Dataset Information

Frailty Worsens Antidepressant Treatment Outcomes in Late Life Depression.

ABSTRACT:

Objective

To investigate the relationship between frailty and treatment response to antidepressant medications in adults with late life depression (LLD).

Methods

Data were evaluated from 100 individuals over age 60 years (34 men, 66 women) with a depressive diagnosis, who were assessed for frailty at baseline (characteristics include gait speed, grip strength, activity levels, fatigue, and weight loss) and enrolled in an 8-week trial of antidepressant medication followed by 10 months of open-treatment.

Results

Frail individuals (n = 49 with ≥3 deficits in frailty characteristics) did not differ at baseline from the non/intermediate frail (n = 51 with 0-2 deficits) on demographic, medical comorbidity, cognitive, or depression variables. On average, frail individuals experienced 2.82 fewer Hamilton Rating Scale for Depression (HRSD) points of improvement (t = 2.12, df 89, p = 0.037) than the non/intermediate frail over acute treatment, with this difference persisting over 10 months of open-treatment. Weak grip strength and low physical activity levels were each associated with decreased HRSD improvement, and lower response and remission rates over the course of the study. Despite their poorer outcomes, frail individuals received more antidepressant medication trials than the non/intermediate frail.

Conclusion

Adults with LLD and frailty have an attenuated response to antidepressant medication and a greater degree of disability compared to non/intermediate frail individuals. This disability and attenuated response remain even after receiving a greater number of antidepressant medication trials. Future research must focus on understanding the specific pathophysiology associated with the frail-depressed phenotype to permit the design and implementation of precision medicine interventions for this high-risk population.

SUBMITTER: Brown PJ

PROVIDER: S-EPMC8225710 | biostudies-literature | 2021 Sep

REPOSITORIES: biostudies-literature

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Publications

Frailty Worsens Antidepressant Treatment Outcomes in Late Life Depression.

Brown Patrick J PJ Ciarleglio Adam A Roose Steven P SP Garcia Carolina Montes CM Chung Sarah S Alvarez Johana J Stein Alexandra A Gomez Stephanie S Rutherford Bret R BR

The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry 20201225 9

<h4>Objective</h4>To investigate the relationship between frailty and treatment response to antidepressant medications in adults with late life depression (LLD).<h4>Methods</h4>Data were evaluated from 100 individuals over age 60 years (34 men, 66 women) with a depressive diagnosis, who were assessed for frailty at baseline (characteristics include gait speed, grip strength, activity levels, fatigue, and weight loss) and enrolled in an 8-week trial of antidepressant medication followed by 10 mon ...[more]

PMID: 33388223

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Project description:ContextResearch on vascular depression has used 2 approaches to subtype late-life depression, based on executive dysfunction or white matter hyperintensity severity.ObjectiveTo evaluate the relationship of neuropsychological performance and white matter hyperintensity with clinical response in late-life depression.DesignTwo-site, prospective, nonrandomized controlled trial.SettingOutpatient clinics at Washington University and Duke University.ParticipantsA total of 217 subjects aged 60 years or older met DSM-IV criteria for major depression, scored 20 or more on the Montgomery-Asberg Depression Rating Scale (MADRS), and received vascular risk factor scores, neuropsychological testing, and magnetic resonance imaging; they were excluded for cognitive impairment or severe medical disorders. Fazekas rating was conducted to grade white matter hyperintensity lesions. Intervention Twelve weeks of sertraline treatment, titrated by clinical response. Main Outcome Measure Participants' MADRS scores over time.ResultsBaseline neuropsychological factor scores correlated negatively with baseline Fazekas scores. A mixed model examined effects of predictor variables on MADRS scores over time. Baseline episodic memory (P = .002), language (P = .007), working memory (P = .01), processing speed (P < .001), executive function factor scores (P = .002), and categorical Fazekas ratings (P = .05) predicted MADRS scores, controlling for age, education, age of onset, and race. Controlling for baseline MADRS scores, these factors remained significant predictors of decrease in MADRS scores, except for working memory and Fazekas ratings. Thirty-three percent of subjects achieved remission (MADRS < or =7). Remitters differed from nonremitters in baseline cognitive processing speed, executive function, language, episodic memory, and vascular risk factor scores.ConclusionsComprehensive neuropsychological function and white matter hyperintensity severity predicted MADRS scores prospectively over a 12-week treatment course with selective serotonin reuptake inhibitors in late-life depression. Baseline neuropsychological function differentiated remitters from nonremitters and predicted time to remission in a proportional hazards model. Predictor variables correlated highly with vascular risk factor severity. These data support the vascular depression hypothesis and highlight the importance of linking subtypes based on neuropsychological function and white matter integrity.Trial registrationclinicaltrials.gov Identifier: NCT00045773.

Dataset Information

Frailty Worsens Antidepressant Treatment Outcomes in Late Life Depression.

Objective

Methods

Results

Conclusion

Publications

Frailty Worsens Antidepressant Treatment Outcomes in Late Life Depression.

Similar Datasets

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