Recovery in Geriatric Depression

Alexopoulos, George S.; Meyers, Barnett S.; Young, Robert C.; Kakuma, Tatsu; Feder, Maria; Einhorn, Adam; Rosendahl, Eileen

doi:10.1001/archpsyc.1996.01830040039008

Cited by 224 publications

(155 citation statements)

References 38 publications

Supporting

Mentioning

140

Contrasting

Unclassified

Order By: Relevance

“…This is supported by a study in severely depressed elderly patients, who rated their functionality as impaired whereas their clinicians did not. The authors concluded that the rating by experienced clinicians was able to distinguish disability contributing to depression from disability resulting from medical illness and/or cognitive impairment (28) . Another study reported that depressed elderly out-patients with chronic heart failure showed a tendency to underestimate their physical ability, whereas they had similar energy expenditure and walking ability as their non-depressive counterparts (27) .…”

Section: Discussionmentioning

confidence: 99%

Malnutrition and depression in the institutionalised elderly

et al. 2009

View full text Add to dashboard Cite

Malnutrition and depression are highly prevalent in the institutionalised elderly and can lead to unfavourable outcomes. The aim of the present study was to assess associations between nutritional status and depressive symptoms and to explore their impact on self-caring capacity and quality of life (QoL) in elderly nursing-home residents (NHR). We conducted a cross-sectional study with 114 NHR (eighty-six female) with a mean age of 84·6 (SD 9·1) years. Nutritional status was assessed with the Mini Nutritional Assessment (MNA). Depressive symptoms were rated with the Geriatric Depression Scale (GDS). Self-caring capacity was measured with the Barthel index (BI) and QoL was assessed with the short-form thirtysix-item (SF-36) questionnaire. Of the NHR, twenty-six (22·8 %) were malnourished according to the MNA and sixty-six (57·9 %) were at nutritional risk. Of the residents, seventy-five could be assessed with the GDS, whereof sixteen (21·3 %) had major and twenty-six (34·7 %) had minor depressive symptoms. GDS scores tended to be higher in patients with impaired nutritional status (5·4 (SD 3·6) in well-nourished subjects and 6·9 (SD 3·2) in residents with malnutrition or at risk of malnutrition). The MNA correlated significantly with the GDS (r 20·313; P¼ 0·006) and the GDS emerged as the only independent risk factor for malnutrition in a multiple regression analysis, whereas age, sex, care level, number of prescriptions and self-caring capacity had no influence. The BI was not reduced in patients with a high GDS. QoL was affected in malnourished residents as well as in study participants with depressive symptoms. The results of the present study point towards an association between malnutrition and depressive symptoms. However, the relationship is complex and it remains unclear whether depression in NHR is the cause or consequence of impaired nutritional status. Further studies are needed to identify the direction of this relationship and to assess the effect of depression treatment on nutritional and functional status as well as on QoL.Nursing-home residents: Malnutrition: Depression: Quality of life Malnutrition is a frequent problem in aged individuals. Whereas the prevalence in free-living elderly ranges between 5 and 10 % (1) , it can reach up to 60 % in institutionalised individuals (2,3) . The aetiology of malnutrition is multifactorial and the consequences are severe: a decrease in functional status (4) and consequently high dependency, an impaired quality of life (5) as well as higher morbidity and mortality (6,7) .Depression is a further common health problem in late life with prevalence rates of up to 45 % in the institutionalised elderly (8 -10) . The consequences of untreated depression are manifold and cause an increased use of health care and medical services (9,11) , affect quality of life and well-being negatively (11) and can cause increased mortality (12) . Despite growing evidence that depression is a problem especially in the institutionalised elderly, only little attention is paid to this ...

show abstract

Section: Discussionmentioning

confidence: 99%

Malnutrition and depression in the institutionalised elderly

et al. 2009

View full text Add to dashboard Cite

show abstract

“…Although a trial of 8 weeks may be necessary to declare nonresponse in younger populations (Quitkin et al, 2003), longer studies may be necessary to detect adequately improvement in the elderly population. For elderly populations, a 12-week trial would allow a sufficient time for clinical response in most of this patient population (Cohn et al, 1990), including very old subjects (Gildengers et al, 2002) and elderly patients with comorbid illness who may require longer to respond (Alexopoulos et al, 1996). However, extending trial duration may increase the risk of placebo response (Walsh et al, 2002).…”

