Treatment Of Late-life Depression Research Articles

The Efficacy and Safety of Neuromodulation Treatments in Late-Life Depression.

In this review, the efficacy and safety of FDA approved neuromodulation devices (electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS) and vagus nerve stimulation (VNS)), as well as emerging neuromodulation treatments currently under investigation. ECT is the "gold standard" somatic therapy for treatment resistant depression (TRD). Although the clinical benefits are outweighed by potential cognitive and cardiovascular side effects in majority of cases, it remains unfairly stigmatized. TMS has few cognitive or somatic side effects but is not as effective the treatment of psychotic depression or more treatment resistant depression in elders. VNS has limited data in older patients but has been shown to be effective in chronic, treatment resistant adults. Several investigative neuromodulation treatments including magnetic seizure therapy (MST), focal electrically administered seizure therapy (FEAST), transcutaneous VNS (tVNS), transcranial direct current stimulation (tDCS), and deep brain simulation (DBS) shown promise in geriatric TRD. ECT, TMS and VNS are effective treatment for late-life depression, and research has continued to refine the techniques. Investigative neuromodulation techniques are promising, but evidence for the safety and efficacy of these devices in the geriatric population is needed.

Transcriptomic signatures of treatment response to the combination of escitalopram and memantine or placebo in late-life depression.

Drugs that target glutamate neuronal transmission, such as memantine, offer a novel approach to the treatment of late-life depression, which is frequently comorbid with cognitive impairment. The results of our recently published double-blind, randomized, placebo-controlled trial of escitalopram or escitalopram/memantine in late-life depression with subjective memory complaints (NCT01902004) indicated no differences between treatments in depression remission, but additional benefits in cognition at 12-month follow-up with combination treatment. To identify pathways and biological functions uniquely induced by combination treatment that may explain cognitive improvements, we generated transcriptional profiles of remission compared with non-remission from whole blood samples. Remitters to escitalopram compared with escitalopram/memantine combination treatment display unique patterns of gene expression at baseline and 6 months after treatment initiation. Functional enrichment analysis demonstrates that escitalopram-based remission associates to functions related to cellular proliferation, apoptosis, and inflammatory response. Escitalopram/memantine-based remission, however, is characterized by processes related to cellular clearance, metabolism, and cytoskeletal dynamics. Both treatments modulate inflammatory responses, albeit via different effector pathways. Additional research is needed to understand the implications of these results in explaining the observed superior effects of combination treatment on cognition observed with prolonged treatment.

High-Frequency External Muscle Stimulation Reduces Depressive Symptoms in Older Male Veterans: A Pilot Study.

Late-life depression (LLD) is a severe public health problem. Given that pharmacological treatments for LLD are limited by their side effects, development of efficient and tolerable nonpharmacological treatment for LLD is urgently required. This study investigated whether high-frequency external muscle stimulation could reduce depressive symptoms in LLD. Twenty-two older male veterans with major depression were recruited and randomized into a treatment (n = 9) or sham control group (n = 13). The groups received high-frequency external muscle stimulation or sham intervention 3 times per week for 12 weeks. Clinical symptoms and muscle strength were evaluated at baseline and every 2 weeks. The 2 groups were homogeneous in age, baseline clinical symptoms, and muscle strength. The treatment group showed significant improvement in depression and anxiety scores and muscle strength (all P < .01), whereas the control group showed no significant change after the 12-week follow-up. Compared to the control group, the treatment group showed significant improvements in depression (Geriatric Depression Scale, P = .009; Hamilton Depression Rating Scale, P = .007) and anxiety scores (HAMA, P = .008) and muscle strength (all P < .001). Changes in depression and anxiety levels were significantly correlated with changes in muscle strength after the study. In the treatment group, we observed a trend of correlation between the reduction in depression and muscle strength gains. High-frequency external muscle stimulation appears to be an effective treatment for older patients with LLD. Large studies with more tests and/or conducted in different populations are warranted to validate these preliminary findings.

Predictors of Cognitive Improvement Following Treatment for Late-Life Depression.

