J. Craig Nelson

J. Craig Nelson
University of California, San Francisco | UCSF · Department of Psychiatry

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271
Publications
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Publications

Publications (271)
Article
Objectives: Late Life Depression (LLD) is associated with persistent cognitive dysfunction even after depression symptoms improve. The present study was designed to examine cognitive outcomes associated with the pattern of depression severity change during psychotherapy intervention for LLD. Methods: 96 community-dwelling adults ages 65-91 with...
Article
Objective: To evaluate response to esketamine nasal spray plus an oral antidepressant (ESK + AD) at day 28 in patients with major depressive disorder (DSM-5) and treatment-resistant depression (TRD) who did not meet response criteria within the first week of treatment. Methods: The current study is a pooled post hoc analysis of two phase 3, double...
Article
Introduction Late life depression (LLD) is a common and heterogeneous condition that is associated with increased disability, cognitive impairment, and all-cause mortality in older adults. Anti-depressant medication and psychotherapy have been identified as effective treatments for LLD, though as many as 50% of patients do not respond to treatment....
Article
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Background: Cognitive impairment (CI) is a key feature of late life depression (LLD), but the contribution of underlying neurodegenerative pathology remains unclear. Objective: To evaluate cognitive dysfunction in LLD relative to a sample of nondepressed (ND) older adults with matched levels of memory impairment and amyloid-β (Aβ) burden. Metho...
Article
Objective To evaluate the association between changes in functional disability and suicide ideation among older adults following psychotherapy for depression. Methods Sixty-five participants (65–91 years old, 72% White, and 66% female) with depression completed 12 sessions of problem solving therapy (PST) and completed measures of disability (WHO...
Article
Background To evaluate the role of cortical amyloid deposition as a factor contributing to memory dysfunction and increased risk of dementia associated with late life depression (LLD). Methods 119 older adult participants with current diagnosis of Major Depression (LLD) from the ADNI Depression study and 119 non-depressed (ND) cognitively unimpair...
Article
Objectives: Assess the relationship of cognitive impairment to disability, accounting for depression severity and frailty, among older adults with late-life depression (LLD). Methods: Data were analyzed from 78 community-dwelling older adults with LLD and without dementia (age M = 71.9; SD = 6.1). Cognitive functioning was assessed using a comprehe...
Article
Objectives: Frailty and disability are commonly found in Late Life Depression (LLD) and have been associated with increased depression severity, health comorbidities and mortality. Additionally, physical frailty has been associated with suicide in later life, independent of presence of a mood disorder. The objective of our study was to assess the a...
Article
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Given the association between functional disability and suicidal ideation (SI) in late life (Lutz & Fiske, 2017), this study examined associations between functional disability and SI among older adults receiving problem solving therapy (PST) for depression. PST is a promising intervention for SI (e.g., Gustavson et al., 2016) and has been shown to...
Article
Objectives: Perceived stress is emerging as a potential contributing factor in suicide-related ideation in older adults. We hypothesized higher levels of perceived stress would be associated with increased self-reported suicidal ideation independent of depressive symptom severity. Methods: This study used data from community-dwelling older adults a...
Article
Objectives Impairment in financial capacity is an early sign of cognitive decline and functional impairment in late life. Cognitive impairments such as executive dysfunction are well documented in late-life major depression; however, little progress has been made in assessing associations of these impairments with financial incapacity. Methods Par...
Article
Objective Use latent class analysis (LCA) to identify patterns of cognitive functioning in a sample of older adults with clinical depression and without dementia and assess demographic, psychiatric, and neurobiological predictors of class membership. Method Neuropsychological assessment data from 121 participants in the Alzheimer’s Disease Neuroim...
Article
Objectives: To assess the relationships of somatic and anxiety symptoms of depression with functional disability in a sample of older adults with late life depression. Method: Data were analyzed from 78 older adults aged 65–88 with current major depression. Somatic and anxiety symptoms from the 24-item Hamilton Depression Rating Scale (HDRS) were s...
