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Du R, Yang K, Li W, Wang Z, Cai H. Research status and global trends of late-life depression from 2004 to 2023: bibliometric analysis. Front Aging Neurosci 2024; 16:1393110. [PMID: 38752209 PMCID: PMC11095109 DOI: 10.3389/fnagi.2024.1393110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/10/2024] [Indexed: 05/18/2024] Open
Abstract
Background Global research hotspots and future research trends in the neurobiological mechanisms of late-life depression (LLD) as well as its diagnosis and treatment are not yet clear. Objectives This study profiled the current state of global research on LLD and predicted future research trends in the field. Methods Literature with the subject term LLD was retrieved from the Web of Science Core Collection, and CiteSpace software was used to perform econometric and co-occurrence analyses. The results were visualized using CiteSpace, VOSviewer, and other software packages. Results In total, 10,570 publications were included in the analysis. Publications on LLD have shown an increasing trend since 2004. The United States and the University of California had the highest number of publications, followed consecutively by China and England, making these countries and institutions the most influential in the field. Reynolds, Charles F. was the author with the most publications. The International Journal of Geriatric Psychiatry was the journal with the most articles and citations. According to the co-occurrence analysis and keyword/citation burst analysis, cognitive impairment, brain network dysfunction, vascular disease, and treatment of LLD were research hotspots. Conclusion Late-life depression has attracted increasing attention from researchers, with the number of publications increasing annually. However, many questions remain unaddressed in this field, such as the relationship between LLD and cognitive impairment and dementia, or the impact of vascular factors and brain network dysfunction on LLD. Additionally, the treatment of patients with LLD is currently a clinical challenge. The results of this study will help researchers find suitable research partners and journals, as well as predict future hotspots.
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Affiliation(s)
| | | | | | - Zhiren Wang
- Huilongguan Clinical Medical School of Peking University, Beijing Huilongguan Hospital, Beijing, China
| | - Haipeng Cai
- Huilongguan Clinical Medical School of Peking University, Beijing Huilongguan Hospital, Beijing, China
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2
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Liu C, Li L, Pan W, Zhu D, Lian S, Liu Y, Ren L, Mao P, Ren Y, Ma X. Altered topological properties of functional brain networks in patients with first episode, late-life depression before and after antidepressant treatment. Front Aging Neurosci 2023; 15:1107320. [PMID: 36949772 PMCID: PMC10025486 DOI: 10.3389/fnagi.2023.1107320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/20/2023] [Indexed: 03/08/2023] Open
Abstract
Objectives To preliminarily explore the functional activity and information integration of the brains under resting state based on graph theory in patients with first-episode, late-life depression (LLD) before and after antidepressant treatment. Methods A total of 50 patients with first-episode LLD and 40 non-depressed controls (NCs) were recruited for the present research. Participants underwent the RBANS test, the 17-item Hamilton depression rating scale (HAMD-17) test, and resting-state functional MRI scans (rs-fMRI). The RBANS test consists of 12 sub-tests that contribute to a total score and index scores across the five domains: immediate memory, visuospatial/constructional, language, attention, and delayed memory. Escitalopram or sertraline was adopted for treating depression, and the dosage of the drug was adjusted by the experienced psychiatrists. Of the 50 LLD patients, 27 cases who completed 6-month follow-ups and 27 NCs matched with age, sex, and education level were included for the final statistical analysis. Results There were significant differences in RBANS total score, immediate memory, visuospatial/constructional, language, attention, and delayed memory between LLD baseline group and NCs group (P < 0.05). Considering the global attribute indicators, the clustering coefficient of global indicators was lower in the LLD baseline group than in the NCs group, and the small-world attribute of functional brain networks existed in all three groups. The degree centrality and node efficiency of some brains were lower in the LLD baseline group than in the NCs group. After 6 months of antidepressant therapy, the scores of HAMD-17, immediate memory, language, and delayed memory in the LLD follow-up group were higher than those in the LLD baseline group. Compared with the LLD baseline group, the degree centrality and node efficiency of some brains in the cognitive control network were decreased in the LLD follow-up group. Conclusions The ability to integrate and divide labor of functional brain networks declines in LLD patients and linked with the depression severity. After the relief of depressive symptoms, the small-world attribute of functional brain networks in LLD patients persists. However, the information transmission efficiency and centrality of some brain regions continue to decline over time, perhaps related to their progressive cognitive impairment.
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Affiliation(s)
- Chaomeng Liu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Li Li
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Weigang Pan
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Dandi Zhu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Siyuan Lian
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yi Liu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Li Ren
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Peixian Mao
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yanping Ren
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
- Yanping Ren
| | - Xin Ma
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
- *Correspondence: Xin Ma
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3
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Therapy Strategies for Late-life Depression: A Review. J Psychiatr Pract 2023; 29:15-30. [PMID: 36649548 DOI: 10.1097/pra.0000000000000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Depression in the elderly requires different treatment options because therapies that are commonly used for depression in younger patients show different effects later in life. Treatment options for late-life depression (LLD) are summarized in this article. METHODS A literature search in Medline/PubMed performed in June 2020 identified 83 relevant studies. RESULTS Pharmacotherapy with selective serotonin reuptake inhibitors can be an effective first-line treatment in LLD, but >50% of elderly patients do not adequately respond. Switching to other selective serotonin reuptake inhibitors or augmenting with mood stabilizers or antipsychotics is often effective in achieving a therapeutic benefit. Severely depressed patients with a high risk of suicidal behavior can be treated with electroconvulsive therapy. Psychotherapy provides a measurable benefit alone and when combined with medication. LIMITATIONS LLD remains an underrepresented domain in research. Paucity of data concerning the effect of specific therapies for LLD, heterogeneity in the quality of study designs, overinterpretation of results from meta-analyses, and discrepancies between study results and guideline recommendations were often noted. CONCLUSIONS Treating LLD is complex, but there are several treatment options with good efficacy and tolerability. Some novel pharmaceuticals also show promise as potential antidepressants, but evidence for their efficacy and safety is still limited and based on only a few trials conducted to date.
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Latronica JR, Tuan WJ, Clegg TJ, Silvis ML, Bone C. Cardiovascular Outcomes Among Older Individuals With Depression Prescribed Amphetamines: A Retrospective Cohort Study. J Gerontol A Biol Sci Med Sci 2022; 77:2459-2463. [PMID: 35137053 DOI: 10.1093/gerona/glac033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Prescription amphetamines are utilized for treatment of depression in older adults, yet cardiovascular risks in this population are not well described. The purpose of this study is to evaluate risk of cardiovascular events among adults aged 65 and older with depression who were prescribed amphetamines. METHODS We conducted a retrospective matched cohort study utilizing the TriNetx database and statistical software. The 1:1 propensity score matching technique was performed using logistic regression to balance the baseline characteristics of the population. Inclusion criteria were a diagnosis of depression and age 65 years and older. We excluded individuals with an adverse cardiovascular event or diagnosis of attention deficit and hyperactivity disorder prior to enrollment. Individuals were followed from January 1, 2018 to December 31, 2020. Those prescribed an amphetamine were considered exposed and others served as controls. We used descriptive statistics and calculated risk ratios to assess the relationship between amphetamine prescriptions and cardiovascular events in these cohorts. RESULTS There were 4 434 included in the exposed cohort and 4 434 matched controls in the unexposed group. The cohort exposed to amphetamines had higher high-density lipoprotein along with lower low-density lipoprotein, total cholesterol, hemoglobin A1C, systolic blood pressure, and body mass index than the control group, but increased risk of cardiovascular events (risk ratio: 8.9; 95% confidence interval: 6.39, 12.48). CONCLUSIONS Amphetamines offer potential benefits to people with depression; however, these data suggest increased risk of cardiovascular events among older individuals. Additional research is warranted to fully characterize risk among subpopulations of older adults and inform patient-provider decision making.
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Affiliation(s)
- James R Latronica
- Department of Psychiatry and Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Wen Jan Tuan
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Taylor J Clegg
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Matthew L Silvis
- Penn State Milton S. Hershey Medical Center, Department of Family and Community Medicine; Department of Orthopedics and Rehabilitation, Hershey, Pennsylvania, USA
| | - Curtis Bone
- Penn State Milton S. Hershey Medical Center, Department of Family and Community Medicine, Hershey, Pennsylvania, USA
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Antidepressant Effect of Ketamine on Inflammation-Mediated Cytokine Dysregulation in Adults with Treatment-Resistant Depression: Rapid Systematic Review. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:1061274. [PMID: 36160713 PMCID: PMC9507757 DOI: 10.1155/2022/1061274] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/25/2022] [Accepted: 08/23/2022] [Indexed: 11/28/2022]
Abstract
Background Major depressive disorder (MDD) and treatment-resistant depression (TRD) represent a global source of societal and health burden. To advise proper management of inflammation-related depression among TRD patients, it is important to identify therapeutic clinical treatments. A key factor is related to proinflammatory cytokines such as interleukin- (IL-) 1β, IL-6, and tumor necrosis factor- (TNF-) α which have been implicated in the pathogenesis of depressive symptoms in MDD patients. Ketamine may provide an anti-inflammatory therapeutic strategy by targeting proinflammatory pathways associated with depressive disorders, which may be exacerbated in the ageing population with TRD. Objective Despite a burgeoning body of literature demonstrating that inflammation is linked to TRD, there is still a lack of comprehensive research on the relationship between proinflammatory biomarkers and ketamine's antidepressant effect on TRD patients. Method The Cochrane Library and PubMed/MEDLINE databases were systematically searched from inception up to February 1, 2022, adopting broad inclusion criteria to assess clinical topics related to the impact of ketamine on inflammatory cytokines in TRD patients. The present work is in compliance with the World Health Organization Rapid Review Guide. Results Five out of the seven studies examined in this review show that ketamine infusion may reduce depressive symptoms with a quick start of effect on TRD patients. Based on the Montgomery-Åsberg Depression Rating Scale (MADRS) and Hamilton Depression Rating Scale (HAM-D) scores, the overall response rate for ketamine was 56%; that is, 56% of those treated with ketamine had MADRS/HAM-D scores decreased by at least 50%. Conclusions While the anti-inflammatory effects of ketamine modulate specific proinflammatory cytokines, its rapid antidepressant effect on TRD patients remains inconsistent. However, our study findings can provide a reliable basis for future research on how to improve systemic inflammatory immune disorders and mental health. We suggest that ketamine infusion may be part of a comprehensive treatment approach in TRD patients with elevated levels of depression-specific inflammatory biomarkers.
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Murri MB, Amore M, Menchetti M, Toni G, Neviani F, Cerri M, Rocchi MBL, Zocchi D, Bagnoli L, Tam E, Buffa A, Ferrara S, Neri M, Alexopoulos GS, Zanetidou S. Physical Exercise for Late-Life Major Depression. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2021; 19:365-373. [PMID: 34690606 DOI: 10.1176/appi.focus.19306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
(Reprinted with permission from Br J Psychiatry 2005; 207: 235-242).