Cognitive impairment is frequently comorbid with late-life depression (LLD) and often persists despite remission of mood symptoms with antidepressant treatment. Increasing understanding of factors that predict improvement of cognitive symptoms in LLD is useful to inform treatment recommendations. We used data from 2 randomized clinical trials of geriatric depression to examine the relationships between sociodemographic factors (resilience, quality of life) and clinical factors (age of depression onset, severity of depression, apathy) with subsequent cognitive outcomes. One hundred sixty-five older adults with major depression who had completed one of 2 clinical trials were included: (1) methylphenidate plus placebo, citalopram plus placebo, and citalopram plus methylphenidate or (2) citalopram combined with Tai Chi or health education. A comprehensive neuropsychiatric battery was administered; 2 measures of cognitive improvement were examined, one defined as an increase in general cognitive performance score of at least 1 standard deviation and the other 0.5 standard deviation pre-post treatment. At posttreatment, 59% of participants had remitted, but less than a third of those who remitted showed cognitive improvement (29%). Cognitive improvement was observed in 18% of nonremitters. Lower baseline depression severity, greater social functioning, and depression onset prior to 60 years of age were significantly associated with cognitive improvement. None of the other measures, including baseline apathy, resilience, and depression remission status, were significantly associated with cognitive improvement. Lower severity of depression, earlier onset, and greater social functioning may predict improvement in cognitive functioning with treatment for depression in LLD.

BEYOND ECT – NEUROMODULATION AND INTERVENTIONAL PSYCHIATRY FOR TREATMENT RESISTANT DEPRESSION IN LATER LIFE

There is a paucity of research, in general, on TRD-LL and on novel approaches and interventional methods for older adults suffering with TRD-LL. Most of the lack of data stems from limited studies on these interventions in older adults since most pharmacotherapy and neuromodulation trials specifically exclude older adults or those with comorbid medical or psychiatric conditions. Broadly, approaches can be divided into those that are FDA approved for depression (but not specifically for TRD-LL) and those that are available and empirically supported but not FDA approved. Among the FDA approved treatments of transcranial magnetic stimulation (all forms of rTMS and dTMS), vagus nerve stimulation (VNS), deep brain stimulation (DBS), and now intranasal ketamine, TMS has been most extensively studied for treatment of late life depression. Newer forms of TMS are also being evaluated in older adults. Though there are extensive data on the use of VNS in TRD, there are no studies in older adults specifically, although a multicenter trial supported by the US Center of Medicare and Medicaid Services, which will recruit adults aged 65 and above, will soon be underway. Published studies in DBS have included older adults but not in appreciable numbers for separate analyses. Studies thus far suggest some benefit in TRD but no specific data for TRD-LL. Most of the published studies of IV ketamine, which is not FDA approved for depression, are limited to case reports which tend to support its use and tolerability in TRD-LL when used as monotherapy or in combination with other interventions. Use of intranasal ketamine, which was recently FDA approved earlier in 2019, in TRD-LL remains anecdotal. Among other approaches with empirical support, but not necessarily FDA approved specific indications, are behavioral interventions (exercise, stress reduction activities), bright light therapy, combination pharmacotherapy (lithium, T3/T4, atypical antipsychotics, psychostimulants, D3 agonists, and opioid analogs), and combination pharmacotherapy and psychotherapy. After briefly reviewing the above interventions, discussion will focus on the clinical assessment of TRD-LL and possible treatment algorithms.

