Treatment-Resistant Depression in the Elderly: Diagnostic and Treatment Approaches

Newman, Brianne M.

doi:10.1007/s13670-016-0186-5

Cited by 6 publications

(7 citation statements)

References 52 publications

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“…Moreover, while previous research has reported an association between depression and polypharmacy [ 45 ], to our knowledge, this is the first study to identify a positive association between depression and potential DDI exposure in the older population. This may be due to treatment-resistant depression, requiring multiple or older, more toxic antidepressants to manage symptoms [ 46 ]. However, other confounding factors contributing to this association cannot be excluded, and further research is therefore needed to validate our findings.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Factors Associated with Potential Drug-Drug Interactions in Older Community-Dwelling Adults: A Prospective Cohort Study

et al. 2021

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Background Older patients are at increased risk of drug-drug interactions (DDIs) due to polypharmacy. Cardiovascular and central nervous system (CNS) drugs are commonly implicated in serious DDIs. Objectives This study aimed to determine the prevalence and factors associated with potential 'severe' cardiovascular and CNS DDIs among older (≥ 70 years) community-dwellers. Methods This was a prospective cohort study using linked data from a national pharmacy claims database and waves 1 and 2 of The Irish LongituDinal study on Ageing (TILDA). 'Severe' cardiovascular and CNS DDIs were identified using the British National Formulary 77 and Stockley's Drug Interactions. The prevalence of 'severe' DDIs (any DDI vs. none) was calculated. Logistic regression was used to examine the association between sociodemographic, functional ability, and medication-related factors and the risk of DDI exposure between waves 1 and 2. Results A total of 1466 patients were included [mean age (standard deviation) = 78 (5.5) years; female n = 795, 54.2%]. In total, 332 community-dwellers aged ≥ 70 years [22.65%, 95% confidence interval (CI) 20.58-24.86] were potentially exposed to at least one 'severe' cardiovascular or CNS DDI, with more than half (54.82%) of this cohort dispensed the same DDI for a prolonged time (≥ 3 consecutive claims). Aspirin-warfarin was the most frequently dispensed (co-prescribed) DDI (n = 34, 10.24%, 95% CI 7.39-14.00), followed by atorvastatin-clarithromycin (n = 19, 5.72%,. Polypharmacy [≥ 10 vs. < 5 drugs, odds ratio (OR) 13.40,] and depression (depressed vs. not, OR 2.12, 95% CI 1.34-3.34) were significantly associated with these DDIs, after multivariable adjustment. Conclusion 'Severe' cardiovascular and CNS DDIs are prevalent in older community-dwellers in Ireland, and those with polypharmacy and depression are at a significantly increased risk.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Factors Associated with Potential Drug-Drug Interactions in Older Community-Dwelling Adults: A Prospective Cohort Study

et al. 2021

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“…Дедалі більше з достатньою ефективністю розширюється роль інших соматичних втручань для пацієнтів з резистентною до терапіı̈депресією, в тому числі стимуляціı̈блукаючого нерва і транскраніальноı̈магнітноı̈стимуляціı. Але ці методи мають деякі побічні ефекти, тому вони потребують подальших досліджень, особливо великих контрольованих рандомізованих досліджень, спрямованих на поглиблене вивчення зон мозку, залучених у розвиток і лікування резистентноı̈депресіı̈ [34], [35].…”

Section: немедикамента терапія резистентних депресійunclassified

Resistant depression: criteria for determination, risk factors and therapeutic strategies

Khaustova

2017

PMGP

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Background Therapy of resistant depression raises a number of diagnostic and therapeutic problems, requires the solution of a number of methodological issues. A scientific discussion continues around the definition of depression resistance, assessment of the degree of reduction of depressive symptoms, the level of social and role functioning of patients; the improvement of models for determining the degree of resistance to various types of depression therapy continues; new methods of therapy and new algorithms of combined therapy are being developed. The ultimate goal of all these efforts should be practical recommendations for determining therapeutic options for the treatment of patients with resistant depression, which will help doctors make informed decisions on intervention strategies. Aim To analyze the therapeutic possibilities of treating depressive disorders that are resistant to therapy. Methods Publications from the Pubmed, MEDLINE, the Cochrane Library, Web of Science, Google Scholar databases were analyzed. Tags: depression, treatment, resistance, psevdoresistence, therapeutic response, resistance to treatment, strategies for treatment of resistant depression. Results The terminology related to resistant depression was defined: lack of a therapeutic response, adequate dose, adequate duration of treatment, antidepressant intolerance, pseudo-resistance, relative resistance to treatment, absolute resistance to treatment, treatment of resistant depression, remission, recovery. Models for determining the resistance of depression have been described: the Thase & Rush model; European stepped model; A step model of the Massachusetts hospital; Step model of Maudsley; Form of the history of treatment with antidepressants. Risk factors for treatment of resistant depression were identified, and the main therapeutic strategies were described: optimization, switching, augmentation, combination and non-drug therapy. Particular attention is paid to the use of atypical antipsychotics, in particular arapiprazole, as the augmentation strategy. A complex approach is described, which includes various combinations of the above strategies. Conclusion Each case of treatment-resistant depression has its own unique characteristics and requires careful evaluation to determine the correct diagnosis and the quality of the therapeutic response. Equally important for building an adequate treatment plan is evaluating risk factors for the treatment of resistant depression. There is a wide variety of options for the treatment of resistant depression, so each therapeutic strategy should be used to help patients with treatment-resistant depression. The combination of antidepressant therapy and atypical antipsychotics with antidepressant properties in combination with psychotherapeutic intervention and adherence to adequate doses and duration of treatment may be a choice strategy for patients with treatment-resistant depression.

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“…The PHQ-9 and GDS. Full psychiatric evaluation should be performed for those screened positive for depression (43) as described in table (2) for diagnostic criteria of DLL.…”

Section: Suicidal Behavior In Dllmentioning

confidence: 99%

Late life Depression: Prevalence, Pathogenesis, Clinical Presentation, Evaluation and Emerging Therapeutics

Hassanin

2015

The Egyptian Journal of Geriatrics and Gerontology

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Treatment-Resistant Depression in the Elderly: Diagnostic and Treatment Approaches

Cited by 6 publications

References 52 publications

Prevalence and Factors Associated with Potential Drug-Drug Interactions in Older Community-Dwelling Adults: A Prospective Cohort Study

Prevalence and Factors Associated with Potential Drug-Drug Interactions in Older Community-Dwelling Adults: A Prospective Cohort Study

Resistant depression: criteria for determination, risk factors and therapeutic strategies

Late life Depression: Prevalence, Pathogenesis, Clinical Presentation, Evaluation and Emerging Therapeutics

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