Conference Paper
Results Of The ADNI-Depression Study. Overview: Late life depression (LLD) is one of the most common mental health disorders with which older patients are afflicted. LLD is complicated by the common co-occurrence of cognitive impairment (CI). Estimates suggest as many as 50-60% of older depressed patients may have mild cognitive deficits however th...
Poster
Full-text available
Introduction: Depression has been strongly linked to suicide ideation in older adults. However, the role of other factors is less clear. Perceived stress is a factor that is emerging as a potential contributing factor in suicide ideation in older adults. We hypothesized higher levels of perceived stress would be associated with increased self-repor...
Article
Background: Less than half of patients with major depressive disorder (MDD) respond to their first antidepressant trial. Our understanding of the underlying mechanisms of selective serotonin reuptake inhibitors (SSRIs) remains poor, and there is no reliable method of predicting treatment response. Methods: Thirty-seven MDD subjects and 41 health...
Article
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Objective: Prior work suggests executive dysfunction (ED) on the Stroop Color and Word Test (SCWT) and the Mattis Dementia Rating Scale-2 Initiation/Perseveration subscale (DRS IP) predicts poor antidepressant response in late-life depression. This study examined if either patient perception of ED or the Trail Making Test Part B (TMT-B) could iden...
Article
Objectives To investigate the association between chronic subsyndromal symptoms of depression (SSD), cerebrospinal fluid (CSF) biomarkers, and neuropsychological performance in individuals with mild cognitive impairment (MCI). Methods Participants included 238 older adults diagnosed with MCI from the Alzheimer's Disease Neuroimaging Initiative rep...
Article
Full-text available
Objective: The authors conducted a systematic review and meta-analysis to determine whether the risk of psychosis is higher in past or future episodes in patients with major depression with psychotic features than in patients with nonpsychotic depression. Method: PubMed, Embase, and PsycINFO were searched, and studies were selected that 1) ident...
Conference Paper
Late life depression is one of the most common and debilitating psychiatric disorders experienced by older adults. Late life depression is complicated by the common co-occurrence of cognitive impairment and some estimates suggest as many as 50-60% of older depressed patients have cognitive deficits. As a consequence some of these patients will meet...
Chapter
Depression is a common disorder in late life that is associated with poor quality of life, increased disability, and increased all-cause mortality. Rates of completed suicide are the highest in older depressed men compared with any other age group. In this age group, depression is often concurrent with medical illness and it can aggravate the cours...
Article
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Background: Patients with major depressive disorder (MDD) who do not adequately respond to antidepressant treatment (ADT) may benefit from adjunctive atypical antipsychotics; however, certain agents target specific symptoms of depression and not the full syndrome. The aim of this analysis was to examine the effects of brexpiprazole, adjunct to ADT...
Article
Objective: Little is known about key factors associated with use of mental health services across the life course. This study determined key socioeconomic, social support, psychiatric, and medical predictors of services use in younger, middle, and older age. Design, setting, participants, measurements: The sample included 3,708 adults with DSM-I...
Article
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Objectives: To investigate the association between cognitive decline and cortical atrophy in individuals with mild cognitive impairment (MCI) and chronic subsyndromal symptoms of depression (SSD) over a 4-year period. Design: Prospective cohort study. Setting: Multicenter, clinic-based. Participants: Within the Alzheimer's Disease Neuroimagi...
Article
Objective: The authors sought to determine the relative morbidity and mortality associated with drugs used to treat depression and to examine specific clinical effects associated with serious outcomes. Method: The National Poison Data System, which receives exposure reports from regional poison centers serving the United States, Puerto Rico, and...
Article
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Objective: To identify symptoms potentially representative of a noradrenergic symptom cluster as possible predictors of response to the selective norepinephrine reuptake inhibitor (NRI) edivoxetine when used as monotherapy or adjunctive treatment in patients with DSM-IV-TR major depressive disorder (MDD). Methods: Pooled data from 4 adjunctive trea...