RACIAL AND ETHNIC DISPARITIES IN DEPRESSION SEVERITY, SYMPTOM BURDEN AND CARE AMONG OLDER ADULTS

Introduction IMPORTANCE: Knowledge gaps persist regarding racial and ethnic variation in late-life depression (LLD), including differences in specific depressive symptoms and disparities in care. Identifying disparities in symptom presentation and treatment of LLD is important, as doing so may guide approaches to reduce morbidity and mortality from LLD. Thus, we aimed to evaluate racial/ethnic differences in depression severity, item-level depressive symptom burden, and depression care. Methods DESIGN, SETTING, PARTICIPANTS: In this community based large cross-sectional study, we included 25,503 participants (mean age=67.1 years) in the late-life depression prevention ancillary study (VITAL-DEP) to the VITamin D and OmegA-3 TriaL, a randomized trial of cancer and cardiovascular disease prevention among 25,871 adults. EXPOSURE: Racial and ethnic group (Non-Hispanic White, Black, Hispanic, Asian and Others/unspecified). MAIN OUTCOMES AND MEASURES: Depressive symptoms were assessed using the Patient Health Questionnaire-8 (PHQ-8); participants reported diagnosis and medication and/or counseling for depression. Differences across racial/ethnic groups were evaluated using: multivariable zero-inflated negative binomial regression to compare PHQ-8 scores; multivariable logistic regression to estimate odds of item-level symptom burden and odds of depression treatment among those with diagnosed depression. Results There were 25,503 participants with adequate depression data (mean [standard deviation] age=67.1 [7.1] years), including: 12888 [50.5%] female, 17828 [69.9%] non-Hispanic White, 5004 [19.6%] Black, 1001 [3.9%] Hispanic, 377 [1.5%] Asian and 1293 [5.1%] Other-reporting/race-unspecified participants. After adjustment for sociodemographic, lifestyle and health confounders, compared to non-Hispanic Whites: Black participants had a 8% higher severity level of PHQ-8 scores (IRR (incidence rate ratio)=1.08, 95% CI: 1.02-1.15; p=0.01); Hispanic participants had 26% higher severity of PHQ-8 (IRR=1.26, 95% CI: 1.12-1.42; p Conclusions In this large cross-sectional study, we observed significant racial and ethnic differences in late-life depression severity, item-level symptom burden, and depression care, after adjustment for numerous confounders. Findings suggest a need for further examination of novel patient- and provider-level factors underlying these associations. This research was funded by: VITAL-DEP is supported by R01 MH091448 from NIMH.

MEMORY COMPLAINTS AND DEPRESSION TREATMENT IN OLDER ADULTS

Introduction Older adults with major depression (or late-life depression) often complain about problems with thinking and memory. Some evidence suggests that subjective cognitive complaints may be a useful prognostic indicator of response to antidepressant medication. In one prior study, older adults with major depression and executive functioning complaints responded more slowly to escitalopram treatment over 12 weeks compared with older depressed adults with no executive functioning complaints. It is unclear whether the potential association between subjective cognitive complaints and treatment response generalizes to other cognitive domains and whether there is a longer-term relationship between treatment response and subjective cognitive complaints. The aim of the current study is to understand the relationship between subjective memory complaints and late-life depression treatment response at 12 weeks and one-year. The mechanism explaining the potential association between subjective cognitive complaints and treatment responses is unclear. Subjective memory complaints may represent subtle changes in objective memory test performance. Better objective story memory at baseline was associated with better depression outcomes one-year later in older adults with major depression. However, a large body of research also suggests subjective memory complaints in older adults are related to the severity of depression, anxiety, and/or personality traits (e.g., neuroticism), all factors that detrimentally influence depression treatment in older adults. Given these findings, we expected to find an association between subjective memory complaints and treatment response in late-life depression but hypothesized that the association would no longer be significant when controlling for depression severity, state anxiety, neuroticism, and objective memory performance. Methods The Neurobiology of Late-Life Depression (NBOLD) is a naturalistic longitudinal observation study of late-life depression. Upon enrollment, all patients were offered open label treatment with sertraline but this was not a requirement of participation. Instead, patients could have received other SSRIs/SNRIs and psychological treatment from non-study providers. Moreover, in some cases of mild major depression, patients may have elected not to receive treatment at all. All subjects underwent annual cognitive evaluations and depression monitoring with the Montgomery Asberg Depression Rating Scale (MADRS) as clinically indicated (and at least every three months). At baseline, subjective memory complaints were measured with the Memory Abilities Scale (MAB), state anxiety was measured with State-Trait Anxiety Inventory (STAI), and neuroticism was measured with the NEO-PI-R. Statistical Analyses: We conducted regression models testing the association between 12 week and one-year MADRS and baseline subjective memory complaints, objective memory performance (Logical Memory Delayed Recall), state anxiety, neuroticism, antidepressant usage, and relevant demographics. We tested both linear (continuous MADRS score) and logistic (yes-no presence of remission defined as MADRS Results The sample consisted of 90 patients at 12 weeks and 85 at one year. Regarding antidepressant treatment, 47.5% of LLD patients (n=57) began treatment with sertraline upon enrollment, 27.5% (n=33) were on some other SSRI and/or SNRI combination, and 25% were not receiving antidepressants. Contrary to our hypotheses, linear regression models revealed that baseline subjective memory complaints were a significant predictor of 12 week (Coefficient = -.087 +- .038, p = .025) and one-year MADRS (Coefficient = -.097 +- .039, p = .014) scores even when accounting for objective memory performance (Logical Memory Delayed Recall), state anxiety, neuroticism, antidepressant usage, and relevant demographics. Using the same covariates, subjective memory complaints also predicted remission at 12 weeks (OR[95%CI] = 1.07 (1.02, 1.11) p Conclusions Subjective memory complaints seem to be a useful indicator of depression treatment response in older adults with major depression. Notably the relationship between subjective memory complaints and treatment response was present even when accounting for other important factors shown to be related to subjective cognitive complaints and treatment outcome. Future work should investigate the biological and cognitive correlates of subjective memory complaints in older adults with major depression. This research was funded by: The research was supported by the Leo and Anne Albert Charitable Trust & NIMH Grant R01 MH108578.