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Affiliation(s)
- M Belvederi Murri
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Department of Medical and Surgical Sciences, University of Bologna; Cardiology Unit, Ramazzini Hospital, Carpi; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Department of Biomedical and Neuromotor Sciences, University of Bologna; Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; primary care physicians, Bologna; Department of Movement and Neurological Sciences, University of Verona; Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; Department of Psychiatry, Weill Cornell Medical College, New York, USA; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - M Amore
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Department of Medical and Surgical Sciences, University of Bologna; Cardiology Unit, Ramazzini Hospital, Carpi; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Department of Biomedical and Neuromotor Sciences, University of Bologna; Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; primary care physicians, Bologna; Department of Movement and Neurological Sciences, University of Verona; Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; Department of Psychiatry, Weill Cornell Medical College, New York, USA; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - M Menchetti
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Department of Medical and Surgical Sciences, University of Bologna; Cardiology Unit, Ramazzini Hospital, Carpi; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Department of Biomedical and Neuromotor Sciences, University of Bologna; Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; primary care physicians, Bologna; Department of Movement and Neurological Sciences, University of Verona; Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; Department of Psychiatry, Weill Cornell Medical College, New York, USA; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - G Toni
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Department of Medical and Surgical Sciences, University of Bologna; Cardiology Unit, Ramazzini Hospital, Carpi; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Department of Biomedical and Neuromotor Sciences, University of Bologna; Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; primary care physicians, Bologna; Department of Movement and Neurological Sciences, University of Verona; Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; Department of Psychiatry, Weill Cornell Medical College, New York, USA; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - F Neviani
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Department of Medical and Surgical Sciences, University of Bologna; Cardiology Unit, Ramazzini Hospital, Carpi; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Department of Biomedical and Neuromotor Sciences, University of Bologna; Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; primary care physicians, Bologna; Department of Movement and Neurological Sciences, University of Verona; Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; Department of Psychiatry, Weill Cornell Medical College, New York, USA; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - M Cerri
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Department of Medical and Surgical Sciences, University of Bologna; Cardiology Unit, Ramazzini Hospital, Carpi; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Department of Biomedical and Neuromotor Sciences, University of Bologna; Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; primary care physicians, Bologna; Department of Movement and Neurological Sciences, University of Verona; Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; Department of Psychiatry, Weill Cornell Medical College, New York, USA; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - M B L Rocchi
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Department of Medical and Surgical Sciences, University of Bologna; Cardiology Unit, Ramazzini Hospital, Carpi; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Department of Biomedical and Neuromotor Sciences, University of Bologna; Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; primary care physicians, Bologna; Department of Movement and Neurological Sciences, University of Verona; Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; Department of Psychiatry, Weill Cornell Medical College, New York, USA; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - D Zocchi
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Department of Medical and Surgical Sciences, University of Bologna; Cardiology Unit, Ramazzini Hospital, Carpi; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Department of Biomedical and Neuromotor Sciences, University of Bologna; Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; primary care physicians, Bologna; Department of Movement and Neurological Sciences, University of Verona; Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; Department of Psychiatry, Weill Cornell Medical College, New York, USA; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - L Bagnoli
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Department of Medical and Surgical Sciences, University of Bologna; Cardiology Unit, Ramazzini Hospital, Carpi; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Department of Biomedical and Neuromotor Sciences, University of Bologna; Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; primary care physicians, Bologna; Department of Movement and Neurological Sciences, University of Verona; Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; Department of Psychiatry, Weill Cornell Medical College, New York, USA; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - E Tam
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Department of Medical and Surgical Sciences, University of Bologna; Cardiology Unit, Ramazzini Hospital, Carpi; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Department of Biomedical and Neuromotor Sciences, University of Bologna; Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; primary care physicians, Bologna; Department of Movement and Neurological Sciences, University of Verona; Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; Department of Psychiatry, Weill Cornell Medical College, New York, USA; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - A Buffa
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Department of Medical and Surgical Sciences, University of Bologna; Cardiology Unit, Ramazzini Hospital, Carpi; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Department of Biomedical and Neuromotor Sciences, University of Bologna; Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; primary care physicians, Bologna; Department of Movement and Neurological Sciences, University of Verona; Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; Department of Psychiatry, Weill Cornell Medical College, New York, USA; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - S Ferrara
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Department of Medical and Surgical Sciences, University of Bologna; Cardiology Unit, Ramazzini Hospital, Carpi; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Department of Biomedical and Neuromotor Sciences, University of Bologna; Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; primary care physicians, Bologna; Department of Movement and Neurological Sciences, University of Verona; Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; Department of Psychiatry, Weill Cornell Medical College, New York, USA; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - M Neri
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Department of Medical and Surgical Sciences, University of Bologna; Cardiology Unit, Ramazzini Hospital, Carpi; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Department of Biomedical and Neuromotor Sciences, University of Bologna; Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; primary care physicians, Bologna; Department of Movement and Neurological Sciences, University of Verona; Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; Department of Psychiatry, Weill Cornell Medical College, New York, USA; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - G S Alexopoulos
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Department of Medical and Surgical Sciences, University of Bologna; Cardiology Unit, Ramazzini Hospital, Carpi; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Department of Biomedical and Neuromotor Sciences, University of Bologna; Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; primary care physicians, Bologna; Department of Movement and Neurological Sciences, University of Verona; Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; Department of Psychiatry, Weill Cornell Medical College, New York, USA; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - S Zanetidou
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Department of Medical and Surgical Sciences, University of Bologna; Cardiology Unit, Ramazzini Hospital, Carpi; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Department of Biomedical and Neuromotor Sciences, University of Bologna; Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; primary care physicians, Bologna; Department of Movement and Neurological Sciences, University of Verona; Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; Department of Psychiatry, Weill Cornell Medical College, New York, USA; Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
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Zikos D, Afolayan-Oloye O. Association between Depressive disorder and hospital outcomes of care for elderly hospitalized patients. AGEING INTERNATIONAL 2021. [DOI: 10.1007/s12126-021-09455-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hoel RW, Giddings Connolly RM, Takahashi PY. Polypharmacy Management in Older Patients. Mayo Clin Proc 2021; 96:242-256. [PMID: 33413822 DOI: 10.1016/j.mayocp.2020.06.012] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 05/18/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022]
Abstract
Medications to treat disease and extend life in our patients often amass in quantities, resulting in what has been termed "polypharmacy." This imprecise label usually describes the accumulation of 5, and often more, medications. Polypharmacy in advancing age frequently results in drug therapy problems related to interactions, drug toxicity, falls with injury, delirium, and nonadherence. Polypharmacy is associated with resulting increased hospitalizations and higher costs of care for individuals and health care systems. To reduce polypharmacy, we delineate a systematic, consultative approach to identify highest-risk medications and drug-therapy problems. We address strategic reductions (deprescribing) of medications in palliative care, long-term care, and ambulatory older adults. Best practices for reducing opioids, benzodiazepines, and other high-risk medications include education about risk and agreement by patients and their families, advocates, and care teams. Addressing deprescribing should be within the framework of patients' health status as their care and goals transition from longevity to a plan of maintaining alertness, comfort, and satisfaction of quality of life. A team approach to address polypharmacy and avoidance of high-risk therapy is optimal within long-term care. Patients with terminal illnesses or those moving toward a comfort-care emphasis benefit from medication adjustments that are recognized beneficially within each patient's care goals. In caring for older adults, the acknowledgement that complicated regimens and high-risk medications requires a care plan to reduce or prevent medication-related problems and costs that are associated with polypharmacy.
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Affiliation(s)
- Robert William Hoel
- Division of Medication Therapy Management, Pharmacy Services, Mayo Clinic, Rochester, MN.
| | | | - Paul Y Takahashi
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN
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Shi S, Gao Y, Sun Y, Liu M, Shao L, Zhang J, Tian J. The top-100 cited articles on biomarkers in the depression field: a bibliometric analysis. PSYCHOL HEALTH MED 2020; 26:533-542. [DOI: 10.1080/13548506.2020.1752924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Shuzhen Shi
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou City, China
- Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Ya Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou City, China
- Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Yue Sun
- Evidence-Based Nursery Center, School of Nursing, Lanzhou University, Lanzhou City, China
| | - Ming Liu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou City, China
- Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Lihua Shao
- The First Clinical Medical College of Lanzhou University
| | - Junhua Zhang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou City, China
- Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
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Sakurai H, Uchida H, Kato M, Suzuki T, Baba H, Watanabe K, Inada K, Kikuchi T, Katsuki A, Kishida I, Sugawara Kikuchi Y, Yasui-Furukori N. Pharmacological management of depression: Japanese expert consensus. J Affect Disord 2020; 266:626-632. [PMID: 32056937 DOI: 10.1016/j.jad.2020.01.149] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/13/2019] [Accepted: 01/26/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Clinically relevant issues in the real-world treatment of depression have not always been captured by conventional treatment guidelines. METHODS Certified psychiatrists of the Japanese Society of Clinical Neuropsychopharmacology were asked to evaluate treatment options regarding 23 clinical situations in the treatment of depression using a 9-point Likert scale (1="disagree" and 9="agree"). According to the responses of 114 experts, the options were categorized into first-, second-, and third-line treatments. RESULTS First-line antidepressants varied depending on predominant symptoms: escitalopram (mean ± standard deviation score, 7.8 ± 1.7) and sertraline (7.3 ± 1.7) were likely selected for anxiety; duloxetine (7.6 ± 1.9) and venlafaxine (7.2 ± 2.1) for loss of interest; mirtazapine for insomnia (8.2 ± 1.6), loss of appetite (7.9 ± 1.9), agitation and severe irritation (7.4 ± 2.0), and suicidal ideation (7.5 ± 1.9). While first-line treatment was switched to either an SNRI (7.7 ± 1.9) or mirtazapine (7.4 ± 2.0) in the case of non-response to an SSRI, switching to mirtazapine (7.1 ± 2.2) was recommended in the case of non-response to an SNRI, and vice versa (switching to an SNRI (7.0 ± 2.0) in the case of non-response to mirtazapine). Augmentation with aripiprazole was considered the first-line treatment for partial response to an SSRI (7.1 ± 2.3) or SNRI (7.0 ± 2.5). LIMITATIONS The evidence level of expert consensus is considered low. All included experts were Japanese. CONCLUSIONS Recommendations made by experts in the field are useful and can supplement guidelines and informed decision making in real-world clinical practice. We suggest that pharmacological strategies for depression be flexible and that each patient's situational needs as well as the pharmacotherapeutic profile of medications be considered.
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Affiliation(s)
- Hitoshi Sakurai
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Takefumi Suzuki
- Department of Neuropsychiatry, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Hajime Baba
- Department of Psychiatry & Behavioral Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Ken Inada
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo Japan
| | - Toshiaki Kikuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Asuka Katsuki
- Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Ikuko Kishida
- Fujisawa Hospital, Kanagawa, Japan; Department of Psychiatry, Yokohama City University School of Medicine, Kanagawa, Japan
| | | | - Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan.