Article
Background: Many patients with major depressive disorder (MDD) do not respond adequately to first-line antidepressant treatment (ADT). Adjunctive treatment with second-generation antipsychotics has demonstrated efficacy for patients with MDD, but is limited by tolerability and safety issues. The recently introduced serotonin-dopamine activity modul...
Article
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Short leukocyte telomere length (LTL) may be associated with several psychiatric disorders, including major depressive disorder (MDD). Short LTL has previously been associated with poor response to psychiatric medications in bipolar disorder and schizophrenia, but no studies have prospectively assessed the relationship of LTL to SSRI response in MD...
Article
Background: Due to the clinical challenges of treatment-resistant depression (TRD), we evaluated the efficacy of mindfulness-based cognitive therapy (MBCT) relative to a structurally equivalent active comparison condition as adjuncts to treatment-as-usual (TAU) pharmacotherapy in TRD. Methods: This single-site, randomized controlled trial compar...
Article
Objective: Little is known about mental health service use by adults with prior suicidal behavior and current mood or anxiety disorders. This study determined nationally representative prevalence estimates of current mental health service use by these adults, examining racial-ethnic, age, and gender differences. Methods: Service use across the l...
Article
increasedifneededby20mgb.i.d.uptoamaximumdosageof 80 mg b.i.d. Adjunctive ziprasidone was more effective than placebo in achieving response on the Hamilton Depression Rating Scale and the self-reported Quick Inventory of Depressive Symptoms (QIDS-SR). The difference between adjunctive ziprasidone and placebo for remission failed to achieve signific...
Article
Two phase 2B, randomized, double-blind studies assessed the efficacy and safety of fixed or flexible dose of triple monoamine uptake inhibitor BMS-820836 in patients with treatment-resistant depression to demonstrate whether switching to BMS-820836 was superior to the continuation of standard antidepressant treatment. Patients with a history of ina...
Chapter
This chapter concentrates on the use of psychostimulants in the long-term treatment of children with disruptive behavior disorders – in particular, attention-deficit/ hyperactivity disorder (ADHD). The indications for stimulants use, the methods for initiating treatment, and the interactions of their effects with comorbid psychiatric problems and d...
Article
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Objectives: To determine if the number of clinic visits affects placebo or drug response in antidepressant trials of late life major depression. Method: A previous systematic review of placebo-controlled antidepressant trials in late life depression was updated. Selected trials randomized patients to antidepressant or placebo and included community...
Article
Background Lithium augmentation of antidepressants for treatment of unipolar major depression was one of the first adjunctive strategies based on a neuropharmacologic rationale. Randomized controlled trials supported its efficacy but most trials added lithium to tricyclic antidepressants (TCAs). Despite its efficacy, use of lithium augmentation rem...
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Background Randomised, placebo-controlled trials of treatments for depression typically collect outcomes data but traditionally only analyse data to demonstrate efficacy and safety. Additional post-hoc statistical techniques may reveal important insights about treatment variables useful when considering inter-individual differences amongst depresse...
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There is a paucity of evidence for outcome predictors in patients with major depressive disorder (MDD) not responding to initial antidepressant therapy (ADT). This post-hoc analysis evaluated whether MDD severity affects response to adjunctive aripiprazole. Data from 3 randomized, double-blind, placebo-controlled trials of adjunctive aripiprazole i...
Article
Objectives To determine the efficacy of psychotherapy in late-life depression and to determine the effect of the type of control group on the magnitude of psychotherapy effects Design A systematic review and meta-analysis of randomized controlled psychotherapy trials for late-life depression Setting Outpatient clinics or in subjects’ home Partic...
Article
Full-text available
Introduction Efficacy of depression treatments, including adjunctive antipsychotic treatment, has not been explored for patients with worsening symptoms after antidepressant therapy (ADT). This post-hoc analysis utilized pooled data from 3 similarly designed, randomized, double-blind, placebo-controlled trials that assessed the efficacy, safety, an...
Article
Residual symptoms of major depressive disorder (MDD) following treatment are increasingly recognized as having a negative impact on the patient because of their association with lack of remission, poorer psychosocial functioning, and a more chronic course of depression. Although the effects of specific residual symptoms have not been as systematica...
