Therapy In Late-life Depression Research Articles

Differential Psychological Treatment Effects in Patients With Late-Life Depression and a History of Childhood Maltreatment

ObjectiveThis is the first interventional study to assess the impact of childhood maltreatment (CM) on psychological treatment outcomes in patients with late-life depression (LLD). MethodsThis is a secondary analysis of a multicenter, randomized controlled trial with 251 participants aged ≥60 years with moderate to severe depression. Participants were randomly assigned to cognitive behavioral therapy for late life depression (LLD-CBT) or to a supportive intervention (SUI). Treatment outcomes were measured by changes in the Geriatric Depression Scale (GDS). ResultsIn the intention-to-treat sample (n = 229), both LLD-CBT (n = 115) and SUI (n = 114) significantly reduced depressive symptoms in patients with CM, with large effects at post-treatment (d = 0.95 [95% CI: 0.65 to 1.25] in LLD-CBT; d = 0.82 [95% CI: 0.52 to 1.12] in SUI). A significant treatment group*CM interaction (F(1,201.31) = 4.71; p = .031) indicated greater depressive symptom reduction in LLD-CBT compared to SUI at week 5 and post-treatment for patients without CM, but not at 6-month follow-up. Across both treatments, higher severity of the CM subtype ‘physical neglect’ was associated with a smaller depressive symptom reduction (F(1,207.16) = 5.37; p = .021). ConclusionsSpecific and non-specific psychotherapy effectively reduced depressive symptoms in older individuals with depression and early trauma. For patients without early trauma, LLD-CBT may be preferable over SUI. Considering early trauma subtypes may contribute to develop personalized treatment approaches.

High-definition transcranial direct current stimulation (HD-tDCS) as augmentation therapy in late-life depression (LLD) with suboptimal response to treatment—a study protocol for a double-blinded randomized sham-controlled trial

BackgroundLate-life depression (LLD) has a poorer prognosis and higher relapse rate than younger adults, with up to one third of patients with LLD showing suboptimal response to antidepressant therapy. LLD has been associated with significant impairment in cognition and daily functioning. Few studies have evaluated the therapeutic effects of high-definition transcranial direct current stimulation (HD-tDCS) on depressive and cognitive symptoms of LLD. The current randomized controlled trial assesses the efficacy of HD-tDCS as an augmentation therapy with antidepressants compared to sham-control in subjects with LLD.MethodsFifty-eight patients with LLD will be recruited and randomly assigned to the active HD-tDCS or sham HD-tDCS group. In both groups, patients will receive the active or sham intervention in addition to their pre-existing antidepressant therapy, for 2 weeks with 5 sessions per week, each lasting 30 min. The primary outcome measures will be the change of depressive symptoms, clinical response and the remission rate as measured with the Hamilton Depression Rating scale (HAMD-17) before and after the intervention, and at the 4th and 12th week after the completed intervention. Secondary outcome measures include cognitive symptoms, anxiety symptoms, daily functioning and adverse effects. DiscussionOlder adults with depression are associated with poorer outcomes or unsatisfactory responses to antidepressant therapy, and significant cognitive decline. Therefore, a new effective treatment option is needed. This randomized control trial aims at assessing the efficacy of HD-tDCS on ameliorating the depressive, cognitive and anxiety symptoms, and improving the daily functioning of subjects with LLD.Trial registrationClinicalTrials.gov NCT05322863. Registered on 11 April 2022.