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Abstract
AbstractDepression in later life is one of the most common mental disorders. Several instruments have been developed to detect the presence or the absence of certain symptoms or emotional disorders, based on cut-off points. However, the use of a cut-off does not allow identification of depression sub-types or distinguish between mild and severe depression. As a result, depression may be under- or over-diagnosed in older people. This paper aims to apply a model-driven approach to classify individuals into distinct sub-groups, based on different combinations of depressive and emotional conditions. This approach is based on two distinct statistical solutions: first, a latent class analysis is applied to the items collected by the depression scale and, according to the final model, the probability of belonging to each class is calculated for every individual. Second, a factor analysis of these classes is performed to obtain a reduced number of clusters for easy interpretation. We use data collected through the EURO-D scale in a large sample of older individuals, participants of the sixth wave of the Survey of Health, Ageing and Retirement in Europe. We show that by using such a model-based approach it is possible to classify individuals in a more accurate way than the simple dichotomisation ‘depressed’ versus ‘non-depressed’.
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Koç Z, Sağlam Z. DETERMINATION OF THE EFFECTS OF DAILY LIFE ACTIVITIES AND SELF-CARE CAPACITY ON DEPRESSION OF THE ELDERLY IN NORTHERN TURKEY. Acta Clin Croat 2019; 58:516-522. [PMID: 31969765 PMCID: PMC6971796 DOI: 10.20471/acc.2019.58.03.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
This study aimed to determine the effects of daily living activities and self-care capacity on depression of the elderly in northern Turkey. The study was conducted with participation of 451 voluntary elderly individuals. Data were collected via a questionnaire, Geriatric Depression Scale, Exercise of Self-care Agency Scale, Daily Activities Index, and Instrumental Activities of Daily Living Index. The mean Exercise of Self-care Agency Scale score and Geriatric Depression Scale score was 91.44±16.32 and 11.87±5.01, respectively. Negative and highly statistically significant correlations (p=0.000) were found between depression scores and self-care capacity scores (r=-0.470), daily activities scores (r=-0.351), and Instrumental Activity of Daily Life scores (r=-0.270). Study results showed that depression scores of the elderly increased as their daily life activities and self-care capacity scores decreased.
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Affiliation(s)
| | - Zeynep Sağlam
- Ondokuz Mayis University Health Science Faculty, Kurupelit, Samsun, Turkey
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Ricou M, Marina S, Vieira PM, Duarte I, Sampaio I, Regalado J, Canário C. Psychological intervention at a primary health care center: predictors of success. BMC FAMILY PRACTICE 2019; 20:116. [PMID: 31420014 PMCID: PMC6698017 DOI: 10.1186/s12875-019-1005-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 08/06/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Few studies in Portugal have attempted to assess the impact of psychological interventions in primary health care regarding the problems shared by clients, and which variables predicted the success of this intervention. The current study, therefore, aimed to identify predictors of success related to psychological intervention in a single primary health care center in the north of Portugal. METHOD This was a retrospective study from secondary data, using the data from 1024 clients who attended the psychological consultation at a primary health care center over a period of 8 years. The success of the psychological consultation was defined according to the discharge made by the psychologist. The multiple logistic regression analysis was employed. RESULTS The attendance of a greater number of consultations and the biweekly frequency of consultations significantly predicted the success of psychological intervention. Additionally, the success was associated with having a diagnosis or specific problem identified. CONCLUSIONS These findings provide contributions to enrich the literature in this field, in particular, in Portuguese primary health care. We highlight the importance of investing in psychological services in primary health care centers.
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Affiliation(s)
- Miguel Ricou
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, Porto University, and CINTESIS, Porto, Portugal.
| | - Sílvia Marina
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, Porto University, and CINTESIS, Porto, Portugal
| | - Paula Marinho Vieira
- University Institute of Maia, Maia, Portugal
- Center for Psychology at University of Porto, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Ivone Duarte
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, Porto University, and CINTESIS, Porto, Portugal
| | - Inês Sampaio
- Trás-os-Montes and Alto Douro University, Vila Real, Portugal
| | | | - Catarina Canário
- Center for Psychology at University of Porto, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
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Lin YT, Lu TS, Hansen RA, Wang CC. Selective Serotonin Reuptake Inhibitor Use and Risk of Arrhythmia: A Nationwide, Population-Based Cohort Study. Clin Ther 2019; 41:1128-1138.e8. [PMID: 31178037 DOI: 10.1016/j.clinthera.2019.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE This study compares the risks of arrhythmia among patients with depression receiving selective serotonin reuptake inhibitors (SSRIs) and those receiving other classes of antidepressants and among patients with depression receiving citalopram-escitalopram and those receiving other SSRIs. METHODS This retrospective cohort study used data from the 2000-2011 National Health Insurance Research Database in Taiwan. Patients with depression who were new antidepressant users were included in the study sample. Propensity score matching was used to balance the covariates between the comparison groups. Crude incidence rates were generated by Poisson regressions, and Cox proportional hazards regression models were used to assess the rates of arrhythmia among SSRI users and nonusers of SSRI antidepressants as well as between citalopram-escitalopram users and users of other SSRIs. FINDINGS Neither SSRI (hazard ratio [HR] = 0.95; 95% CI, 0.83-1.08) nor citalopram-escitalopram (HR = 1.20; 95% CI, 0.95-1.51) exposure was associated with a risk of arrhythmia compared with other, newer non-SSRI antidepressants or noncitalopram SSRIs. An increase in mortality was, however, observed among citalopram-escitalopram users (HR = 1.21; 95% CI, 1.08-1.31). IMPLICATIONS Citalopram, escitalopram, and other SSRIs were not associated with an elevated risk of arrhythmia compared with each other or with non-SSRI antidepressants. Nevertheless, citalopram and escitalopram were associated with an increase in mortality risk compared with other SSRIs and deserve further investigation.
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Affiliation(s)
- Yi-Ting Lin
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsui-Shan Lu
- Department of Mathematics, National Taiwan Normal University, Taipei, Taiwan
| | | | - Chi-Chuan Wang
- School of Pharmacy, National Taiwan University, Taipei, Taiwan; Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
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Sobieraj DM, Martinez BK, Hernandez AV, Coleman CI, Ross JS, Berg KM, Steffens DC, Baker WL. Adverse Effects of Pharmacologic Treatments of Major Depression in Older Adults. J Am Geriatr Soc 2019; 67:1571-1581. [DOI: 10.1111/jgs.15966] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/12/2019] [Accepted: 03/15/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Adrian V. Hernandez
- University of Connecticut School of Pharmacy Storrs Connecticut
- Vicerrectorado de Investigacion, Universidad SanIgnacio de Loyola (USIL) Lima Peru
| | | | - Joseph S. Ross
- Yale University School of Medicine and School of Public Health New Haven Connecticut
| | - Karina M. Berg
- University of Connecticut School of Medicine Farmington Connecticut
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Lozupone M, La Montagna M, D'Urso F, Piccininni C, Sardone R, Dibello V, Giannelli G, Solfrizzi V, Greco A, Daniele A, Quaranta N, Seripa D, Bellomo A, Logroscino G, Panza F. Pharmacotherapy for the treatment of depression in patients with alzheimer's disease: a treatment-resistant depressive disorder. Expert Opin Pharmacother 2018; 19:823-842. [PMID: 29726758 DOI: 10.1080/14656566.2018.1471136] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Pharmacotherapy for the treatment of depressive disorders in Alzheimer's Disease (AD) represents a clinical challenge. pharmacological options are often attempted after a period of watchful waiting (8-12 weeks). monoaminergic antidepressant drugs have shown only modest or null clinical benefits, maybe because the etiology of depressive symptoms in ad patients is fundamentally different from that of nondemented subjects. AREAS COVERED The following article looks at the selective serotonin reuptake inhibitor sertraline, which is one of the most frequently studied antidepressant medications in randomized controlled trials (RCTs). It also discusses many other pharmacological approaches that have proven to be inadequate (antipsychotics, acetylcholinesterase inhibitors, anticonvulsants, hormone replacement therapy) and new drug classes (mainly affecting glutamate transmission) that are being studied for treating depression in AD. It also gives discussion to the phase II RCT on the alternative drug S47445 and the potential effect on cognition of the multimodal antidepressant vortioxetine in older depressed patients. Finally, it discusses the N-methyl-D-aspartate antagonist ketamine. EXPERT OPINION The present RCT methodologies are too disparate to draw firm conclusions. Future studies are required to identify effective and multimodal pharmacological treatments that efficiently treat depression in AD. Genotyping may boost antidepressant treatment success.
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Affiliation(s)
- Madia Lozupone
- a Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs , University of Bari Aldo Moro , Bari , Italy
| | - Maddalena La Montagna
- b Psychiatric Unit, Department of Clinical and Experimental Medicine , University of Foggia , Foggia , Italy
| | - Francesca D'Urso
- b Psychiatric Unit, Department of Clinical and Experimental Medicine , University of Foggia , Foggia , Italy
| | - Carla Piccininni
- b Psychiatric Unit, Department of Clinical and Experimental Medicine , University of Foggia , Foggia , Italy
| | - Rodolfo Sardone
- c Department of Epidemiology and Biostatistics , National Institute of Gastroenterology "S. de Bellis" Research Hospital , Castellana Grotte, Bari , Italy
| | - Vittorio Dibello
- d Interdisciplinary Department of Medicine (DIM), Section of Dentistry , University of Bari Aldo Moro , Bari , Italy
| | - Gianluigi Giannelli
- c Department of Epidemiology and Biostatistics , National Institute of Gastroenterology "S. de Bellis" Research Hospital , Castellana Grotte, Bari , Italy
| | - Vincenzo Solfrizzi
- e Geriatric Medicine-Memory Unit and Rare Disease Centre , University of Bari Aldo Moro , Bari , Italy
| | - Antonio Greco
- f Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences , IRCCS "Casa Sollievo della Sofferenza" , San Giovanni Rotondo, Foggia , Italy
| | - Antonio Daniele
- g Institute of Neurology , Catholic University of Sacred Heart , Rome , Italy
| | - Nicola Quaranta
- h Otolaryngology Unit , University of Bari "Aldo Moro" , Bari , Italy
| | - Davide Seripa
- f Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences , IRCCS "Casa Sollievo della Sofferenza" , San Giovanni Rotondo, Foggia , Italy
| | - Antonello Bellomo
- b Psychiatric Unit, Department of Clinical and Experimental Medicine , University of Foggia , Foggia , Italy
| | - Giancarlo Logroscino
- a Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs , University of Bari Aldo Moro , Bari , Italy.,i Department of Clinical Research in Neurology , University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico" , Tricase, Lecce , Italy
| | - Francesco Panza
- a Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs , University of Bari Aldo Moro , Bari , Italy.,f Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences , IRCCS "Casa Sollievo della Sofferenza" , San Giovanni Rotondo, Foggia , Italy.,i Department of Clinical Research in Neurology , University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico" , Tricase, Lecce , Italy
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Abstract
UNLABELLED This paper reviews recent research on late-life depression (LLD) pharmacotherapy, focusing on updated information for monotherapy and augmentation treatments. We then review new research on moderators of clinical response and how to use the information for improved efficacy. RECENT FINDINGS A recent review shows that sertraline, paroxetine, and duloxetine were superior to placebo for the treatment of LLD. There is concern that paroxetine could have adverse outcomes in the geriatric population due to anticholinergic properties; however, studies show no increases in mortality, dementia risk, or cognitive measures. Among newer antidepressants, vortioxetine has demonstrated efficacy in LLD, quetiapine has demonstrated efficacy especially for patients with sleep disturbances, and aripiprazole augmentation for treatment resistance in LLD was found to be safe and effective. Researchers have also been identifying moderators of LLD that can guide treatment. Researchers are learning how to associate moderators, neuroanatomical models, and antidepressant response. SSRI/SNRIs remain first-line treatment for LLD. Aripiprazole is an effective and safe augmentation for treatment resistance. Studies are identifying actionable moderators that can increase treatment response.