Cognitive behavioural therapy for the treatment of late life depression: study protocol of a multicentre, randomized, observer-blinded, controlled trial (CBTlate)

BackgroundLate-life depression (LLD) is one of the most prevalent mental disorders in old age. It is associated with various adverse outcomes and frequent use of health care services thereby remaining a serious public health concern. Compared with depression in early adulthood, most treatment options of LLD are less effective. Psychotherapy may be particularly beneficial for LLD due to specific psychological conditions in old age and a low risk of side effects. Although cognitive behavioural therapy (CBT) is highly established and effective in depression in young and mid-life there is only a limited number of small studies on CBT in LLD. An LLD-specific CBT has not yet been compared to an active, but unspecific supportive psychological intervention in a multicentre trial.MethodsHere we present the design of the CBTlate trial, which is a multicentre, randomized, observer-blinded, active-controlled, parallel group trial. CBTlate aims at including 248 patients with LLD of both genders at 7 sites in Germany. The purpose of the study is to test the hypothesis that a 15-session individually-delivered CBT specific for LLD is of superior efficacy in reducing symptoms of depression in comparison with a supportive unspecific intervention (SUI) of the same quantity. The intervention includes 8 weeks of individual treatment sessions twice per week and a follow-up period of 6 months after randomization. The primary end point is the severity of depression at the end of treatment measured by the self-rated 30-item Geriatric Depression Scale (GDS). Secondary endpoints include depressive symptoms at week 5 and at follow-up (6 months after randomization). Additional secondary endpoints include the change of depressive symptoms assessed with a clinician-rating-scale and a patient reported outcome instrument for major depressive disorder, anxiety symptoms, sleep, cognition, quality of life, and overall health status from baseline to end-of treatment and to end of follow-up. Add-on protocols include MRI and the collection of blood samples.DiscussionThis study is the first multicentre trial of a specific CBT intervention for LLD compared to an unspecific supportive psychological intervention administered in a specialist setting. It has important implications for developing and implementing efficient psychotherapeutic strategies for LLD and may be a significant step to broaden treatment options for people suffering from LLD.Trial registrationClinicalTrials.gov (NCT03735576, registered on 24 October 2018); DRKS (DRKS00013769, registered on 28 June 2018).

Group Psychotherapy for Late-Life Depression

Depression is a common and disabling diagnosis in the elderly. Psychotherapy, both individual and group, has emerged as an important adjunctive treatment for late-life depression along with medications and neurostimulation therapies. This review seeks to summarize recent literature on group psychotherapy for late-life depression, define the type of therapies commonly used, and discuss both the theory and practice of group psychotherapy. Studies show that various group-based psychotherapies are effective for late-life depression, and there is increasing support for an integrated approach. Accommodations must be made to make therapy accessible and useful for the older adult. Our experience leading a geriatric psychotherapy group at University of Connecticut Medical Center is shared with the reader. Recent evidence-based clinical practice guidelines and other measures, published by the American Group Psychotherapy Association to assist the therapist, are briefly described as well. Group psychotherapy, in particular utilizing cognitive behavioral therapy and reminiscence therapy, is an effective intervention for late-life depression.