P.0381 Long-term outcome following electroconvulsive therapy for late-life depression: 5-year follow-up data from the modect study

P.0381 Long-term outcome following electroconvulsive therapy for late-life depression: 5-year follow-up data from the modect study

The ratio and interaction between neurotrophin and immune signaling during electroconvulsive therapy in late-life depression

BackgroundElectroconvulsive therapy (ECT) is the most effective treatment for severe late-life depression (LLD), and several hypotheses on the precise working mechanism have been proposed. Preclinical evidence suggests that ECT induces changes in neurotrophin and inflammatory signaling and that these neurotrophic and inflammatory systems affect each other. We examine the relation, interaction, and ratio between the neurotrophic brain-derived neurotrophic factor (BDNF) and the proinflammatory cytokines interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α), and depression severity during ECT. MethodsIn this naturalistic longitudinal study, linear mixed models were used to analyze the relation between BDNF, IL-6, TNF-α, and depression severity (determined by the Montgomery-Åsberg Depression Rating Scale; MADRS) in 99 patients with severe LLD before ECT (T0), three weeks after the first ECT (T1), and one week after the last ECT (T2). ResultsNo significant association was found between BDNF, IL-6 and TNF-α, and MADRS scores at any time point. However, a significant interaction between TNF-α and BDNF in relation to MADRS was established (p ​= ​.020) at all time points. With higher levels of TNF-α, the relation between BDNF and MADRS becomes more negative. Furthermore, a higher ratio of TNF-α/BDNF was associated with a higher score on the MADRS (p ​= ​.007). ConclusionA possible explanation for the absence of a significant coevolution between the proinflammatory cytokines and BDNF could be that the study design was unable to determine parameters shortly after ECT sessions. However, the TNF-α/BDNF ratio was positively associated with depression severity, and the association of BDNF-level and depression severity depended on the level of TNF-α. This suggests that the interaction and balance between neurotrophin and immune signaling, specifically BDNF and TNF-α, could be relevant in LLD. This could be a focus in future research regarding treatment and the working mechanism of ECT.

NON-PHARMACOLOGICAL INTERVENTIONS IN LATE-LIFE DEPRESSION AND LATE-LIFE ANXIETY

Mindfulness, Mindfulness Based Cognitive Therapy MBCT and based Problem-solving therapy (PST) techniques have emerging research supporting them as positive additions to treatment as usual/standard care for mood, anxiety and/or cognitive disorders among older adults. This session will highlight this recent research and evidence of the benefits of these interventions in the context of late-life depression (LLD) and late-life anxiety (LLA). In the spirit of the 2020 American Association of Geriatric Psychiatry (AAGP) conference's theme of partnership, these results are presented by a team of researchers located at McGill University, Montreal, Quebec, Canada and the University of Western Ontario, London, Ontario, Canada, working with a variety of interdisciplinary stakeholders and contexts. The aim of this session is to present findings of non-pharmacological, meditation-based intervention clinical trials for, LLD and LLA, as well as potential effects on cognition. The session will be chaired by Soham Rej MD. Emily Ionson M.Sc. will present research findings that examined the feasibility and efficacy of implementing case manager-delivered group-based Problem-solving therapy for LLD in a real-world community setting. Marouane Nassim, M.Sc., will be presenting an RCT examining the efficacy of a chair-side mindfulness intervention compared to an active control condition, the Health Enhancement Program (HEP), in the treatment of depression and anxiety for older patients on hemodialysis. Elena Dikaios, B.A., will present findings of a study examining whether continuation groups are helpful to maintain sustained therapeutic effects of MBCT for late-life depression and anxiety patients in primary care. Following the presentations, there will be an interactive discussion, led by Dr. Akshya Vasudev (discussant) and Dr. Rej, concerning the clinical applications of these interventions and directions for future research.

Association between hippocampal volume change and change in memory following electroconvulsive therapy in late-life depression.

Electroconvulsive therapy (ECT)-induced hippocampal volume change (HVC) has been repeatedly described in recent years. The similar time course of HVC and ECT-related cognitive effects suggest a relation, that is to date, understudied. This study investigates whether HVC following ECT predicts the change in memory performance six months after the end of the ECT treatment. Hippocampal volume (HV) was measured via high-resolution 3D T1-weighted images in 88 patients with late-life depression, within 1week before and after ECT. Memory performance was assessed before and six months after ECT. Multiple linear regression was used to examine whether change in memory performance could be predicted based on ECT-induced changes in HV. Larger right absolute HVC predicts less pronounced improvement on the VAT (visual memory) in the whole sample. For the 8-Word Test (verbal memory), Category Fluency Test (semantic memory), and MMSE, the effect is only present in patients who switched from right unilateral to bitemporal stimulation after six ECT sessions. Absolute HVC in the left hemisphere was not significantly related to cognitive change. A larger absolute change in right HV during ECT is associated with less improvement in memory performance up to 6months post-ECT.