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Blumberger D, Conn D, Kennedy JS, Mulsant BH, Pollock BG, Rabheru K, Rapoport MJ, Seitz D. Some of the CANMAT Recommendations for the Pharmacological Treatment of Late-life Depression Are Not Congruent with Available Evidence or Expert Opinion. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:351-352. [PMID: 28525727 PMCID: PMC5459232 DOI: 10.1177/0706743717700877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Patel K, Abdool PS, Rajji TK, Mulsant BH. Pharmacotherapy of major depression in late life: what is the role of new agents? Expert Opin Pharmacother 2017; 18:599-609. [DOI: 10.1080/14656566.2017.1308484] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Kinjal Patel
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Petal S. Abdool
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Outpatient Geriatric Mental Health Services, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tarek K. Rajji
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Geriatric Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Benoit H. Mulsant
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Conti EC, Stanley MA, Amspoker AB, Kunik ME. Sedative-Hypnotic Use Among Older Adults Participating in Anxiety Research. Int J Aging Hum Dev 2016; 85:3-17. [DOI: 10.1177/0091415016685330] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Older adults are prescribed sedative-hypnotic medications at higher rates than younger adults. These are not recommended for older adults due to risk of sedation, cognitive impairment, and falls. Severe generalized anxiety disorder (GAD) is a possibly appropriate use of these medications in older people, but little is available on use of sedative-hypnotic medications among older adults with GAD. This study examined the frequency and predictors of sedative-hypnotic medication use among older adults screening positive for anxiety. 25.88% ( n = 125) of participants reported taking sedative-hypnotics over the past 3 months; 16.36% ( n = 79) reported taking benzodiazepines, and 12.22% ( n = 59) reported taking hypnotic sleep medications. Depressive symptoms were more strongly associated with sedative-hypnotic use than insomnia or worry. Major depressive disorder and posttraumatic stress disorder, but not GAD, predicted sedative-hypnotic use. Other medications and treatments are more appropriate and efficacious for depression, anxiety, and insomnia in this population.
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Affiliation(s)
- Elizabeth C. Conti
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Melinda A. Stanley
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
- VA South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA
| | - Amber B. Amspoker
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Mark E. Kunik
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
- VA South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA
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Abstract
INTRODUCTION The updated American Geriatrics Society (AGS) 2015 Beers Criteria include the following antidepressant classes as potentially inappropriate medications to be used with caution in older adults: selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants, and mirtazapine. METHODS A search of the medical literature using PubMed and references included in the AGS 2015 Beers Criteria. RESULTS The treatment of depression in the older adult can additionally be complicated by comorbid conditions, as 80% of older adults have at least 1 comorbid condition and 50% have at least 2. These considerations limit the pharmacologic treatment options for depression in older adults. However, the treatment of major depression should not be overlooked, as it is quite common, with estimates of up to 5% of older adults in the community and up to 13.5% in older adults who receive home health care. DISCUSSION This article reviews treatment considerations of depression in the older adult, including both available screening tools and a discussion balancing the need for treatment of depression in this population with the concerns addressed in the 2015 Beers Criteria.
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Affiliation(s)
- Bridget Bradley
- Assistant Professor, Pacific University School of Pharmacy, Hillsboro, Oregon,
| | - Danielle Backus
- Assistant Professor, Pacific University School of Pharmacy, Hillsboro, Oregon
| | - Emily Gray
- PharmD Candidate, Pacific University School of Pharmacy, Hillsboro, Oregon
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Hanus RJ, Lisowe KS, Eickhoff JC, Kieser MA, Statz-Paynter JL, Zorek JA. Evaluation of a pharmacist-led pilot service based on the anticholinergic risk scale. J Am Pharm Assoc (2003) 2016; 56:555-61. [DOI: 10.1016/j.japh.2016.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 02/16/2016] [Accepted: 02/23/2016] [Indexed: 12/24/2022]
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Agudelo C, Aizenstein HJ, Karp JF, Reynolds CF. Applications of magnetic resonance imaging for treatment-resistant late-life depression. DIALOGUES IN CLINICAL NEUROSCIENCE 2016. [PMID: 26246790 PMCID: PMC4518699 DOI: 10.31887/dcns.2015.17.2/cagudelo] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Late-life depression (LLD) is a growing public and global health concern with diverse clinical manifestations and etiology. This literature review summarizes neuroimaging findings associated with depression in older adults and treatment-response variability. LLD has been associated with cerebral atrophy, diminished myelin integrity, and cerebral lesions in frontostriatal-limbic regions. These associations help explain the depression-executive dysfunction syndrome observed in LLD, and support cerebrovascular burden as a pathogenic mechanism. Furthermore, this review suggests that neuroimaging determinants of treatment resistance also reflect cerebrovascular burden. Of the theoretical etiologies of LLD, cerebrovascular burden may mediate treatment resistance. This review proposes that neuroimaging has the potential for clinical translation. Controlled trials may identify neuroimaging biomarkers that may inform treatment by identifying depressed adults likely to remit with pharmacotherapy, identifying individualized therapeutic dose, and facilitating earlier treatment response measures. Neuroimaging also has the potential to similarly inform treatment response variability from treatment with aripiprazole (dopamine modulator) and buprenorphine (opiate modulator).
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Affiliation(s)
- Christian Agudelo
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Howard J Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jordan F Karp
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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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.
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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
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Brown EL, Raue PJ, Halpert K. Evidence-Based Practice Guideline: Depression Detection in Older Adults With Dementia. J Gerontol Nurs 2015; 41:15-21. [DOI: 10.3928/00989134-20151015-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Belvederi Murri M, Amore M, Menchetti M, Toni G, Neviani F, Cerri M, Rocchi MBL, Zocchi D, Bagnoli L, Tam E, Buffa A, Ferrara S, Neri M, Alexopoulos GS, Zanetidou S. Physical exercise for late-life major depression. Br J Psychiatry 2015. [PMID: 26206864 DOI: 10.1192/bjp.bp.114.150516] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Interventions including physical exercise may help improve the outcomes of late-life major depression, but few studies are available. AIMS To investigate whether augmenting sertraline therapy with physical exercise leads to better outcomes of late-life major depression. METHOD Primary care patients (465 years) with major depression were randomised to 24 weeks of higher-intensity, progressive aerobic exercise plus sertraline (S+PAE), lower-intensity, non-progressive exercise plus sertraline (S+NPE) and sertraline alone. The primary outcome was remission (a score of ≤10 on the Hamilton Rating Scale for Depression). RESULTS A total of 121 patients were included. At study end, 45% of participants in the sertraline group, 73% of those in the S+NPE group and 81% of those in the S+PAE group achieved remission (P = 0.001). A shorter time to remission was observed in the S+PAE group than in the sertraline-only group. CONCLUSIONS Physical exercise may be a safe and effective augmentation to antidepressant therapy in late-life major depression.
