Augmentation strategies in geriatric depression

Abstract

SUMMARYApproximately 3040% of elderly patients with major depression have inadequate response to an initial therapeutic trial of antidepressant medication. In these cases augmentation of the antidepressant has been recommended as one way of improving the rate of response. This article reviews the literature on augmentation strategies in treatmentresistant geriatric depression. Successful augmentation with lithium, triiodothyronine, stimulants, carbamazepine, valproate and a tricyclic-serotonin reuptake inhibitor combination have been described. However, there have been no controlled trials and, with the exception of two open prospective studies of lithium potentiation, the literature consists entirely of case reports and retrospective case series. As a result, it is difficult to draw conclusions about the efficacy of these strategies in late life, especially since treatment failures seldom get reported. Side-effects may limit the usefulness of some augmentation regimens in old age-up to 25% of patients treated with lithium or carbamazepine discontinued these medications because of adverse events. There is a need for controlled studies to better determine the clinical utility of augmentation strategies in physically well depressed elderly, as well as those with depression complicating medical illness, dementia and other neurological disorders.

Diagnosis and Management of Late Life Depression: A Guide for the Primary Care Physician

“…Flint, in a recent review of augmentation strategy for geriatric depression, notes the absence of controlled trials and concludes that it is difficult to evaluate the efficacy of these strategies in late life, especially since treatment failures seldom get reported [27]. Most primary care physicians would refer to a psychiatrist if augmentation is being considered.…”

Chapter 7; Depression and Anxiety

“…Such barriers can be categorized as patient barriers, provider barriers, conceptual barriers, and policy/funding barriers. As discussed earlier, a number of studies have documented treatment resistance among depressed older adults (e.g., Baldwin & Simpson, 1997;Bonner & Howard, 1995;Flint, 1995;Kamholz & Mellow, 1996). Besides patient and provider barriers to using psychosocial interventions, there may also be conceptual barriers as well as barriers stemming from the interrelated issues of policy, funding, and the context of treatment.…”

Refractory depression in late life: a review of treatment options

“…7 The utility of the term 'refractory' could be made more meaningful if there was a clearer conceptualization of the process of depression management. It is not clear whether they refer to patient variables, treatment variables or both.…”