T128. Medial Temporal Lobe and Subcortical Shape Changes Following Electroconvulsive Therapy in Late-Life Depression

ECT has been associated with grey matter (GM) volume increase. We aim to localize ECT-induced GM surface area and displacement changes and investigate electrode placement and dose effects on subcortical GM and its relationship to mood.

Late-life depression: issues for the general practitioner.

Late-life depression (LLD) is both a prevalent and life-threatening disorder, affecting up to 13.3% of the elderly population. LLD can be difficult to identify because patients mainly consult their general practitioner (GP) for somatic complaints. Moreover, patients may be hesitant to express the problem to their GP. Increased vigilance on the part of the GP can only benefit older people with depression. To recognize the risk of LLD, screening tools are provided in addition to treatment options for LLD. This review aims to provide the GP with guidance in recognizing and treating LLD. It tries to connect mainstream etiologies of LLD (e.g., vascular, inflammation, hypothalamo–pituitary–adrenal axis) with risk factors and current therapies. Therefore, we provide a basis to the GP for decision-making when choosing an appropriate therapy for LLD.

445. Neural Predictors and Correlates of Electroconvulsive Therapy in Late-Life Depression

445. Neural Predictors and Correlates of Electroconvulsive Therapy in Late-Life Depression

Relationship Between Hippocampal Volume, Serum BDNF, and Depression Severity Following Electroconvulsive Therapy in Late-Life Depression

Recent structural imaging studies have described hippocampal volume changes following electroconvulsive therapy (ECT). It has been proposed that serum brain-derived neurotrophic factor (sBDNF)-mediated neuroplasticity contributes critically to brain changes following antidepressant treatment. To date no studies have investigated the relationship between changes in hippocampal volume, mood, and sBDNF following ECT. Here, we combine these measurements in a longitudinal study of severe late-life unipolar depression (LLD). We treated 88 elderly patients with severe LLD twice weekly until remission (Montgomery-Åsberg Depression Rating Scale (MADRS) <10). sBDNF and MADRS were obtained before ECT (T0), after the sixth ECT (T1), 1 week after the last ECT (T2), 4 weeks after the last ECT (T3), and 6 months after the last ECT (T4). Hippocampal volumes were quantified by manual segmentation of 3T structural magnetic resonance images in 66 patients at T0 and T2 and in 23 patients at T0, T2, and T4. Linear mixed models (LMM) were used to examine the evolution of MADRS, sBDNF, and hippocampal volume over time. Following ECT, there was a significant decrease in MADRS scores and a significant increase in hippocampal volume. Hippocampal volume decreased back to baseline values at T4. Compared with T0, sBDNF levels remained unchanged at T1, T2, and T3. There was no coevolution between changes in MADRS scores, hippocampal volume, and sBDNF. Hippocampal volume increase following ECT is an independent neurobiological effect unrelated to sBDNF and depressive symptomatology, suggesting a complex mechanism of action of ECT in LLD.

