Depression is the elderly is more common than in the average adult, but is less often treated.
Antidepressants Less Effective in the Elderly: Of 68 DB PC studies of antidepressant medication for major depressive disorder, 6 were of elderly patients. In comparison to studies of younger adults, the proportion of patients responding to placebo in studies of older individuals was slightly higher, and the proportion of patients responding to active medication was lower, leading to a significantly reduced effect size. Placebo control groups in trials of major depressive disorder among older patients. Walsh BT, et al. Columbia University. . J Clin Psychopharmacol. 2005 Aug;25(4 Suppl 1):S29-33.
Anxiety with Depression Worse Prognosis: In elderly with Major Depressive Disorder (MDD), coexisting Generalized Anxiety Disorder (GAD) or Panic Disorder (PD) is associated with more severe symptoms and poorer short-term treatment outcomes. In a 4-year follow-up study of 79 elderly with major depressive disorder who had responded to initial treatment, the co-morbid anxious group showed a greater decline in memory, but not in other cognitive measures or measures of functional status. Depression recurrence was similar in the anxious and non-anxious groups. Among those in the anxious group, a later age of onset (> 55) of the anxiety disorder was associated with worse overall cognition at baseline, but a similar rate of decline in cognition over time, compared with early-onset anxiety disorder. Comorbid anxiety disorder in late life depression: association with memory decline over four years. Deluca AK, et al. University of Pittsburgh. Int J Geriatr Psychiatry. 2005 Aug 22;20(9):848-854
Brain: Antidepressants May Protect Against Gray Matter Loss in Geriatric Depression: In an MRI study of 41 elderly patients with major depressive disorder (32 women; 11 antidepressant exposure and 30 drug-naive; mean age 70.5 years) and 41 controls (20 women; mean age 72.2 years), in multivariate analysis, the depressed group had smaller corrected orbitofrontal cortex (OFC) total and gray matter volumes compared to the controls (p < .01). However, depressed patients with prior antidepressant exposure had larger OFC gray matter volumes compared to drug-naive depressed patients, but smaller than those in normal controls (p = .005). Antidepressant exposure may protect against decrement in frontal gray matter volumes in geriatric depression. Lavretsky H, et al. University of California, Los Angeles. J Clin Psychiatry. 2005 Aug;66(8):964-7
Carotid Thickening More Common: In a study of 14 elderly patients with late-onset major depressive disorder and 11 non-depressed controls, the carotid artery intima-medium thickness (IMT) was higher in the patient group vs the control group (1.26 vs 1.00; p < 0.03). There was a high correlation (r = 0.55, p < 0.05) between the carotid IMT and white matter hyperintensities among patients with late-onset major depressive disorder. The findings support the vascular depression hypothesis. Carotid intima-media thickness in late-onset major depressive disorder. Chen CS, et al. Kaohsiung, Taiwan. Int J Geriatr Psychiatry 2005 Dec 2;21(1):36-42.
Collaborative Care of Elderly Depression Helped: In a very large 12-month random-assignment study of 1801 elderly over age 59 (average 71)with Major Depressive Disorder, those randomized to the Improving Mood: Promoting Access to Collaborative Treatment (IMPACT) intervention compared to a control group receiving usual care experienced significantly better physical functioning at 1 year than usual-care patients. Intervention patients were also less likely to rate their health as fair or poor (37.3% vs 52.4%, P<.001). Combining both study groups, patients whose depression improved were more likely to experience improvement in physical functioning. Treatment of depression improves physical functioning in older adults. Callahan CM, Kroenke K, et al. Indiana University Center for Aging Research. J Am Geriatr Soc. 2005 Mar;53(3):367-73.
Dementia and Mortality Higher After Late-Onset Depression: Late-onset depression (LOD) has a poor prognosis which may be worsened by the presence of cerebrovascular disease. In a 3-year follow-up of 50 patients with LOD and 35 healthy age matched controls, 7 participants had died (all from the depressed group) and six developed dementia, all but one from the depressed group. Poor outcome was predicted by lower High Density Lipoprotein (HDL), raised Erythrocyte Sedimentation Rate (ESR) and one test of immediate memory. Initial response to treatment was not associated with later outcome. Prognosis of late life depression: a three-year cohort study of outcome and potential predictors. Baldwin RC, et al. Manchester Royal Infirmary, UK. Int J Geriatr Psychiatry 2005 Dec 2;21(1):57-63.
