MECHANISMS INFORMING INTERVENTIONS: NEW APPROACHES TO TREATING LATE-LIFE DEPRESSION: Session 107

Abstract

Late-life depression is characterized by medical comorbidity and deficits in cognitive function, specifically in cognitive control deficits. These medical and cognitive factors are associated with poor antidepressant responses, and even when response occurs, rates are often poor and limited. Moreover, remission may not persist and depressed elders are at a high risk of recurrence. Current antidepressant treatments are not only limited in the benefit they provide to affective symptoms, but typically do not benefit the comorbid medical problems and cognitive deficits common in this population. There is a substantial need for new treatment approaches that are both more robust and benefit these comorbid medical and cognitive domains. Across presentations, this symposium focuses on novel treatment approaches for late-life depression. Sessions will be framed within NIMH's Experimental Therapeutics paradigm, with discussions on the underlying mechanism and proposed targets for engagement. Given the clinical population, sessions will further integrate how treatments may provide benefit beyond mood symptoms. The first sessions will examine novel pharmacological treatments of drugs that may be repurposed for late-life depression. This includes findings from a recent trial examining the clinical effect and mechanisms of treatment response of buprenorphine in older adults with treatment resistant depression. Next will be a presentation of results from a pilot trial of transdermal nicotine patches in depressed elders with subjective cognitive decline. These results include clinical and cognitive results, but also pilot neuroimaging results examining potential drug mechanisms. We then shift to discuss a computerized cognitive remediation approach, examining a video game intervention targeting the cognitive control network with the goal of improving both mood and executive function. Finally, the panel discussant will put these findings in context of past intervention studies in late-life depression. This will include a discussion on how to optimize current antidepressant medications and discuss the rationale of the PCORI-funded OPTIMUM study of treatment-resistant older adults.