STRENGTHENING LATE-LIFE DEPRESSION COLLABORATIVE CARE THROUGH COMMUNITY ENGAGEMENT: CARE PARTNERS INITIATIVE

Despite the availability of effective treatments for late life depression, many older adults with depression either do not access or fully engage in treatment. The goal of this study was to examine the feasibility and two-year outcomes from an Archstone Foundation funded Care Partners Initiative to strengthen depression care for adults 65 years of age and older. Seven sites throughout California implemented evidence-based collaborative care through partnerships between primary care organizations, community-based organizations (CBOs), and families of older adults with depression. Evaluation used a mixed-methods approach incorporating both qualitative and quantitative data. Of the seven sites, six formed partnerships between primary care clinics and CBOs and one site only focused on engaging family members in treatment. In the first two years, 274 patients were enrolled and rates of depression improvement were comparable to prior depression care effectiveness trials. Overall, 49% of patients at CBO sites interacted 3+ times with CBO staff/clinicians, while at the family site, 79% of patients had 3+ contacts including a family member. Using data from key informant interviews, focus groups, and site progress documents, seven core components were identified that facilitated successful implementation and delivery of partnered collaborative care, including three foundational components: strong stakeholder buy-in, effective patient engagement, and the promotion of depression treatment as a core value across organizations. Multiple complexities of partnering between primary care clinics and CBOs or families were identified. Challenges and lessons learned from this initiative will also be discussed.

Virtual Therapy as a Method Supporting Treatment of Late-Life Depression

Virtual Therapy as a Method Supporting Treatment of Late-Life Depression

Management of Late-Life Depression in the Context of Cognitive Impairment: a Review of the Recent Literature.

Evidence regarding the treatment of late-life depression is not necessarily generalizable to persons with a neurocognitive disorder and comorbid depression. Thus, this article reviews recent evidence that pertains to the treatment of depression in older adults with neurocognitive disorders, and synthesizes and critically analyzes this literature to identify methodological issues and gaps for the purpose of future research. Controlled trials and meta-analyses examining depression treatment in neurocognitive disorders, published between 2015 and 2019 (N = 16 reports), can be divided into those addressing pharmacotherapy, psychological and behavioral therapy, and somatic therapy. The evidence generally does not support benefit of antidepressant medication over placebo in treating depressive disorders in dementia. No pharmacological studies since 2015 have examined antidepressant medication in participants with mild cognitive impairment (MCI). Problem adaptation therapy demonstrates efficacy for depression in MCI and mild dementia. Other psychological and behavioral interventions for depressive symptoms in dementia demonstrate mixed findings. The only somatic treatment trials published since 2015 have assessed bright light therapy, with positive findings but methodological limitations. Psychological, behavioral, and somatic treatments represent promising treatment options for depression in neurocognitive disorders, but further studies are needed, particularly in participants with depressive disorders rather than subclinical depressive symptoms. Little is known about the treatment of depression in patients with MCI, and rigorous identification of MCI in late-life depression treatment trials will help to advance knowledge in this area. Addressing methodological issues, particularly the diagnosis and measurement of clinically significant depression in dementia, will help to move the field forward.

Isotemporal substitution modeling on sedentary behaviors and physical activity with depressive symptoms among older adults in the U.S.: The national health and nutrition examination survey, 2007–2016

BackgroundLate-life depression is a great burden of public health. Previous studies reported that physical activity is associated with reduced depressive symptoms among older adults, while the competing nature of physical activity and sedentary behaviors has been largely neglected in studies. We aimed to examine the associations of replacing sedentary behaviors with walking/bicycling or moderate-to-vigorous physical activity (MVPA) with depressive symptoms in older adults. MethodsA cross-sectional analysis was conducted among 8374 older adults (60 years or older) included in the National Health and Nutrition Examination Survey (NHANES), 2007–2016. The Global Physical Activity Questionnaire was used to measure self-reported time for sedentary behaviors, walking/bicycling, and MVPA. The 9-item Patient Health Questionnaire was used to measure depressive symptoms (including overall, somatic, and cognitive). Z-scores were created for depressive symptoms. Isotemporal substitution models using multivariable linear regression were applied to examine the associations of sedentary behaviors, walking/bicycling, and MVPA with z-scores of depressive symptoms. ResultsReplacing 30 min/day sedentary behaviors with 30 min/day of MVPA (beta (β) = -0.10, 95% confidence interval (CI): -0.14, -0.06) or 30 min/day of walking/bicycling (β = -0.04, 95% CI: -0.06, -0.02) was associated with lower z-score for depressive symptoms. Replacing 30 min/day of walking/bicycling for 30 min/day of MVPA was associated with lower z-score for depressive symptoms (β = -0.06, 95% CI: -0.10, -0.02). LimitationsA cross-sectional study design precludes causal inferences. ConclusionReplacing sedentary behaviors with walking/bicycling or MVPA is associated with lower depressive symptoms among older adults. Future research is expected to investigate the effectiveness of physical activity on prevention and treatment of late-life depression.