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Affiliation(s)
- M Belvederi Murri
- Martino Belvederi Murri, MD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Mario Amore, MD, PhD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Marco Menchetti, MD, PhD, Department of Medical and Surgical Sciences, University of Bologna; Giulio Toni, MD, Cardiology Unit, Ramazzini Hospital, Carpi; Francesca Neviani, MD, PhD, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Matteo Cerri, MD, PhD, Department of Biomedical and Neuromotor Sciences, University of Bologna; Marco B. L. Rocchi, Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; Donato Zocchi, MD, Luigi Bagnoli, MD, primary care physicians, Bologna; Enrico Tam, PhD, Department of Movement and Neurological Sciences, University of Verona; Angela Buffa, MD, PhD, Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Serena Ferrara, PsyD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Mirco Neri, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; George S. Alexopoulos, MD, PhD, Department of Psychiatry, Weill Cornell Medical College, New York, USA; Stamatula Zanetidou, MD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - M Amore
- Martino Belvederi Murri, MD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Mario Amore, MD, PhD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Marco Menchetti, MD, PhD, Department of Medical and Surgical Sciences, University of Bologna; Giulio Toni, MD, Cardiology Unit, Ramazzini Hospital, Carpi; Francesca Neviani, MD, PhD, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Matteo Cerri, MD, PhD, Department of Biomedical and Neuromotor Sciences, University of Bologna; Marco B. L. Rocchi, Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; Donato Zocchi, MD, Luigi Bagnoli, MD, primary care physicians, Bologna; Enrico Tam, PhD, Department of Movement and Neurological Sciences, University of Verona; Angela Buffa, MD, PhD, Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Serena Ferrara, PsyD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Mirco Neri, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; George S. Alexopoulos, MD, PhD, Department of Psychiatry, Weill Cornell Medical College, New York, USA; Stamatula Zanetidou, MD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - M Menchetti
- Martino Belvederi Murri, MD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Mario Amore, MD, PhD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Marco Menchetti, MD, PhD, Department of Medical and Surgical Sciences, University of Bologna; Giulio Toni, MD, Cardiology Unit, Ramazzini Hospital, Carpi; Francesca Neviani, MD, PhD, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Matteo Cerri, MD, PhD, Department of Biomedical and Neuromotor Sciences, University of Bologna; Marco B. L. Rocchi, Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; Donato Zocchi, MD, Luigi Bagnoli, MD, primary care physicians, Bologna; Enrico Tam, PhD, Department of Movement and Neurological Sciences, University of Verona; Angela Buffa, MD, PhD, Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Serena Ferrara, PsyD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Mirco Neri, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; George S. Alexopoulos, MD, PhD, Department of Psychiatry, Weill Cornell Medical College, New York, USA; Stamatula Zanetidou, MD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - G Toni
- Martino Belvederi Murri, MD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Mario Amore, MD, PhD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Marco Menchetti, MD, PhD, Department of Medical and Surgical Sciences, University of Bologna; Giulio Toni, MD, Cardiology Unit, Ramazzini Hospital, Carpi; Francesca Neviani, MD, PhD, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Matteo Cerri, MD, PhD, Department of Biomedical and Neuromotor Sciences, University of Bologna; Marco B. L. Rocchi, Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; Donato Zocchi, MD, Luigi Bagnoli, MD, primary care physicians, Bologna; Enrico Tam, PhD, Department of Movement and Neurological Sciences, University of Verona; Angela Buffa, MD, PhD, Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Serena Ferrara, PsyD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Mirco Neri, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; George S. Alexopoulos, MD, PhD, Department of Psychiatry, Weill Cornell Medical College, New York, USA; Stamatula Zanetidou, MD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - F Neviani
- Martino Belvederi Murri, MD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Mario Amore, MD, PhD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Marco Menchetti, MD, PhD, Department of Medical and Surgical Sciences, University of Bologna; Giulio Toni, MD, Cardiology Unit, Ramazzini Hospital, Carpi; Francesca Neviani, MD, PhD, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Matteo Cerri, MD, PhD, Department of Biomedical and Neuromotor Sciences, University of Bologna; Marco B. L. Rocchi, Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; Donato Zocchi, MD, Luigi Bagnoli, MD, primary care physicians, Bologna; Enrico Tam, PhD, Department of Movement and Neurological Sciences, University of Verona; Angela Buffa, MD, PhD, Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Serena Ferrara, PsyD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Mirco Neri, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; George S. Alexopoulos, MD, PhD, Department of Psychiatry, Weill Cornell Medical College, New York, USA; Stamatula Zanetidou, MD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - M Cerri
- Martino Belvederi Murri, MD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Mario Amore, MD, PhD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Marco Menchetti, MD, PhD, Department of Medical and Surgical Sciences, University of Bologna; Giulio Toni, MD, Cardiology Unit, Ramazzini Hospital, Carpi; Francesca Neviani, MD, PhD, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Matteo Cerri, MD, PhD, Department of Biomedical and Neuromotor Sciences, University of Bologna; Marco B. L. Rocchi, Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; Donato Zocchi, MD, Luigi Bagnoli, MD, primary care physicians, Bologna; Enrico Tam, PhD, Department of Movement and Neurological Sciences, University of Verona; Angela Buffa, MD, PhD, Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Serena Ferrara, PsyD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Mirco Neri, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; George S. Alexopoulos, MD, PhD, Department of Psychiatry, Weill Cornell Medical College, New York, USA; Stamatula Zanetidou, MD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - M B L Rocchi
- Martino Belvederi Murri, MD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Mario Amore, MD, PhD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Marco Menchetti, MD, PhD, Department of Medical and Surgical Sciences, University of Bologna; Giulio Toni, MD, Cardiology Unit, Ramazzini Hospital, Carpi; Francesca Neviani, MD, PhD, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Matteo Cerri, MD, PhD, Department of Biomedical and Neuromotor Sciences, University of Bologna; Marco B. L. Rocchi, Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; Donato Zocchi, MD, Luigi Bagnoli, MD, primary care physicians, Bologna; Enrico Tam, PhD, Department of Movement and Neurological Sciences, University of Verona; Angela Buffa, MD, PhD, Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Serena Ferrara, PsyD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Mirco Neri, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; George S. Alexopoulos, MD, PhD, Department of Psychiatry, Weill Cornell Medical College, New York, USA; Stamatula Zanetidou, MD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - D Zocchi
- Martino Belvederi Murri, MD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Mario Amore, MD, PhD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Marco Menchetti, MD, PhD, Department of Medical and Surgical Sciences, University of Bologna; Giulio Toni, MD, Cardiology Unit, Ramazzini Hospital, Carpi; Francesca Neviani, MD, PhD, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Matteo Cerri, MD, PhD, Department of Biomedical and Neuromotor Sciences, University of Bologna; Marco B. L. Rocchi, Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; Donato Zocchi, MD, Luigi Bagnoli, MD, primary care physicians, Bologna; Enrico Tam, PhD, Department of Movement and Neurological Sciences, University of Verona; Angela Buffa, MD, PhD, Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Serena Ferrara, PsyD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Mirco Neri, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; George S. Alexopoulos, MD, PhD, Department of Psychiatry, Weill Cornell Medical College, New York, USA; Stamatula Zanetidou, MD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - L Bagnoli
- Martino Belvederi Murri, MD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Mario Amore, MD, PhD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Marco Menchetti, MD, PhD, Department of Medical and Surgical Sciences, University of Bologna; Giulio Toni, MD, Cardiology Unit, Ramazzini Hospital, Carpi; Francesca Neviani, MD, PhD, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Matteo Cerri, MD, PhD, Department of Biomedical and Neuromotor Sciences, University of Bologna; Marco B. L. Rocchi, Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; Donato Zocchi, MD, Luigi Bagnoli, MD, primary care physicians, Bologna; Enrico Tam, PhD, Department of Movement and Neurological Sciences, University of Verona; Angela Buffa, MD, PhD, Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Serena Ferrara, PsyD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Mirco Neri, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; George S. Alexopoulos, MD, PhD, Department of Psychiatry, Weill Cornell Medical College, New York, USA; Stamatula Zanetidou, MD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - E Tam
- Martino Belvederi Murri, MD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Mario Amore, MD, PhD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Marco Menchetti, MD, PhD, Department of Medical and Surgical Sciences, University of Bologna; Giulio Toni, MD, Cardiology Unit, Ramazzini Hospital, Carpi; Francesca Neviani, MD, PhD, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Matteo Cerri, MD, PhD, Department of Biomedical and Neuromotor Sciences, University of Bologna; Marco B. L. Rocchi, Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; Donato Zocchi, MD, Luigi Bagnoli, MD, primary care physicians, Bologna; Enrico Tam, PhD, Department of Movement and Neurological Sciences, University of Verona; Angela Buffa, MD, PhD, Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Serena Ferrara, PsyD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Mirco Neri, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; George S. Alexopoulos, MD, PhD, Department of Psychiatry, Weill Cornell Medical College, New York, USA; Stamatula Zanetidou, MD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - A Buffa
- Martino Belvederi Murri, MD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Mario Amore, MD, PhD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Marco Menchetti, MD, PhD, Department of Medical and Surgical Sciences, University of Bologna; Giulio Toni, MD, Cardiology Unit, Ramazzini Hospital, Carpi; Francesca Neviani, MD, PhD, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Matteo Cerri, MD, PhD, Department of Biomedical and Neuromotor Sciences, University of Bologna; Marco B. L. Rocchi, Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; Donato Zocchi, MD, Luigi Bagnoli, MD, primary care physicians, Bologna; Enrico Tam, PhD, Department of Movement and Neurological Sciences, University of Verona; Angela Buffa, MD, PhD, Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Serena Ferrara, PsyD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Mirco Neri, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; George S. Alexopoulos, MD, PhD, Department of Psychiatry, Weill Cornell Medical College, New York, USA; Stamatula Zanetidou, MD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - S Ferrara
- Martino Belvederi Murri, MD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Mario Amore, MD, PhD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Marco Menchetti, MD, PhD, Department of Medical and Surgical Sciences, University of Bologna; Giulio Toni, MD, Cardiology Unit, Ramazzini Hospital, Carpi; Francesca Neviani, MD, PhD, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Matteo Cerri, MD, PhD, Department of Biomedical and Neuromotor Sciences, University of Bologna; Marco B. L. Rocchi, Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; Donato Zocchi, MD, Luigi Bagnoli, MD, primary care physicians, Bologna; Enrico Tam, PhD, Department of Movement and Neurological Sciences, University of Verona; Angela Buffa, MD, PhD, Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Serena Ferrara, PsyD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Mirco Neri, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; George S. Alexopoulos, MD, PhD, Department of Psychiatry, Weill Cornell Medical College, New York, USA; Stamatula Zanetidou, MD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - M Neri
- Martino Belvederi Murri, MD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Mario Amore, MD, PhD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Marco Menchetti, MD, PhD, Department of Medical and Surgical Sciences, University of Bologna; Giulio Toni, MD, Cardiology Unit, Ramazzini Hospital, Carpi; Francesca Neviani, MD, PhD, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Matteo Cerri, MD, PhD, Department of Biomedical and Neuromotor Sciences, University of Bologna; Marco B. L. Rocchi, Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; Donato Zocchi, MD, Luigi Bagnoli, MD, primary care physicians, Bologna; Enrico Tam, PhD, Department of Movement and Neurological Sciences, University of Verona; Angela Buffa, MD, PhD, Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Serena Ferrara, PsyD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Mirco Neri, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; George S. Alexopoulos, MD, PhD, Department of Psychiatry, Weill Cornell Medical College, New York, USA; Stamatula Zanetidou, MD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - G S Alexopoulos
- Martino Belvederi Murri, MD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Mario Amore, MD, PhD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Marco Menchetti, MD, PhD, Department of Medical and Surgical Sciences, University of Bologna; Giulio Toni, MD, Cardiology Unit, Ramazzini Hospital, Carpi; Francesca Neviani, MD, PhD, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Matteo Cerri, MD, PhD, Department of Biomedical and Neuromotor Sciences, University of Bologna; Marco B. L. Rocchi, Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; Donato Zocchi, MD, Luigi Bagnoli, MD, primary care physicians, Bologna; Enrico Tam, PhD, Department of Movement and Neurological Sciences, University of Verona; Angela Buffa, MD, PhD, Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Serena Ferrara, PsyD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Mirco Neri, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; George S. Alexopoulos, MD, PhD, Department of Psychiatry, Weill Cornell Medical College, New York, USA; Stamatula Zanetidou, MD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
| | - S Zanetidou
- Martino Belvederi Murri, MD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy, and Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Mario Amore, MD, PhD, Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Marco Menchetti, MD, PhD, Department of Medical and Surgical Sciences, University of Bologna; Giulio Toni, MD, Cardiology Unit, Ramazzini Hospital, Carpi; Francesca Neviani, MD, PhD, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena; Matteo Cerri, MD, PhD, Department of Biomedical and Neuromotor Sciences, University of Bologna; Marco B. L. Rocchi, Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino; Donato Zocchi, MD, Luigi Bagnoli, MD, primary care physicians, Bologna; Enrico Tam, PhD, Department of Movement and Neurological Sciences, University of Verona; Angela Buffa, MD, PhD, Unit of Internal Medicine, Geriatrics and Nephrology, S. Orsola Malpighi Hospital, Bologna; Serena Ferrara, PsyD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna; Mirco Neri, Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; George S. Alexopoulos, MD, PhD, Department of Psychiatry, Weill Cornell Medical College, New York, USA; Stamatula Zanetidou, MD, Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy; the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group
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Abstract
This article aims to discuss the rapidly growing field of palliative medicine and its unique approach to treating depression in older adults.
