Incomplete response in late-life depression: getting to remission

Abstract

Incomplete response in the treatment of late-life depression is a large public health challenge: at least 50% of older people fail to respond adequately to first-line antidepressant pharmacotherapy, even under optimal treatment conditions. Treatment-resistant late-life depression (TRLLD) increases risk for early relapse, undermines adherence to treatment for coexisting medical disorders, amplifies disability and cognitive impairment, imposes greater burden on family caregivers, and increases the risk for early mortality, including suicide. Getting to and sustaining remission is the primary goal of treatment, yet there is a paucity of empirical data on how best to manage TRLLD. A pilot study by our group on aripiprazole augmentation in 24 incomplete responders to sequential SSRI and SRNI pharmacotherapy found that 50% remitted over 12 weeks with the addition of aripiprazole, and that remission was sustained in all participants during 6 months of continuation treatment. In addition to controlled assessment, evidence is needed to support personalized treatment by testing the moderating role of clinical (e.g., comorbid anxiety, medical burden, and executive impairment) and genetic (eg, selected polymorphisms in serotonin, norepinephrine, and dopamine genes) variables, while also controlling for variability in drug exposure. Such studies may advance us toward the goal of personalized treatment in late-life depression.

Effects of integrated telehealth-delivered cognitive-behavioral therapy for depression and insomnia in rural older adults.

“…Another possibility might be that changes in depression are less salient and more nuanced than those in observed with insomnia; so patients may be underreporting progress upon follow-up relative to the perceived rate of their insomnia improvement. Last, at least 50% of older adults with major depressive disorder fail to adequately respond to first-line treatments (Lenze et al, 2008), making late-life treatment-resistant depression the norm rather than the exception. For patients that do not respond to an initial course of psychotherapy, follow-up treatment strategies include switching treatments (to a different psychotherapy or antidepressant) or augmenting psychotherapy with medication (Thase, Connolly, Roy-Byrne, & Solomon, 2015).…”

Association of Molecular Senescence Markers in Late-Life Depression With Clinical Characteristics and Treatment Outcome

“…Treatment response and remission rates in LLD are approximately 50% after first-line antidepressant treatment. 1 Nonremission leads to persistent depressive symptoms, a source of depleted psychological well-being, increased disability, accelerated cognitive decline, and premature mortality in older adults. 2 Therefore, identifying mechanisms and factors associated with treatment outcomes is key for improving therapeutics and for a priori identification of individuals for whom antidepressant treatment would be more effective.…”

Effects of Mindfulness-Based Cognitive Therapy on Peripheral Markers of Stress and Inflammation in Older-Adults With Depression and Anxiety: A Parallel Analysis of a Randomized Controlled Trial

“…Between sessions, participants practiced daily for at least 15 min. Adaptations included: (1) reducing time of body scan meditation, (2) replacing yoga mats with chairs during meditation practices, (3) performing seated yoga using modified movements, (4) encouraging participants to modify postures and pillows to promote well-being and safety, (5) slowing down the pace of walking meditation, (6) ensuring all participants can hear and understand by projecting the voice and (7) taking more frequent breaks. More detailed explanations are published elsewhere (20).…”