The association of late-life depression with all-cause and cardiovascular mortality among community-dwelling older adults: systematic review and meta-analysis.

Late-life depression has become an important public health problem. Available evidence suggests that late-life depression is associated with all-cause and cardiovascular mortality among older adults living in the community, although the associations have not been comprehensively reviewed and quantified.AimTo estimate the pooled association of late-life depression with all-cause and cardiovascular mortality among community-dwelling older adults. We conducted a systematic review and meta-analysis of prospective cohort studies that examine the associations of late-life depression with all-cause and cardiovascular mortality in community settings. A total of 61 prospective cohort studies from 53 cohorts with 198 589 participants were included in the systematic review and meta-analysis. A total of 49 cohorts reported all-cause mortality and 15 cohorts reported cardiovascular mortality. Late-life depression was associated with increased risk of all-cause (risk ratio 1.34; 95% CI 1.27, 1.42) and cardiovascular mortality (risk ratio 1.31; 95% CI 1.20, 1.43). There was heterogeneity in results across studies and the magnitude of associations differed by age, gender, study location, follow-up duration and methods used to assess depression. The associations existed in different subgroups by age, gender, regions of studies, follow-up periods and assessment methods of late-life depression. Late-life depression is associated with higher risk of both all-cause and cardiovascular mortality among community-dwelling elderly people. Future studies need to test the effectiveness of preventing depression among older adults as a way of reducing mortality in this population. Optimal treatment of late-life depression and its impact on mortality require further investigation.Declaration of interestNone.

HEARING AIDS AND LATE-LIFE DEPRESSION: A METHODS STUDY

Introduction Age-related hearing loss (AHRL) is the third most common health condition affecting older adults after heart disease and arthritis. The prevalence of clinically significant hearing impairment rises steeply with age, from 3% among adults 20-29 to 49% of adults ages 60-69 and over 80% in individuals 85 years of age and older. Initial studies suggest that remediation of hearing loss using hearing aids may decrease depressive symptoms over longitudinal follow-up. However, important limitations to these studies call for controlled trials of hearing remediation as a treatment for late-life depression (LLD). We conducted the first double-blind randomized clinical trial utilizing rigorous control groups, objective documentation of compliance of the hearing aid, enrollment of subjects with clinical depression, and incorporation of comprehensive neuropsychological assessments. Our main aims were to consider the feasibility, acceptability, tolerability of such a study, as well as ability to blind the hearing aid devices. Methods 12 individuals were recruited who were aged ≥60 years, diagnosed with a clinically significant depressive disorder, and had mild-severe hearing loss. Baseline psychiatric, audiometric, neuropsychological, and functional assessments were performed. Participants were then randomized to receive either full-amplitude active hearing aids or low-amplitude sham hearing aids over a 12-week prospective trial, either as monotherapy or as an augmentation with antidepressant medications. The sham hearing aid was programmed to a hearing threshold of 10dB, which resulted in a small volume increase without substantively improving the subject's ability to hear. The baseline evaluation was repeated at the study endpoint. Results Of the 12 subjects who completed the study, 7 received active and 5 received sham hearing aids. Acceptability of the hearing aid, evaluated as the duration of time participants wore the hearing aids between the active and sham groups, was high as all subjects used the devices for >9 hours a day and the duration was not statistically significant between groups (p = 0.05). Tolerability was measured as proportions of subjects who experienced adverse events during participation, which were acceptable and included insomnia, drowsiness, and excitement. Feasibility was also acceptable, as 86.7% of the enrolled subjects completed the 12-week study. Blind assessments were evaluated as proportions of subjects who correctly guessed whether they were wearing active or sham hearing aids and was not in effect as the majority of subjects guessed correctly (92% in sham [p Conclusions Data from this study suggests that the study design of a double-blind randomized clinical trial of hearing aids as a treatment for LLD was highly acceptable to the subjects. Future studies with larger sample sizes should investigate whether hearing remediation may be an effective therapeutic strategy for LLD. Efforts should be made to improve the ability to blind the hearing aid such as increasing the hearing threshold of the sham devices. Should future studies prove to be successful, this suggests a novel therapeutic strategy for LLD and thereby mitigate its public health burden, while also contributing to the increased recognition and treatment of ARHL more generally. This research was funded by CaMPR Phase II: Columbia University Irving Institute for Clinical and Translational Research (Rutherford [PI]) Phonak, a hearing assistance company, supplied the Audeo BR 90 hearing aid devices. PDF: http://submissions.mirasmart.com/Verify/AAGP2019/Original/AAGP2019-000298/AAGP2019-000298_Fig1.pdf PDF: http://submissions.mirasmart.com/Verify/AAGP2019/Original/AAGP2019-000298/AAGP2019-000298_Fig2.pdf