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Olagunju AT, Olutoki MO, Ogunnubi OP, Adeyemi JD. Late-life depression: Burden, severity and relationship with social support dimensions in a West African community. Arch Gerontol Geriatr 2015; 61:240-6. [PMID: 26003904 DOI: 10.1016/j.archger.2015.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 05/04/2015] [Accepted: 05/05/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The occurrence of depression in old age is often linked with grave consequences. The purpose of this study is to investigate the burden of depression and its relationship with perceived social support among the elderly in a West African community setting. METHODS In this cross-sectional study, participants made up of 350 elders aged 60 years and above were selected through multi-stage random sampling technique. All participants were interviewed with designed questionnaire, multidimensional scale of perceived social support (MSPSS) and Geriatric Depression Scale (GDS) to elicit socio-demographic profile, social support and depressive psychopathology respectively. RESULTS The participants were largely females (52.9%) and their mean age was 68.8±7.3 years. A little above one-quarter (26.4%) had depressive episode, and mild severity was preponderant. Low level of social support was associated with depression (χ(2)=8.418, p=0.004); especially low social supports from significant others (χ(2)=3.989, p=0.046) and family members (χ(2)=4.434, p=0.035). Similarly, severity of depression in the elderly correlated negatively with availability of social support from significant others (χ(2)=5.495, p=0.019) and family members (χ(2)=5.149, p=0.023). CONCLUSION Considering the burden of depression in this elderly population and the influential roles of social support especially from family and significant others on depression; strengthening of informal social support and formal social support for the elders is advocated. In addition, design of community based geriatric mental health with social services and articulation of public policy to address old age needs are implied.
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Affiliation(s)
- Andrew Toyin Olagunju
- Department of Psychiatry, College of Medicine, University of Lagos, PMB 12003, Lagos, Nigeria; Department of Psychiatry, Lagos University Teaching Hospital, PMB 12003, Lagos, Nigeria.
| | - Michael Olasunkanmi Olutoki
- Federal Neuropsychiatric Hospital, Yaba, PMB 2008, Lagos, Nigeria; Federal Neuropsychiatric Hospital, Calabar, PMB 1052, Calabar, Cross River State, Nigeria
| | | | - Joseph Dada Adeyemi
- Department of Psychiatry, College of Medicine, University of Lagos, PMB 12003, Lagos, Nigeria; Department of Psychiatry, Lagos University Teaching Hospital, PMB 12003, Lagos, Nigeria
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Dmitrieva NO, Fyffe D, Mukherjee S, Fieo R, Zahodne LB, Hamilton J, Potter GG, Manly JJ, Romero HR, Mungas D, Gibbons LE. Demographic characteristics do not decrease the utility of depressive symptoms assessments: examining the practical impact of item bias in four heterogeneous samples of older adults. Int J Geriatr Psychiatry 2015; 30:88-96. [PMID: 24737612 PMCID: PMC4198512 DOI: 10.1002/gps.4121] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 03/10/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Previous studies have identified differential item function (DIF) in depressive symptoms measures, but the impact of DIF has been rarely reported. Given the critical importance of depressive symptoms assessment among older adults, we examined whether DIF due to demographic characteristics resulted in salient score changes in commonly used measures. METHODS Four longitudinal studies of cognitive aging provided a sample size of 3754 older adults and included individuals both with and without a clinical diagnosis of major depression. Each study administered at least one of the following measures: the Center for Epidemiologic Studies Depression scale (20-item ordinal response or 10-item dichotomous response versions), the Geriatric Depression Scale, and the Montgomery-Åsberg Depression Rating Scale. Hybrid logistic regression-item response theory methods were used to examine the presence and impact of DIF due to age, sex, race/ethnicity, and years of education on the depressive symptoms items. RESULTS Although statistically significant DIF due to demographic factors was present on several items, its cumulative impact on depressive symptoms scores was practically negligible. CONCLUSIONS The findings support substantive meaningfulness of previously reported demographic differences in depressive symptoms among older adults, showing that these individual differences were unlikely to have resulted from item bias attributable to demographic characteristics we examined.
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Affiliation(s)
- Natalia O. Dmitrieva
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC 27710, U.S.A
| | - Denise Fyffe
- Kessler Foundation Research Center, Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers, the State University of New Jersey, West Orange, NJ 07052, U.S.A
| | | | - Robert Fieo
- Cognitive Neuroscience Division, Department of Neurology and Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY 10032, U.S.A
| | - Laura B. Zahodne
- Cognitive Neuroscience Division, Department of Neurology and Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY 10032, U.S.A
| | - Jamie Hamilton
- Cognitive Neuroscience Division, Department of Neurology and Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY 10032, U.S.A
| | - Guy G. Potter
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC 27710, U.S.A
- Joseph and Kathleen Bryan Alzheimer’s Disease Research Center, Duke University Medical Center, Durham, NC 27705, U.S.A
| | - Jennifer J. Manly
- Cognitive Neuroscience Division, Department of Neurology and Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY 10032, U.S.A
| | - Heather R. Romero
- Joseph and Kathleen Bryan Alzheimer’s Disease Research Center, Duke University Medical Center, Durham, NC 27705, U.S.A
- Department of Psychology, University of Notre Dame, Notre Dame, IN 46556, U.S.A
| | - Dan Mungas
- Department of Neurology, University of California, Davis, University of California, Davis Medical Center, Sacramento, CA 95817, U.S.A
| | - Laura E. Gibbons
- General Internal Medicine, University of Washington, Seattle, WA 98104, U.S.A
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Alamo C, López-Muñoz F, García-García P, García-Ramos S. Risk-benefit analysis of antidepressant drug treatment in the elderly. Psychogeriatrics 2014; 14:261-8. [PMID: 25495088 DOI: 10.1111/psyg.12057] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 07/18/2014] [Indexed: 01/01/2023]
Abstract
Depression in the elderly is a significant health issue that has the potential to seriously affect physical and emotional well-being. Therefore, the treatment of geriatric depression is necessary. Antidepressant treatment in older depressed patients is efficacious, but differences in the effectiveness of different classes of antidepressants have not been demonstrated. However, differences in tolerability profile are most recognizable in the elderly. With ageing, a series of changes occur in the elderly that modify both the pharmacokinetics and pharmacodynamics of antidepressants and may influence the efficacy, tolerability and safety of treatment in the elderly. Comorbidities require the use of other drugs, which increases the possibility of drug-drug interactions. Given these aspects, individualized therapy for each elderly patient is needed to achieve acceptable risk-benefit ratio. Effective treatment of depression in the elderly, which may require combined pharmacological with psychosocial treatment, can decrease both morbidity and mortality; it also may lead to reduced demands on family members and on health-care and social services.
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Affiliation(s)
- Cecilio Alamo
- Department of Biomedical Sciences (Pharmacology Area), Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain
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31
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Shiroma PR, Thuras P, Johns B, Lim KO. Emotion recognition processing as early predictor of response to 8-week citalopram treatment in late-life depression. Int J Geriatr Psychiatry 2014; 29:1132-9. [PMID: 24706294 DOI: 10.1002/gps.4104] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 02/24/2014] [Accepted: 02/25/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND In subjects with depression, exposure to antidepressants improves recognition of positive emotions. This phenomenon, which occurs early in the course of treatment, has been proposed as the initial step in the mechanism of action to subsequent therapeutic effects of antidepressants. To this date, it has not been well examined among older depressed patients. METHOD Older subjects with non-psychotic major depressive disorder were treated with citalopram in an 8-week open-label study. The main predictor of response and remission was the change in emotion recognition between baseline and day 7. Covariates included executive functions, baseline anxiety level, medical comorbidity, level of subjective stress, serum citalopram level, and level of social support. RESULTS Twenty-seven patients were considered for final analysis. Overall, accuracy of emotion recognition significantly improved between baseline (75%) and day 7 (83%) (X(2) = 34.50, df = 1, p < 0.001). Improvement to identify happy expressions occurred at 25% and 50% intensity with ceiling effect at 0%, 75%, and 100%. Change in emotion processing was marginally significant in predicting antidepressant response at day 56. Multivariate analysis showed that emotion processing is a significant predictor of response and remission when considered along with perceived level of social support. CONCLUSIONS Recognition of mildly intense happy expression, which improved early in the course of citalopram treatment, predicts subsequent antidepressant response and remission when considered along with perception of social support. Further studies would be necessary to examine specific neural substrates in the affective network involved in the acute therapeutic action of antidepressant in late-life depression.
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Affiliation(s)
- Paulo R Shiroma
- Mental Health Service Line, Minneapolis VA Medical Center, Minneapolis, MN, USA; Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
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Etchepare F, Sanglier T, André M, Verdoux H, Tournier M. Antidepressant treatment patterns in younger and older adults from the general population in a real-life setting. Int J Geriatr Psychiatry 2014; 29:928-35. [PMID: 24477963 DOI: 10.1002/gps.4081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 12/23/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The treatment of depression in real-life settings appears to be influenced by health care systems. Antidepressant drugs have been found to be underused in the older population relative to younger adults when refunding of such drugs is poor. No study assessed the pattern of antidepressant use according to age in a universal health care system. The objective is to assess whether the pattern of antidepressant drug use differs between younger and older adults with respect to treatment duration, adherence to treatment, coprescription of other psychotropic drugs, switch, or combination of antidepressant drugs. METHODS A historical cohort study included 7747 older (65+ years) and 27,306 younger (younger than 65 years) adults representative of the beneficiaries of the French national health care insurance system who initiated a new antidepressant treatment. Follow-up after treatment initiation was at least 6 months. RESULTS Older patients had a significantly longer duration of treatment than younger adults (hazard ratio = 0.90; 95%CI[0.88-0.93]). Adherence was more often good in older than in younger adults when the treatment was initiated by a general practitioner (23.4% vs. 16.7%; Odds ratio (OR) = 1.35[1.25-1.46]), a hospital practitioner (OR = 1.68[1.40-2.03]) or another specialist (OR = 1.60[1.19-2.17]). The coprescription of psychotropic drugs decreased with older age in men (OR = 0.77[0.70-0.85]) and increased with older age in women (OR = 1.14[1.07-1.22]). Switches and combinations of antidepressants were not associated with age. CONCLUSION In a universal health care system, with similar reimbursement of drugs regardless of age, treatment duration, and adherence were better in the older patients than in the younger ones.
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Affiliation(s)
- Fanny Etchepare
- INSERM U657, Bordeaux, France; Université de Bordeaux, Bordeaux, France
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Abstract
Depression is related to disability and affects rehabilitation participation, outcomes, and compliance with treatment. Improving older adult depression detection and referral requires knowledge, skills, supportive organizational policies, and access to mental health experts. This review provides a selected overview of evidence-based approaches for screening of suspected cases of depression in older adults by physical therapists and other non-mental health professionals and discusses procedures to refer suspected cases to primary care providers and/or mental health specialists for evaluation, including resources and a tool to assist in communicating depression-related information to the primary care provider or mental health specialist. We hope that this review will promote the incorporation of evidence-based screening and referral of suspected cases of depression in older adults into routine practice.
