TY - JOUR
T1 - Incomplete response in late-life depression
T2 - Getting to remission
AU - Lenze, Eric J.
AU - Sheffrin, Meera
AU - Driscoll, Henry C.
AU - Mulsant, Benoit H.
AU - Pollock, Bruce G.
AU - Dew, Mary Amanda
AU - Lotrich, Frank
AU - Devlin, Bernie
AU - Bies, Robert
AU - Reynolds, Charles F.
PY - 2008
Y1 - 2008
N2 - Incomplete response in the treatment of late-life depression is a large public health challenge: at least 50% of older people fail to respond adequately to first-line antidepressant pharmacotherapy, even under optimal treatment conditions. Treatment-resistant late-life depression (TRLLD) increases risk for early relapse, undermines adherence to treatment for coexisting medical disorders, amplifies disability and cognitive impairment, imposes greater burden on family caregivers, and increases the risk for early mortality including suicide. Getting to and sustaining remission is the primary goal of treatment, yet there is a paucity of empirical data on how best to manage TRLLD. A pilot study by our group on aripiprazole augmentation in 24 incomplete responders to sequential SSRI and SRNI pharmacotherapy found that 50% remitted over 12 weeks with the addition of aripiprazole, and that remission was sustained in all participants during 6 months of continuation treatment. In addition to controlled assessment, evidence is needed to support personalized treatment by testing the moderating role of clinical (eg, comorbid anxiety, medical burden, and executive impairment) and genetic (eg, selected polymorphisms in serotonin, norepinephrine, and dopamine genes) variables, while also controlling for variability in drug exposure. Such studies may advance us toward the goal of personalized treatment in late-life depression.
AB - Incomplete response in the treatment of late-life depression is a large public health challenge: at least 50% of older people fail to respond adequately to first-line antidepressant pharmacotherapy, even under optimal treatment conditions. Treatment-resistant late-life depression (TRLLD) increases risk for early relapse, undermines adherence to treatment for coexisting medical disorders, amplifies disability and cognitive impairment, imposes greater burden on family caregivers, and increases the risk for early mortality including suicide. Getting to and sustaining remission is the primary goal of treatment, yet there is a paucity of empirical data on how best to manage TRLLD. A pilot study by our group on aripiprazole augmentation in 24 incomplete responders to sequential SSRI and SRNI pharmacotherapy found that 50% remitted over 12 weeks with the addition of aripiprazole, and that remission was sustained in all participants during 6 months of continuation treatment. In addition to controlled assessment, evidence is needed to support personalized treatment by testing the moderating role of clinical (eg, comorbid anxiety, medical burden, and executive impairment) and genetic (eg, selected polymorphisms in serotonin, norepinephrine, and dopamine genes) variables, while also controlling for variability in drug exposure. Such studies may advance us toward the goal of personalized treatment in late-life depression.
KW - Aripiprazole
KW - Incomplete response
KW - Old-age depression
KW - Pharmacologic augmentation
KW - Remission
UR - http://www.scopus.com/inward/record.url?scp=59149100221&partnerID=8YFLogxK
M3 - Article
C2 - 19170399
AN - SCOPUS:59149100221
SN - 1294-8322
VL - 10
SP - 419
EP - 430
JO - Dialogues in Clinical Neuroscience
JF - Dialogues in Clinical Neuroscience
IS - 4
ER -