ENGAGEMENT IN SOCIALLY REWARDING ACTIVITIES AS A PREDICTOR OF OUTCOME IN BEHAVIORAL ACTIVATION THERAPY FOR LATE LIFE DEPRESSION

Introduction Late life depression has detrimental effects on older adults’ functioning and well-being. Depressed older adults often experience loneliness and social isolation, which are risk factors for incident depression, increased depression severity, and medical illness. Neurobiological studies suggest that depressed individuals of all ages exhibit impairments in the reward systems and recent studies suggest that socially rewarding experiences may be especially important for depressed older adults. Results of a pilot study conducted by our group has shown that “Engage”, a neurobiologically informed, streamlined brief behavioral activation for depression, led to significant reduction in depressive symptoms. “Engage” targets impairments in positive valence system function through “reward exposure” (i.e. engagement in rewarding and meaningful activities). However, it is unknown whether engagement in certain types of rewarding activities is more beneficial than others. We predicted that given the centrality of social isolation in late life depression, social (versus non-social) rewarding activities would predict greater improvement in depression severity. Methods Forty-eight older adults with unipolar depression without cognitive impairment received 9 sessions of “Engage” psychotherapy. Depression severity was assessed using the Montgomery–Asberg Depression Rating Scale (MADRS) and behavioral activation was measured using the Behavioral Activation for Depression Scale (BADS) at baseline, weeks 6 and 9. We also assessed depression severity on a weekly basis using the Patient Health Questionnaire (PHQ-9). Patients’ weekly behavioral plans were categorized into three groups: a) solitary activities; b) social-group activities (attending a social gathering or going to a social setting such as church or a senior center); c) social-individual activities (engaging in an interpersonal interaction with a specific friend and/or family member). Results Logistic regression analyses showed that higher percentage of social-individual activities (compared to solitary and social-group activities) predicted subsequent improvement in depressive symptoms and increase in behavioral activation, when controlling for baseline scores on MADRS and BADS respectively. Preliminary analysis suggests that patients who selected social individual activities, in addition to solitary and social group activities, had a steeper reduction of depression by the third session compared to patients lacking social individual activities in their reward exposure plans. This observation suggests that engagement in social individual activities is associated with early response of depression to Engage. Conclusions Our preliminary results suggest that exposure to socially rewarding experiences could contribute to the efficacy of psychotherapy for late-life depression. Additionally, these findings highlight the importance of studying the effects of engagement in specific types of rewarding activities in behavioral activation treatment for late-life depression. This research was funded by P50 MH113838 R01 MH102252 T32 MH019132