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Affiliation(s)
- Edgar Ramos Vieira
- 1College of Nursing and Health Sciences, Florida International University, Miami. 2Weill Cornell Medical College, Cornell University, White Plains, New York
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Olutoki MO, Olagunju AT, Adeyemi JD. Correlates of depressive illness among the elderly in a mixed urban community in Lagos, Nigeria. Aging Ment Health 2014; 18:561-9. [PMID: 24102150 DOI: 10.1080/13607863.2013.843156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Little is known about the factors associated with depression among elderly Nigerians despite research evidence suggesting that some correlates of depression may be important in early detection, treatment and prognosis. This study aimed to determine the correlates of depression among a community based elderly population. METHODS The study population made up of 350 consenting participants was selected using multistage stratified random sampling technique. Face-to-face interviews were conducted among the participants using a research instrument consisting of two parts: a self-designed questionnaire to elicit their socio-demographic profile, level of social support as well as their health status and the 30-item Geriatric Depression Scale to diagnose depression using cut-off score ≥11. Both the English and Yoruba versions of the study instruments were used depending on the level of education of the participants. RESULTS Depression was found to be associated with being younger old (χ(2) = 6.19, p = 0.045), prolonged stay in current residence (χ(2) = 6.62, p = 0.01), living in less developed area of the community and not having children (χ(2) = 0.03, p = 0.01), while higher social support (χ(2) = 4.19, p = 0.041) seems protective. However, only low social support (odds ratio [OR] = 0.573; 95% confidence interval [CI], 0.330-0.994; p = 0.048), living in less developed area (OR = 5.342; 95% CI = 1.027, 27.776; p = 0.046) and prolonged stay in current residence (OR = 0.407; 95% CI = 0.205, 0.806; p = 0.01) independently predicted depression in participants. CONCLUSION To enhance early detection and treatment of depressive disorders in the elderly, physicians should be alert to the diagnosis of depression in late life, especially among the younger old, elderly not having children, those with low social support as well as prolonged stay in a residence and living in less developed parts of the community. Further research is needed to shed light on the intriguing link between depression and associated factors in geriatric population.
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Mulsant BH, Blumberger DM, Ismail Z, Rabheru K, Rapoport MJ. A systematic approach to pharmacotherapy for geriatric major depression. Clin Geriatr Med 2014; 30:517-34. [PMID: 25037293 DOI: 10.1016/j.cger.2014.05.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The broadening use of antidepressants among older Americans has not been associated with a notable decrease in the burden of geriatric depression. This article, based on a selective review of the literature, explores several explanations for this paradox. The authors propose that the effectiveness of antidepressants depends in large part on the way they are used. Evidence supports that antidepressant pharmacotherapy leads to better outcomes when guided by a treatment algorithm as opposed to attempting to individualize treatment. Several published guidelines and pharmacotherapy algorithms developed for the treatment of geriatric depression are reviewed, and an updated algorithm proposed.
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Affiliation(s)
- Benoit H Mulsant
- Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, Ontario M6J 1H4, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada.
| | - Daniel M Blumberger
- Department of Psychiatry, Faculty of Medicine, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, Ontario M6J 1H4, Canada
| | - Zahinoor Ismail
- Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, Ontario M6J 1H4, Canada; Hotchkiss Brain Institute, Foothills Hospital, University of Calgary, 1403 29th Street Northwest, Calgary, Alberta T2N 2T9, Canada
| | - Kiran Rabheru
- Geriatric Psychiatry & ECT Program, Department of Psychiatry, The Ottawa Hospital, University of Ottawa, 75 Bruyere Street, Suite 137 Y, Ottawa, Ontario K1N 5C7, Canada
| | - Mark J Rapoport
- Department of Psychiatry, Faculty of Medicine, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada; Sunnybrook Health Sciences Centre, FG37-2075 Bayview Avenue, Toronto, Ontario M4C 5N6, Canada
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Brahm NC, Kelly-Rehm MC. Antidepressant-mediated gastroesophageal reflux disease. ACTA ACUST UNITED AC 2014; 26:274-8. [PMID: 21486738 DOI: 10.4140/tcp.n.2011.274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Anticholinergic effects of medications are factors in autonomic control of the lower esophageal sphincter function. Changes in sphincter control often lead to gastroesophageal reflux disease (GERD), a chronic disease with a prevalence of up to 25% for adults. This effect is a consideration in the treatment of depression, the fourth-leading disease burden. Lower esophageal-sphincter changes are well documented in association with tricyclic antidepressants. The newer medications, selective serotonin-reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors, are often used as first-line agents. This case report reviews the emergence of GERD in association with the use of newer agents. The patient, a 55-year-old woman, presented to her primary care physician with complaints of low energy, dysphoric mood, and anhedonia of several months' duration. Trials of citalopram and escitalopram were associated with reports of persistent nausea and gastric reflux unresolved by changes in dosing schedule or positioning. Over-the-counter omeprazole on an as-needed basis was added. Ultimately, the patient was successfully managed with desvenlafaxine for dysphoric mood and low energy and scheduled administration of omeprazole for GERD. The adverse drug reaction was evaluated using the Naranjo Adverse Drug Reaction Probability Scale. This methodology indicated a probable relationship (score of 7 out of 12) between initiation of antidepressant therapy and the presentation of GERD symptoms. When evaluating patient response to medication, inquiring about new-onset symptoms may help assess pharmacotherapy, identify potential medication-related effects such as the anticholinergic profile, evaluate the need to add an antisecretory/antispasmodic agent, or consider an alternative treatment strategy.
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Affiliation(s)
- Nancy C Brahm
- The University of Oklahoma College of Pharmacy, Tulsa, Oklahoma
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Cooley ME, Lobach DF, Johns E, Halpenny B, Saunders TA, Del Fiol G, Rabin MS, Calarese P, Berenbaum IL, Zaner K, Finn K, Berry DL, Abrahm JL. Creating computable algorithms for symptom management in an outpatient thoracic oncology setting. J Pain Symptom Manage 2013; 46:911-924.e1. [PMID: 23680580 PMCID: PMC4096777 DOI: 10.1016/j.jpainsymman.2013.01.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 01/12/2013] [Accepted: 01/28/2013] [Indexed: 10/26/2022]
Abstract
CONTEXT Adequate symptom management is essential to ensure quality cancer care, but symptom management is not always evidence based. Adapting and automating national guidelines for use at the point of care may enhance use by clinicians. OBJECTIVES This article reports on a process of adapting research evidence for use in a clinical decision support system that provided individualized symptom management recommendations to clinicians at the point of care. METHODS Using a modified ADAPTE process, panels of local experts adapted national guidelines and integrated research evidence to create computable algorithms with explicit recommendations for management of the most common symptoms (pain, fatigue, dyspnea, depression, and anxiety) associated with lung cancer. RESULTS Small multidisciplinary groups and a consensus panel, using a nominal group technique, modified and subsequently approved computable algorithms for fatigue, dyspnea, moderate pain, severe pain, depression, and anxiety. The approved algorithms represented the consensus of multidisciplinary clinicians on pharmacological and behavioral interventions tailored to the patient's age, comorbidities, laboratory values, current medications, and patient-reported symptom severity. Algorithms also were reconciled with one another to enable simultaneous management of several symptoms. CONCLUSION A modified ADAPTE process and nominal group technique enabled the development and approval of locally adapted computable algorithms for individualized symptom management in patients with lung cancer. The process was more complex and required more time and resources than initially anticipated, but it resulted in computable algorithms that represented the consensus of many experts.
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Affiliation(s)
- Mary E Cooley
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
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Psychotropic prescribing in the oldest old attending a geriatric psychiatry service: a retrospective, cross-sectional study. Ir J Psychol Med 2013; 30:187-196. [PMID: 30189496 DOI: 10.1017/ipm.2013.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE More people are living beyond their 90s, yet this group has not been much studied. This study aimed to describe a sample of non-agenarians and centerians attending an old age psychiatry service with a focus on pharmacotherapy. METHODS Retrospective, cross-sectional survey of patients aged >90 in contact with the Department of Old Age Psychiatry in a university hospital over a 1-year period. Results were compared with the Beers, the Canadian and Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria. RESULTS A total of 65 nonagenarians or centerians were identified (mean age 93, 82% female). The majority (65%) resided in a nursing home; dementia was the most common diagnosis (77%), followed by depression (29%). The most commonly prescribed psychotropics were antidepressants (58%), followed by antipsychotics (45%), hypnotics (42%), anti-dementia agents (31%) and anxiolytics (26%). Overall, patients were on a mean of 2.1 (S.D. 1.3, range 0-5) psychotropics and 4.99 (S.D. 2.7, range 0-11) non-psychotropics. Mean Mini Mental State Examination (MMSE) score was 15 (S.D. 8.1). Increasing anticholinergic burden was negatively associated with MMSE scores (B = -1.72, p = 0.013). Residing in a nursing home was associated with a higher rate of antidepressant [OR 5.71 (95% CI 1.9-17.4)], anxiolytic [OR 13.5 (95% CI 1.7-110.4)] and antipsychotic [OR 3.4 (95% CI 1.1-10.4)] use. Potentially inappropriate prescribing included long-term benzodiazepine use (26%) and long-term antipsychotic use (25%). CONCLUSIONS Our sample had a high psychiatric morbidity burden with high levels of psychotropic use. Ongoing review and audit of psychotropic use in elderly patients can identify potentially inappropriate prescribing in a group vulnerable to high levels of polypharmacy and extended psychotropic use.
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Willet MN, Hayes DK, Zaha RL, Fuddy LJ. Social-emotional support, life satisfaction, and mental health on reproductive age women's health utilization, US, 2009. Matern Child Health J 2012; 16 Suppl 2:203-12. [PMID: 22956364 PMCID: PMC4545528 DOI: 10.1007/s10995-012-1096-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
To examine the associations among social-emotional support, life satisfaction, and mental health with not having a routine checkup among women of reproductive age in the US, data from the 2009 Behavioral Risk Factor Surveillance System, a population-based telephone survey of health behaviors, were analyzed among reproductive aged (18-44 years) women in the US. Prevalence estimates were calculated for not having a routine checkup in the past year with measures of social-emotional support, life satisfaction, and mental distress. Independent multivariable logistic regressions for each measure assessed not having a routine checkup within the past year with adjustment for age, race/ethnicity, education level, and health care coverage. Among women of reproductive age, 33.7 % (95 % CI 33.0-34.4) did not have a routine checkup within the past year. Factors associated with not having a routine checkup included: having social-emotional support most of the time (AOR = 1.29, 95 % CI 1.20-1.38) or sometimes or less (AOR = 1.47, 95 % CI 1.34-1.61) compared to those who reported always having the social-emotional support they need; reporting life satisfaction as being satisfied (AOR = 1.27, 95 % CI 1.19-1.36) or dissatisfied (AOR = 1.65, 95 % CI 1.43-1.91) compared to being very satisfied; and frequent mental distress (AOR = 1.19, 95 % CI 1.09-1.30) compared to those without. Women who report lower levels of social-emotional support, less life satisfaction, and frequent mental distress are less likely to see a doctor for a routine checkup. Targeted outreach that provides appropriate support are needed so these women can access clinical services to increase exposure to preventive health opportunities and improve overall health.
