This review addresses the question of whether there is evidence that antidepressants are more efficacious than placebo in the treatment of late-life depression and what is the rate of response that physician and patient can expect when antidepressant medication is prescribed in a typical clinical setting. To date, 5 placebo-controlled and 10 comparison trials have study designs of sufficient rigor to provide evidence of antidepressant efficacy and effectiveness in the treatment of late-life depression. The results suggest that antidepressant medications are more effective than placebo. However, placebo-controlled trials are not a simple comparison of only medication versus placebo. Rather, the amount of nonspecific psychosocial interventions included in these trials is considerable and often not systematically measured. Trial design also affects outcome: response and remission rates in comparison trials consistently are 20% to 30% higher than those reported in placebo-controlled trials. Clinical trials do not consistently assess the many moderators that are believed to affect treatment outcome in late-life depression, and therefore, comparisons across studies are problematic because of an inability to determine whether patient samples are truly comparable. For future clinical trials to have maximal relevance, study design should evolve to reflect as closely as possible a typical clinical setting especially with respect to frequency and duration of patient visits.
"In many efficacy trials of antidepressants in the treatment of late-life depression, antidepressants were more effective than placebos, and no difference was found in antidepressant class outcomes among older adults with major depression or nonspecific depression severity, although SSRIs may be better tolerated than tricyclics (Roose and Schatzberg 2005; Reynolds et al. 2006). However, a meta-analysis of the use of second-generation antidepressants in late life found their effects tend to be modest (Nelson et al. 2008). "
[Show abstract][Hide abstract] ABSTRACT: Little research has been done on the use of antidepressants among homebound older adults, especially low-income homebound older adults, and their perceptions of the effectiveness of their medication. The purposes of this study were to examine self-reported use of antidepressants among depressed homebound older adults, class and type of antidepressants used, individual-level correlates of antidepressant use, and users' perceptions of the effectiveness of antidepressants. Data on self-reported use of antidepressants were obtained as part of a feasibility study of short-term telehealth problem-solving therapy for depressed low-income homebound adults (n = 162) aged 50 or older. The 24-item Hamilton Rating Scale for Depression (HAMD) was used to assess depression severity. The findings show that about half of the study participants were taking antidepressants, with 26.6% of those on antidepressants rating their medications very effective and 21.5% rating them effective. Female gender was positively, but older age and being Black/African American were negatively associated with the likelihood of antidepressant use. Perceived effectiveness of antidepressants was negatively associated with older age and the HAMD score. The findings suggest that personalized approaches to depression management may be needed in subgroups of depressed older adults, including culturally tailored medication counseling in Black/African-American older adults.
Brain and Behavior 03/2012; 2(2):178-86. DOI:10.1002/brb3.48 · 2.24 Impact Factor
"Clinically, it could be suggested that the data may imply that serotonergic drugs may be less likely to be effective in depression in the elderly. However, there is little evidence that this is the case (Roose and Schatzberg, 2005). Our previous report (Mace et al., 2010) examined the effects of ATD on mood in PD and healthy controls and included data from a number of the healthy controls in the current study. "
[Show abstract][Hide abstract] ABSTRACT: Few studies have investigated the function of the serotonin (5-HT) system in the elderly. Previous studies have shown effects of reducing serotonin function, by acute tryptophan depletion (ATD), on neuropsychological function in healthy subjects but this technique has not previously been employed over a wide age range in the elderly. This study compared the effects of ATD on mood, cognitive function and motor function in two groups of healthy volunteers, one group aged 50-69 and the other aged 70-89. The effects of ATD were investigated in a double-blind, placebo-controlled, counterbalanced, crossover, randomized design. The effects of ATD were not significantly different between age groups, suggesting that there is relatively little functional change across these age ranges. Compared with studies in much younger age groups there was, however, more evidence of an adverse effect of ATD on psychomotor function and working memory. There was no effect of ATD on mood despite inclusion of subjects with a family history of depression.
Journal of Psychopharmacology 12/2011; 25(10):1337-43. DOI:10.1177/0269881110389094 · 3.59 Impact Factor
"However, most published studies examined small sample sizes and were not controlled for the presence of coexistent medical conditions, including cerebrovascular disease (Taylor & Doraiswamy, 2004). Roose and Schatzberg (2005) analysed the available evidence on the efficacy of antidepressants for treatment of LLD. The clinical trials examined in this analysis did not select for patients with VaD, although many subjects would likely meet criteria for this diagnosis. "
[Show abstract][Hide abstract] ABSTRACT: Late-life depression (LLD) is a frequent complication of the ageing process, occurring in up to 5% of community-dwelling elderly and in a higher proportion of subjects with coexistent medical illnesses. Its presence has been consistently associated with cognitive impairment, greater disability and increased mortality. Approximately half of patients with LLD have evidence of subcortical ischaemic damage in prefrontal circuits revealed by MRI. This might constitute the biological substrate of the cardinal symptoms of depression and of executive dysfunction. An important proportion of patients with LLD do not achieve remission of their depressive symptoms in spite of adequate pharmacological and psychotherapeutic treatment. In addition, a group of LLD patients progress to further impairment and disability in the form of a dementing disorder. There is an imperative need to develop new treatment strategies for LLD. Non-invasive brain stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are safe and efficacious interventions that might be used in combination with other therapeutic options to improve treatment outcomes. However, there are still questions regarding the optimal way in which rTMS and dTCS should be delivered as well as to the way in which we may identify the subjects who will benefit the most from these interventions.
International Review of Psychiatry 10/2011; 23(5):437-44. DOI:10.3109/09540261.2011.633501 · 1.80 Impact Factor
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