Elderly Depressed Patients Had Cortical Brain Abnormalities: A study of 24 depressed elderly and 19 control with MRIs of seven prefrontal subregions: the anterior cingulate, gyrus rectus, orbitofrontal cortex, precentral gyrus, superior frontal cortex, middle frontal cortex, and inferior frontal cortex. Highly significant bilateral volume reductions in gray matter were observed in the anterior cingulate, the gyrus rectus, and the orbitofrontal cortex. Depressed patients also exhibited significant bilateral white matter volume reductions and significant CSF volume increases in the anterior cingulate and the gyrus rectus. Finally, the depressed group showed significant CSF volume reductions in the orbitofrontal cortex relative to the comparison subjects. None of the other regions examined revealed significant structural abnormalities. Anterior Cingulate, Gyrus Rectus, and Orbitofrontal Abnormalities in Elderly Depressed Patients: An MRI-Based Parcellation of the Prefrontal Cortex. Ballmaier M, Toga AW, et al. Am J Psychiatry. 2004 Jan 1;161(1):99-108
Exercise May Be Important in Alzheimer's Depression: In a study of 224 Alzheimer's victims, 18% depressed patients took exercise compared with 44% of non-depressed [OR = 2.9, p = 0.001]. Independent predictors of depression were: lack of exercise (p < 0.001, OR = 3.4), taking cholinesterase inhibitors (p < 0.05, OR = 2.4) and having less involvement in hobbies or interests (p < 0.05, OR = 1.2). Relationship of exercise and other risk factors to depression of Alzheimer's disease: the LASER-AD study. Regan C, Katona C, et al. University College London, London, UK. Int J Geriatr Psychiatry. 2005 Feb 16;20(3):261-268
Nursing Home Patients Better on SSRI than Venlafaxine (Effexor): In a small 52-patient DB PC study of depressed elderly by the Univ of Pennsylvania, those on venlafaxine (up to 150 mg/d) did less well than those on sertraline (up to 100 mg/d) due to a higher rate of serious side-effects without evidence of increased efficacy. Probing the safety of medications in the frail elderly: evidence from a randomized clinical trial of sertraline and venlafaxine in depressed nursing home residents. Oslin DW, Ten Have TR, et al. J Clin Psychiatry. 2003 Aug;64(8):875-82
Post-Stroke Anxious Depression Better with SSRI, Retarded Depression with Reboxetine: A DB 16-week, 74-patient study of post-stroke patients were divided into half anxious and half retarded depression. They were then treated with the SSRI citalopram or the pure noradrenergic reboxetine. Catalia, Sicily. Prediction of the response to citalopram and reboxetine in post-stroke depressed patients. Rampello L, Chiechio S, et al. Psychopharmacology (Berl). 2003 Dec 17
Post-Stroke Depression: Sertraline (Zoloft) Not Helpful: In a 26-week DB PC study of 123 post-stroke depressed patients (average age 70) at a mean of 128 days after stroke and either a diagnosis of major depressive episode (N = 76) or minor depressive disorder (N = 47), sertraline (50-100 mg/day) did no better for antidepressant effect and neurologic outcome except at week 6 (p < .05). At week 26, the improvement in QoL was better in sertraline patients (p < .05) and there was a trend for emotionalism (p = .07). Double-blind comparison of sertraline and placebo in stroke patients with minor depression and less severe major depression. Murray V, et al. Karolinska Institutet, Stockholm, Sweden. . J Clin Psychiatry. 2005 Jun;66(6):708-16
Anti-Depressant Treatment Helps Cognitive Functioning in Elderly Depressed: A 444-patient, 12-week DB study of sertraline, nortriptyline, and fluoxetine found improvements in cognitive tests including the Shopping List Tast and Digit Symbol Substitution Test. Depression improvement correlated with cognitive improvement most strongly with sertraline, followed by nortriptyline then fluoxetine. Anti-cholinergic dry mouth and constipation tended to associate with less improvement. Duke. Does antidepressant therapy improve cognition in elderly depressed patients? Doraiswamy PM, Krishnan KR, et al. J Gerontol A Biol Sci Med Sci. 2003 Dec;58(12):M1137-44