Depresja wieku podeszłego – wyzwania diagnostyczne

&lt;p&gt;Depresja wieku podeszłego stanowi poważny i nasilający się w skali społecznej problem, choć w praktyce wydaje się on zbyt rzadko diagnozowany. Podwyższa ona wskaźniki śmiertelności, wiąże się z niepomyślnym przebiegiem schorzeń somatycznych, nasila niepełnosprawność i prowadzi do utraty samodzielności, wpływając na jakość życia pacjentów i ich bliskich. Zaburzenie to stanowi wyzwanie na etapie diagnozowania ze względu na maskowanie objawów depresyjnych przez inne problemy natury psychologicznej i zdrowotnej występujące w tym okresie życia. W artykule zarysowano specyfikę obrazu klinicznego depresji wieku podeszłego i psychospołeczny kontekst jej ujawniania. Wskazano na rodzaj trudności diagnostycznych i ich uwarunkowania. Scharakteryzowane zostały zaburzenia poznawcze występujące w przebiegu depresji, z uwzględnieniem tzw. depresyjnego zespołu dysfunkcji wykonawczych. Sformułowano też zalecenia dotyczące monitorowania stanu funkcji poznawczych starszych pacjentów z rozpoznaniem depresji.&lt;/p&gt;

Psychobiological factors of resilience and depression in late life

In contrast to traditional perspectives of resilience as a stable, trait-like characteristic, resilience is now recognized as a multidimentional, dynamic capacity influenced by life-long interactions between internal and environmental resources. We review psychosocial and neurobiological factors associated with resilience to late-life depression (LLD). Recent research has identified both psychosocial characteristics associated with elevated LLD risk (e.g., insecure attachment, neuroticism) and psychosocial processes that may be useful intervention targets (e.g., self-efficacy, sense of purpose, coping behaviors, social support). Psychobiological factors include a variety of endocrine, genetic, inflammatory, metabolic, neural, and cardiovascular processes that bidirectionally interact to affect risk for LLD onset and course of illness. Several resilience-enhancing intervention modalities show promise for the prevention and treatment of LLD, including cognitive/psychological or mind–body (positive psychology; psychotherapy; heart rate variability biofeedback; meditation), movement-based (aerobic exercise; yoga; tai chi), and biological approaches (pharmacotherapy, electroconvulsive therapy). Additional research is needed to further elucidate psychosocial and biological factors that affect risk and course of LLD. In addition, research to identify psychobiological factors predicting differential treatment response to various interventions will be essential to the development of more individualized and effective approaches to the prevention and treatment of LLD.

MMSE during ECT in late-life depression: useful or useless?

Introduction: Electroconvulsive therapy (ECT) is an effective and well-established treatment for late-life depression (LLD). However, there is on ongoing concern about the possible negative impact of ECT on cognition. Our aims were to map the change of Mini-Mental State Examination (MMSE) scores during and after ECT, and to compare the evolution of MMSE-scores in a group of cognitively impaired and unimpaired patients.

Cost-effectiveness analysis of collaborative treatment of late-life depression in primary care (GermanIMPACT)

BackgroundLate-life depression is a highly prevalent disorder that causes a large economic burden. A stepped collaborative care program was set up in order to improve care for patients with late-life depression in primary care in Germany: GermanIMPACT is the adaption of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) program that has already been established in primary care in the USA. The aim of this study was to determine the cost-effectiveness of GermanIMPACT compared with treatment as usual from a societal perspective. MethodsThis study is part of a 12-month bi-centric cluster-randomized controlled trial aiming to assess the effectiveness of GermanIMPACT compared with treatment as usual among patients with late-life depression. A cost-effectiveness analysis using depression-free days (DFDs) was performed. Net-monetary benefit (NMB) regressions adjusted for baseline differences for different willingness-to-pay (WTP) thresholds were conducted and cost-effectiveness acceptability curves were constructed. ResultsIn total, n = 246 patients (intervention group: n = 139; control group: n = 107) with a mean age of 71 from 71 primary care practices were included in the analysis. After 12 months, adjusted mean differences in costs and DFDs between intervention group and control group were +€354 and +21.4, respectively. Only the difference in DFDs was significant (p = 0.022). According to the unadjusted incremental cost-effectiveness ratio, GermanIMPACT was dominant compared with treatment as usual. The probability of GermanIMPACT being cost-effective was 80%, 90% or 95% if societal WTP per DFD was ≥€70, ≥€110 or ≥€180, respectively. ConclusionEvidence for cost-effectiveness of GermanIMPACT relative to treatment as usual is not clear. Only if societal WTP was ≥€180 for an additional DFD, GermanIMPACT could be considered cost-effective with certainty.