Systematic Review of Cognitive Effects of Electroconvulsive Therapy in Late-Life Depression

Late-life depression (LLD) is known to negatively impact cognition even after remission of mood symptoms. Electroconvulsive therapy (ECT) and newer nonconvulsive electrical and magnetic brain stimulation interventions have been shown to have cognitive effects in patients with neuropsychiatric disorders. This review systematically assessed the effects of ECT on cognition in LLD. EMBASE, Ovid Medline, and PsycINFO were systematically searched through June 2015. The search was limited to publications from peer-reviewed journals in the English language. A total of 5,154 publications was identified; 318 were reviewed in full text, of which 39 publications related to ECT were included. We focused this review only on ECT because evidence on newer interventions was deemed insufficient for a systematic review. This literature suggests increased rates of interictal and postictal cognitive decline with ECT but no long-term (i.e., 6 months or longer) deleterious effects on cognition. Instead, long-term cognitive outcomes with ECT have been reported as either not changed or improved. This literature favors nondominant unilateral ECT over bilateral ECT for cognition. Published literature on brain stimulation interventions in LLD is mainly limited to ECT. This literature suggests that deleterious effects of ECT in LLD are limited and transient, with better cognitive outcomes with unilateral ECT. There is not enough evidence to fully characterize long-term deleterious effects of ECT or effects of newer brain stimulation techniques on cognition in LLD.

Treatment Course With Antidepressant Therapy in Late-Life Depression

Treatment Course With Antidepressant Therapy in Late-Life Depression

A Longitudinal Pilot Investigation of Neuropsychological Performance Associated with Electroconvulsive Therapy in Late Life Depression

Previous investigations have assessed global cognitive scores or a single cognitive domain in the context of electroconvulsive therapy (ECT) in the elderly, but the specific cognitive domains that affected by electroconvulsive therapy are poorly understood. The present investigation used neuropsychological assessment to delineate the specific cognitive domains that are affected by treatment with ECT in late-life major depressive disorder (MDD). We hypothesized that ECT response would result in improvement in specific domains of cognitive functioning.

Treatment Course With Antidepressant Therapy in Late-Life Depression

In order to assess the effect of gray matter volumes and cortical thickness on antidepressant treatment response in late-life depression, the authors examined the relationship between brain regions identified a priori and Montgomery-Åsberg Depression Rating Scale (MADRS) scores over the course of an antidepressant treatment trial. In a nonrandomized prospective trial, 168 patients who were at least 60 years of age and met DSM-IV criteria for major depression underwent MRI and were enrolled in a 12-week treatment study. Exclusion criteria included cognitive impairment or severe medical disorders. The volumes or cortical thicknesses of regions of interest that differed between the depressed group and a comparison group (N=50) were determined. These regions of interest were used in analyses of the depressed group to predict antidepressant treatment outcome. Mixed-model analyses adjusting for age, education, age at depression onset, race, baseline MADRS score, scanner, and interaction with time examined predictors of MADRS scores over time. Smaller hippocampal volumes predicted a slower response to treatment. With the inclusion of white matter hyper-intensity severity and neuropsychological factor scores, the best model included hippocampal volume and cognitive processing speed to predict rate of response over time. A secondary analysis showed that hippocampal volume and frontal pole thickness differed between patients who achieved remission and those who did not. These data expand our understanding of the prediction of treatment course in late-life depression. The authors propose that the primary variables of hippocampal volume and cognitive processing speed, subsuming other contributing variables (episodic memory, executive function, language processing) predict antidepressant response.

Late-Life Depression Research: Lessons Learned From the Metabolic Syndrome

Late-Life Depression Research: Lessons Learned From the Metabolic Syndrome

Short‐and Long‐term Efficacy of Electroconvulsive Therapy for Late‐life Depression: A Pilot Study