Section: Methodological Considerations For Antidepressant Trials In Tmentioning

confidence: 99%

A Systematic Review of Antidepressant Placebo-Controlled Trials for Geriatric Depression: Limitations of Current Data and Directions for the Future

Taylor

Doraiswamy

2004

Neuropsychopharmacol

View full text Add to dashboard Cite

Depression in the elderly is a major public health problem as untreated depression adversely impacts comorbid illnesses. It is important to develop safe and effective antidepressant therapies for older individuals. We performed a systematic review of all published randomized, placebo-controlled antidepressant medication trials in populations over age 55 years. Papers were obtained via MEDLINE (1966( -August 2003 and PSYCINFO (1872-August 2003. Unpublished trials, trials examining nonpharmacologic interventions, and papers reporting post hoc analyses were not included in this review unless they provided new insights. A total of 18 placebo-controlled trials examining acute efficacy met our criteria. The combined sample size in these studies was 2252. The mean sample size was 51 (range 20-728) and mean trial duration was 7 weeks. A total of 12 trials examined tricyclic antidepressants (TCAs), five trials examined selective serotonin reuptake inhibitors (SSRIs), two trials examined bupropion, and one trial examined mirtazapine. There were no published trials of venlafaxine or nefazodone. In all, 71.5% of trials reported significantly greater efficacy with drug than placebo. In conclusions, there is a paucity of published controlled antidepressant trials in the elderly. Most published studies examine small sample sizes and do not include common comorbid conditions. Efficacy studies examining relapse prevention are lacking. Large placebo response rates, lack of controlled head to head comparisons, and other methodological design differences make crosstrial comparisons difficult. Large simple studies are urgently needed to address the unmet needs for data on safety and efficacy of antidepressants in this population.

show abstract

“…LLD can be effectively treated using pharmacotherapy, psychotherapy or both, 21 and response and remission rates are comparable to those in individuals with mid-life depression. 22 Successful diagnosis and treatment of LLD improves depressive symptoms and decreases suicide rates.…”

Section: Late-life Depression: Definition Extent Burden and Hopementioning

confidence: 99%

The Age-by-Disease Interaction Hypothesis of Late-Life Depression

McKinney

Sibille

2013

The American Journal of Geriatric Psychiatry

View full text Add to dashboard Cite

The phenomenological diagnosis of depression is successful in increasing diagnostic reliability, but it is a classification scheme without biological bases. One subtype of depression for which evidence suggests a unique biological basis is late-life depression (LLD), with first onset of symptoms after the age of 65. LLD is common and poses a significant burden on affected individuals, caretakers, and society. The pathophysiology of LLD includes disruptions of the neural network underlying mood, which can be conceptualized as the result of dysfunction in multiple underlying biological processes. Here, we briefly review current LLD hypotheses and then describe the characteristics of molecular brain aging and their overlap with disease processes. Further, we propose a new hypothesis for LLD, the Age-by-Disease Interaction hypothesis, which posits that the clinical presentation of LLD is the integrated output of specific biological processes that are pushed in LLD-promoting directions by changes in gene expression naturally occurring during brain aging, hence leading the brain to a physiological state that is more susceptible to LLD, since additional pushes by genetic, environmental and biochemical factors may now be sufficient to generate dysfunctional states that produce depressive symptoms. We put our propositions together into a decanalization model to aid in illustrating how age-related biological changes of the brain can shift the repertoire of available functional states in a pro-depression direction, and how additional factors can readily lead the system into distinct and stable maladaptive phenotypes, including LLD. This model brings together basic research on neuropsychiatric and neurodegenerative diseases more closely with the investigation of normal aging. Specifically, identifying biological processes affected during normal aging may inform the development of new interventions for the prevention and treatment of LLD.

show abstract

Recovery in Geriatric Depression

Cited by 224 publications

References 38 publications

Malnutrition and depression in the institutionalised elderly

Malnutrition and depression in the institutionalised elderly

A Systematic Review of Antidepressant Placebo-Controlled Trials for Geriatric Depression: Limitations of Current Data and Directions for the Future

The Age-by-Disease Interaction Hypothesis of Late-Life Depression

Contact Info

Product

Resources

About