Article
Full-text available
To compare patterns of cognitive performance in older adults with late-onset depression (LOD; ≥65 years of age) with that of older adults with early-onset depression (EOD; <65 years). Participants were 171 adults aged 60 years or older with major depression and executive dysfunction who were participating in a randomized psychotherapy trial. Partic...
Article
The objective of the present study is to investigate the efficacy and safety of the selegiline transdermal system (STS) in major depressive disorder (MDD) with atypical features. This was a post-hoc analysis of 5 short-term trials. The atypical subtype was defined as the presence of at least 1 item with a score of 2 or greater from items 22-26 on t...
Article
We investigated patient and disease characteristics predictive of relapse of MDD during a 52-week placebo controlled trial of selegiline transdermal system (STS) to identify patient characteristics relevant for STS treatment. After 10 weeks of open-label stabilization with STS, 322 remitted patients with MDD were randomized to 52-weeks of double-bl...
Article
Objective: To assess fall events in older depressed patients during treatment with duloxetine. Method: Post hoc analysis of solicited fall events collected at each study visit using a questionnaire during a 24-week, multicenter, randomized, placebo-controlled, double-blind, phase 4 trial (November 2006 to November 2009). Older outpatients (≥ 65...
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Background: Depression is frequently debilitating. The American Psychiatric Association recommends adjunctive atypical antipsychotics as a treatment option when response to antidepressants is inadequate. Objective: To compare medical costs and hospitalizations among patients with depression treated with adjunctive aripiprazole, olanzapine, or qu...
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Objective: The authors sought to identify factors that moderate outcome in late-life major depression and that identify patients for whom antidepressants have clinically meaningful effects. Method: A previous systematic review identified 10 placebo-controlled trials of second-generation antidepressants in outpatients with major depressive disord...
Article
Objective: We examined whether identification of patients with placebo-remitter characteristics and placebo-nonremitter characteristics enhances the ability to identify drug-placebo treatment differences and, perhaps, differences between agents in major depressive disorder (MDD). We hypothesized: 1) that drug-placebo differences in remission rates...
Article
Full-text available
Objective The purpose of this study was to determine the impact of psychotherapy on cognitive functioning in older adults with late life depression (LLD) and executive dysfunction. Method 221 adults aged 60 years and older participated in a randomized clinical trial comparing the efficacy of Problem Solving Therapy (PST) and Supportive Therapy (ST...
Article
Chronic inflammation and oxidative stress have been implicated in the pathophysiology of Major Depressive Disorder (MDD), as well as in a number of chronic medical conditions. The aim of this study was to examine the relationship between peripheral inflammatory and oxidative stress markers in un-medicated subjects with MDD compared to non-depressed...
Article
Prior studies of Hypothalamic-Pituatary-Adrenal (HPA) associations with hippocampal (HC) volume have yielded inconsistent results. This might be due to the use of basal cortisol rather than cortisol reactivity measures and to the use of cortisol in isolation from related steroids. Therefore, in this study, we assessed the relationship of HC volume...
Article
Oxidative stress (an imbalance between free radicals and the ability to neutralize them with antioxidants) occurs in several mental illnesses, including major depression (MDD). A major antioxidant in humans is glutathione peroxidase, which reduces GSSH to GSH, increasing glutathione's ability to scavenge free radicals. The brain, and the hippocampu...
Article
The cellular enzyme elomerase replenishes telomeric DNA, which can be lost during repeated mitoses or during exposure to inflammation and oxidation. However, telomerase may have other, non-canonical functions, including (in animal models) antidepressant and neurogenesis-enhancing effects. In this study, we determined the relationship between telome...
Article
Inflammation and oxidative stress have been implicated both separately and jointly in aging and the pathophysiology of many diseases. This study examines the relationship between inflammation and oxidative stress in controls and in unmedicated MDD patients (N = 18/group) before and after antidepressant treatment. Fasting blood samples were assayed...