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P57: The ENGAGED study: dementia prevention co-design for people living with depression
- Eleanor Curran, Victoria Palmer, Charles Abraham, Terence W.H. Chong, Tom Rego, Kali Godbee, Barry Baulch, Sabah Khalid, Robyn Garlick, Nicola Lautenschlager
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- Journal:
- International Psychogeriatrics / Volume 35 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 02 February 2024, pp. 116-117
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Background:
People living with depression are at increased risk of poor health outcomes, including dementia. Interventions to reduce dementia risk (dementia risk reduction (DRR)), include physical activity, diet and vascular health interventions. These can also benefit depressive symptoms and broader health, making DRR an important part of holistic mental health care for depression. However, enabling engagement and adherence, and embedding interventions in mental health clinician practice are ongoing challenges that limit the impact of interventions and implementation in clinical practice. Improved intervention tailoring and new approaches to intervention design and implementation are urgently needed. Co-design approaches have been shown to improve engagement and the impact of complex interventions in diverse fields, but have not previously been used in DRR.
Objective:The ENGAGED study will examine DRR intervention needs specifically for people living with depression, then co-design a tailored DRR intervention for use in mental health clinical settings.
Methods:The study will adapt a co-design model for mental health settings that emphasizes lived-expertise, and incorporate processes and evidence from behavioral science. Participants will include middle-aged and older people living with depression, and mental health clinicians.
Semi-structured interviews with both participant groups will examine unmet intervention needs. Illuminated shared experiences and themes will be explored further through focus group discussions to develop consensus intervention priorities. They will also be analyzed to produce a contextualized model of relevant behavior change. Participants and researchers will then work together to co-design intervention components and refine prototypes. Finally, mixed methods survey will evaluate the co- design process and participant experiences.
Results:This study will provide two key outputs to enhance future intervention tailoring and engagement:
1. 1) a pragmatic blueprint for DRR intervention with people experiencing depression across diverse mental health clinical settings, ready for evaluation and implementation
2. 2) a model of DRR behavior change that is specified to this population.
Conclusion:This research addresses the need for new approaches to tailored, integrated mental, physical and cognitive healthcare for people living with depression that emphasize stakeholder expertise and engagement to facilitate holistic support.
The prescriber’s guide to classic MAO inhibitors (phenelzine, tranylcypromine, isocarboxazid) for treatment-resistant depression
- Vincent Van den Eynde, Wegdan R. Abdelmoemin, Magid M. Abraham, Jay D. Amsterdam, Ian M. Anderson, Chittaranjan Andrade, Glen B. Baker, Aartjan T.F. Beekman, Michael Berk, Tom K. Birkenhäger, Barry B. Blackwell, Pierre Blier, Marc B.J. Blom, Alexander J. Bodkin, Carlo I. Cattaneo, Bezalel Dantz, Jonathan Davidson, Boadie W. Dunlop, Ryan F. Estévez, Shalom S. Feinberg, John P.M. Finberg, Laura J. Fochtmann, David Gotlib, Andrew Holt, Thomas R. Insel, Jens K. Larsen, Rajnish Mago, David B. Menkes, Jonathan M. Meyer, David J. Nutt, Gordon Parker, Mark D. Rego, Elliott Richelson, Henricus G. Ruhé, Jerónimo Sáiz-Ruiz, Stephen M. Stahl, Thomas Steele, Michael E. Thase, Sven Ulrich, Anton J.L.M. van Balkom, Eduard Vieta, Ian Whyte, Allan H. Young, Peter K. Gillman
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- Journal:
- CNS Spectrums / Volume 28 / Issue 4 / August 2023
- Published online by Cambridge University Press:
- 15 July 2022, pp. 427-440
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This article is a clinical guide which discusses the “state-of-the-art” usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies. There is a clear and broad consensus (more than 70 international expert endorsers), based on 6 decades of experience, for the recommendations herein exposited. They are based on empirical evidence and expert opinion—this guide is presented as a new specialist-consensus standard. The guide provides practical clinical advice, and is the basis for the rational use of these drugs, particularly because it improves and updates knowledge, and corrects the various misconceptions that have hitherto been prominent in the literature, partly due to insufficient knowledge of pharmacology. The guide suggests that MAOIs should always be considered in cases of treatment-resistant depression (including those melancholic in nature), and prior to electroconvulsive therapy—while taking into account of patient preference. In selected cases, they may be considered earlier in the treatment algorithm than has previously been customary, and should not be regarded as drugs of last resort; they may prove decisively effective when many other treatments have failed. The guide clarifies key points on the concomitant use of incorrectly proscribed drugs such as methylphenidate and some tricyclic antidepressants. It also illustrates the straightforward “bridging” methods that may be used to transition simply and safely from other antidepressants to MAOIs.