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Affiliation(s)
- Michelle N. Willet
- Family Health Services Division, Hawaii State Department of Health, 3652 Kilauea Avenue, Honolulu, HI 96816, USA
| | - Donald K. Hayes
- Family Health Services Division, Hawaii State Department of Health, 3652 Kilauea Avenue, Honolulu, HI 96816, USA,
| | - Rebecca L. Zaha
- Family Health Services Division, Hawaii State Department of Health, 3652 Kilauea Avenue, Honolulu, HI 96816, USA
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Scuteri A, Modestino A, Fedullo F, Assisi AP, Gianni W. Depression treatment selectively modifies arterial stiffness in older participants. J Gerontol A Biol Sci Med Sci 2012; 68:719-25. [PMID: 23160364 DOI: 10.1093/gerona/gls230] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Depression is emerging as an independent cardiovascular disease risk factor. We investigated whether treating depression in older participants impacted on arterial stiffness, a known cardiovascular disease risk factor and a clinical marker of arterial aging. METHODS Seventy-five participants with pulse wave velocity (PWV), the gold standard measure for arterial stiffness, at baseline and at 12-month follow-up were included. Depressed patients were randomized to escitalopram (10mg/d) or to duloxetine (60mg/d). In patients without depression, no antidepressant therapy was started. The psychologist and the doctor measuring PWV were both unaware of antidepressant treatment. RESULTS At study entry, no difference in PWV were observable in the three groups of participants. A significant time × drug interaction term (p < .05) was observed for the impact of antidepressant therapy on PWV by analysis of covariance analysis. After 12 months of therapy, duloxetine treatment resulted in a significant (+21%) and escitalopram treatment in a not significant (6%) PWV increase. These changes in PWV were accompanied by a similar increase in blood pressure and LDL cholesterol in the two treated groups. However, duloxetine resulted in a significant 10% greater heart rate after 12 months that was not observable in participants treated with escitalopram nor in not-depressed older participants. Multiple regression models revealed that a drug-specific effect on PWV persisted after controlling for cardiovascular risk factor levels. CONCLUSION Duloxetine but not escitalopram significantly increased PWV in older depressed participants after 12 months of treatment. The effect was not fully explained by concomitant changes in traditional cardiovascular risk factors known to significantly impact arterial stiffness.
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Depression interventions among racial and ethnic minority older adults: a systematic review across 20 years. Am J Geriatr Psychiatry 2012; 20:915-31. [PMID: 22828202 PMCID: PMC3479358 DOI: 10.1097/jgp.0b013e31825d091a] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
While there is strong evidence in support of geriatric depression treatments, much less is available with regard to older U.S. racial and ethnic minorities. The objectives of this review are to identify and appraise depression treatment studies tested with samples of U.S. racial and ethnic minority older adults. We include an appraisal of sociocultural adaptations made to the depression treatments in studies meeting our final criteria. Systematic search methods were utilized to identify research published between 1990 and 2010 that describe depression treatment outcomes for older adults by racial/ethnic group, or for samples of older adults who are primarily (i.e., >50%) racial/ethnic minorities. Twenty-three unduplicated articles included older adults and seven met all inclusion criteria. Favorable depression treatment effects were observed for older minorities across five studies that took place in different types of settings and with varying levels of sociocultural adaptations. The effectiveness of depression care remains mixed, although collaborative or integrated care shows promise for African Americans and Latinos. The degree to which the findings generalize to non-English-speaking, low acculturated, and low-income older persons, and to other older minority groups (i.e., Asian and Pacific Islanders, and American Indian and Alaska Natives), remains unclear. Given the high disease burden among older minorities with depression, it is imperative to provide timely, accessible, and effective depression treatments. Increasing their participation in behavioral health research should be a national priority.
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Barry LC, Abou JJ, Simen AA, Gill TM. Under-treatment of depression in older persons. J Affect Disord 2012; 136:789-96. [PMID: 22030136 PMCID: PMC3272123 DOI: 10.1016/j.jad.2011.09.038] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 09/23/2011] [Accepted: 09/28/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Due to the cross-sectional design of most existing studies, longitudinal characterization of treatment for depression in older persons is largely unknown. METHOD Seven hundred fifty-four men and women (aged 70+ years) underwent monthly assessments of mental health professional use and 18-month assessments of antidepressant medication use and depressive symptoms over 9 years. Scores of ≥20 on the Center for Epidemiological Studies-Depression (CES-D) scale denoted depression. We evaluated trends in depression treatment over time in the entire sample and among the depressed participants. Using generalized linear models, we determined characteristics associated with receiving treatment for depression in these groups and among those with persistent depression. RESULTS During the 9-year follow-up period (1998-2007), 339 (45.0%) of the participants reported depression treatment. Over time, antidepressant use alone decreased (p trend<0.001) while treatment with both antidepressants and a mental health professional increased (p trend=0.002). Of the 286 (27.9%) depressed participants, between 43% and 69% did not receive depression treatment during any 18-month interval. 30.5% of the 121 participants with persistent depression did not receive treatment during the study period. Increasing number of years of education, decreasing cognitive status score, and being physically frail were associated with a higher likelihood of receiving treatment in all models. LIMITATIONS Pre-baseline depression, pre-baseline treatment, and indication for treatment were unavailable. CONCLUSIONS Our findings indicate that the profile of treatment for depression in older persons has changed over time, that depressed older persons, including those with persistent depression, are under-treated, and that patient characteristics influence receipt of treatment.
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Affiliation(s)
- Lisa C. Barry
- UConn Center on Aging, University of Connecticut Health Center, Farmington, Connecticut
| | - Janet J. Abou
- University of California Los Angeles Medical Center, Los Angeles, California
| | - Arthur A. Simen
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Thomas M. Gill
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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Impact of Medicare Part D on antidepressant treatment, medication choice, and adherence among older adults with depression. Am J Geriatr Psychiatry 2011; 19:989-97. [PMID: 22123272 PMCID: PMC3233981 DOI: 10.1097/jgp.0b013e3182051a9b] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Depression in older adults is often undertreated due, in part, to medication costs. We examined the impact of improved prescription drug coverage under Medicare Part D on use of antidepressants, medication choice, and adherence. DESIGN, SETTING AND PARTICIPANTS Observational claims-based study of older adults with depression (ICD-9: 296.2, 296.3, 311, 300.4) continuously enrolled in a Medicare managed care plan between 2004 and 2007. Three groups with limited ($150 or $350 quarterly caps) or no drug coverage in 2004-2005 obtained Part D benefits in 2006. A comparison group had stable employer-sponsored coverage throughout. MEASUREMENTS Any antidepressant prescription fill, antidepressant choice (tricyclics or monoamine oxidase inhibitors versus newer antidepressants), and adherence (80% of days covered) in the first 6 months of treatment. RESULTS : Part D was associated with increased odds of any antidepressant use among those who previously lacked coverage (odds ratio [OR] 1.61, 95% confidence interval [CI] 1.41-1.85) but odds of use did not change among those with limited prior coverage. Use of older antidepressant agents did not change with Part D. All three groups whose coverage improved with Part D had significantly higher odds of 80% of days covered with an antidepressant (OR = 1.86 [95% CI: 1.44-2.39] for no coverage, 1.74 [95% CI: 1.25%3.42] for $150 cap; and 1.19 [95% CI: 1.06-1.34] for the $350 cap groups). CONCLUSIONS Medicare Part D was associated with improvements in antidepressant use and adherence in depressed older adults who previously had no or limited drug coverage but not with changes in use of older agents. use and adherence in depressed older adults who previously had no or limited drug coverage but not with changes in use of older agents.
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Andreescu C, Reynolds CF. Late-life depression: evidence-based treatment and promising new directions for research and clinical practice. Psychiatr Clin North Am 2011; 34:335-55, vii-iii. [PMID: 21536162 PMCID: PMC8442985 DOI: 10.1016/j.psc.2011.02.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
As the population ages, successive cohorts of older adults will experience depressive disorders. Late-life depression (LLD) carries additional risk for suicide, medical comorbidity, disability, and family caregiving burden. Although response and remission rates to pharmacotherapy and electroconvulsive therapy are comparable with those in midlife depression, relapse rates are higher, underscoring the challenge to achieve and maintain wellness. This article reviews the evidence base for LLD treatment options and provides an analysis of treatment options for difficult-to-treat LLD variants (eg, psychotic depression, vascular depression). Treatment algorithms are also reviewed based on predictors of response and promising novel treatment options.
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Affiliation(s)
- Carmen Andreescu
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, 3811 O’Hara Street, 247 Sterling Plaza, Pittsburgh, PA 15213, USA
| | - Charles F. Reynolds
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, 3811 O’Hara Street, 758 Bellefield Towers, Pittsburgh, PA 15213, USA,Corresponding author.
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Stojanović-Špehar S, Ozretić L, Blažeković-Milaković S, Bergman-Marković B. Late life depression: Challenge or curse for the general practitioner (GP). A cohort study. Arch Gerontol Geriatr 2011; 52:e134-9. [DOI: 10.1016/j.archger.2010.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 09/07/2010] [Accepted: 09/11/2010] [Indexed: 11/26/2022]
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Abstract
AbstractThis article reviews common sources of suffering in patients with advanced illness, identifies challenges in appropriately diagnosing and treating depression in this setting, and examines the relationship between depression and other key clinical outcomes in the setting of advanced disease. A systematic literature review was conducted. Most of the existing research on patients with advanced illness has been conducted with cancer patients. Approximately 18 percent of patients with advanced illness meet criteria for major or minor depression; multiple psychiatric co-morbidities occur frequently. Prevalence rates increase as patients become sicker. However, depression is frequently underdiagnosed and undertreated in the setting of advanced illness. One of the key clinical challenges is differentiating depression from grief. Both psychosocial and psychopharmacologic interventions have been shown to be effective in treating depression in patients with advanced cancer. In conclusion, depression is a regular complication of advanced illness, reduces quality of life, compromises family member function, interferes with treatment decisions, and may shorten survival. However, numerous effective treatment approaches, including both medications and psychotherapy, exist and can be used to alleviate depression.
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Rikala M, Korhonen MJ, Sulkava R, Hartikainen S. Psychotropic drug use in community-dwelling elderly people—characteristics of persistent and incident users. Eur J Clin Pharmacol 2011; 67:731-9. [DOI: 10.1007/s00228-011-0996-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 01/10/2011] [Indexed: 11/29/2022]
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