Background: Electroconvulsive therapy (ECT) is often administered among the elderly, who are particularly likely to have concurrent medical conditions and medication intolerance. Objective: To examine the short‐and long‐term efficacy of ECT for late‐life depression, we performed a two‐phase, prospective, naturalistic follow‐up study that compared treatment outcome in old‐aged with that in middle‐aged subjects. Methods: Phase I study: Twenty‐one subjects who were consecutively referred for ECT, aged at least 50 years, and met the DSM‐IV criteria for a major depressive episode were enrolled. Before ECT, severity of concurrent medical conditions was assessed with the cumulative illness rating scale (CIRS). Before and after a course of ECT, the severity of depressive symptoms was evaluated with the 17‐item Hamilton rating scale for depression (HAM‐D). Phase II study: Seventeen subjects who responded to an acute ECT course in the phase I study were enrolled. Various continuation medications were administered, and symptoms were monitored and evaluated with the HAM‐D for 24 weeks or until relapse. Results: Overall the subjects had an 81 % short‐term response rate and a 47% relapse rate within 24 weeks after ECT. Response and relapse rates were not significantly different between the middle‐and old‐aged groups (response rates: 91% vs. 70%; relapse rates: 40% vs. 57%). However, the old‐aged patients had higher post‐ECT HAM‐D scores than the middle‐aged patients did (P&lt;0.05), and CIRS scores positively correlated with post‐ECT HAM‐D scores (P&lt;0.05). Relapsers tended to have higher CIRS scores than non‐relapsers did (P=0.06). Conclusion: In late‐life depression, the short‐term response rate to ECT is considerably good, but the relapse rate was relatively high. Clinicians need to take into consideration the age of patient and any concurrent medical conditions, when planning long‐term management of residual depressive symptoms and prevention of relapse after an initial good response to ECT.

An empirical review of cognitive therapy for late life depression: does research evidence suggest adaptations are necessary for cognitive therapy with older adults?

This paper describes the treatment of depression in older adults using cognitive behaviour therapy (CBT) as first developed by Beck and colleagues. Evidence for the validity and effectiveness of this form of treatment is considered by reference to published outcome research and meta-analysis studies. Attempts to compare CBT approaches with other forms of psychotherapy have indicated minimal differences in outcome with all therapy modalities reporting beneficial effects in comparison to no treatment or placebo. It is clear that an empirical evaluation of cognitive-behaviour therapy for late life depression is still in its early stages as evidenced by the small number of published studies. The clinical issue of whether therapeutic adaptations are necessary in order for cognitive therapy to be effective with older adults is briefly discussed with reference to the literature from outcome research. Copyright © 2001 John Wiley & Sons, Ltd.

An empirical review of cognitive therapy for late life depression: does research evidence suggest adaptations are necessary for cognitive therapy with older adults?

AbstractThis paper describes the treatment of depression in older adults using cognitive behaviour therapy (CBT) as first developed by Beck and colleagues. Evidence for the validity and effectiveness of this form of treatment is considered by reference to published outcome research and meta‐analysis studies. Attempts to compare CBT approaches with other forms of psychotherapy have indicated minimal differences in outcome with all therapy modalities reporting beneficial effects in comparison to no treatment or placebo. It is clear that an empirical evaluation of cognitive‐behaviour therapy for late life depression is still in its early stages as evidenced by the small number of published studies. The clinical issue of whether therapeutic adaptations are necessary in order for cognitive therapy to be effective with older adults is briefly discussed with reference to the literature from outcome research. Copyright © 2001 John Wiley &amp; Sons, Ltd.

A Prospective Naturalistic Study of Electroconvulsive Therapy in Late-Life Depression

We performed a prospective, naturalistic study using standardized clinical rating scales to characterize the effect of electroconvulsive therapy (ECT) on mood, cognition, and medical status in late-life depression. Over a 16-month period, 40 patients aged 60 years and over who fulfilled DSM-III criteria for a major depressive episode received a total of 42 ECT courses. Three patients (7%) developed significant medical complications: one had a syncopal episode due to arrhythmia, and two had symptomatic vertebral compression fractures. Confusion was noted during 13 courses (31%) and persisted at discharge in four (10%). More than half the patients were either psychotic or demented on admission, and all but three had been either unresponsive or intolerant to pharmacotherapy. All patients experienced a decrease in their depressive symptoms and more than two thirds were in complete or partial remission at discharge. Patients with psychotic depression experienced a greater improvement than patients with nonpsychotic depression, and patients with organic mental disorders experienced the same improvement as other patients. This study confirms that ECT is a safe and effective treatment of depression in late life.