSRIs in the management of depression but the latter are better tolerated. Randomized controlled trials of antidepressants for post-stroke emotionalism are positive and this is encouraging. The current evidence base for psychological interventions either as first line or augmentative strategies is too limited and inconclusive to permit definite recommendations. Future studies might include multi-modal interventions using the principles of active case management and pharmacological studies which target both specific neuropsychiatric symptoms and underlying cerebrovascular disorder.
Collapse
Affiliation(s)
- Raghu Paranthaman
- Edale House, Manchester Mental Health & Social Care Trust, Manchester Royal Infirmary, Manchester, UK
| | | |
Collapse
|
49
|
Bosmans J, de Bruijne M, van Hout H, van Marwijk H, Beekman A, Bouter L, Stalman W, van Tulder M. Cost-effectiveness of a disease management program for major depression in elderly primary care patients. J Gen Intern Med 2006; 21:1020-6. [PMID: 16836625 PMCID: PMC1831631 DOI: 10.1111/j.1525-1497.2006.00555.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Major depression is common in older adults and is associated with increased health care costs. Depression often remains unrecognized in older adults, especially in primary care. OBJECTIVE To evaluate the cost-effectiveness of a disease management program for major depression in elderly primary care patients compared with usual care. DESIGN Economic evaluation alongside a cluster randomized-controlled trial. PARTICIPANTS Consecutive patients of 55 years and older were screened for depression using the Geriatric Depression Scale and the PRIME-MD was used for diagnosis. INTERVENTIONS General practitioners in the intervention group received training on how to implement the disease management program consisting of screening, patient education, drug therapy with paroxetine, and supportive contacts. General practitioners in the usual care group were blind to the screening results. Treatment in this group was not restricted in any way. MEASUREMENTS Severity of depression, recovery from depression, and quality of life. Resource use measured over a 12-month period using interviews and valued using standard costs. RESULTS Differences in clinical outcomes between the intervention and usual care group were small and statistically insignificant. Total costs were 2,123 dollars in the intervention and 2,259 dollars in the usual care group (mean difference -136 dollars, 95% confidence interval: -1,194 dollars; 1,110 dollars). Cost-effectiveness planes indicated that there were no statistically significant differences in cost-effectiveness between the 2 groups. CONCLUSIONS This disease management program for major depression in elderly primary care patients had no statistically significant relationship with clinical outcomes, costs, and cost-effectiveness. Therefore, based on these results, continuing usual care is recommended.
Collapse
Affiliation(s)
- Judith Bosmans
- Health Technology Assessment Unit, Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
50
|
van Schaik A, van Marwijk H, Adèr H, van Dyck R, de Haan M, Penninx B, van der Kooij K, van Hout H, Beekman A. Interpersonal psychotherapy for elderly patients in primary care. Am J Geriatr Psychiatry 2006; 14:777-86. [PMID: 16943174 DOI: 10.1097/01.jgp.0000199341.25431.4b] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Interpersonal psychotherapy (IPT) is recommended in most depression treatment guidelines, but little is known about its effectiveness in real-life practice. This study investigates whether IPT, delivered by mental health workers to elderly patients with major depressive disorder, is more effective than usual general practitioners' care (CAU). METHODS A pragmatic randomized, controlled trial was conducted in which 143 patients were allocated to IPT (10 sessions) or to CAU. PRIMary care Evaluation of Mental Disorders (PRIME-MD) and Montgomery Asberg Depression Rating Scale (MADRS) assessments were used as primary outcomes. RESULTS IPT was significantly more effective in reducing the percentage of patients with a diagnosis of depression (PRIME-MD), but not in inducing remission (MADRS <10). Among treatment completers, IPT was superior in improving social and overall mental functioning. A post hoc analysis revealed that IPT was superior to CAU in moderately to severely depressed patients, but not significantly so in mildly depressed patients. CONCLUSIONS IPT was more effective than CAU for elderly patients with moderate to severe major depressive disorder in general practice. Future research should focus on determinants of treatment outcome.
Collapse
Affiliation(s)
- Anneke van Schaik
- Department of Psychiatry, Department of General Practice, Institute for Research in Extramural Medicine (EMGO), VU University Medical Center, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|