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Depression in the Elderly: The Unique Features Related to Diagnosis and Treatment
- Katherine Shear, David L. Ginsberg, Steven P. Roose, Eric J. Lenze, George S. Alexopoulos, Eric Hollander
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- Journal:
- CNS Spectrums / Volume 10 / Issue S8 / 2005
- Published online by Cambridge University Press:
- 07 November 2014, pp. 1-41
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Depression affects 6.5 million of the 35 million Americans ≥65 years of age. While depression usually begins earlier in life and recurs periodically, it can present for the first time in people 80–90 years of age as well. Depression throughout the lifespan has a genetic/biological component but is also very much affected by social environmental factors. As people age, demographic factors, social support, and negative life events remain important to overall mental health, while physical illness and disability begin to take on a much more prominent role. Depression in the elderly is associated with impairment, dependency, disability, and significant distress for the individual and their family. This population is likely to present with concomitant cognitive dysfunction and medical illness, which can complicate the identification and treatment of psychiatric conditions. Bereavement is almost universal in late life and is sometimes a deterrent to appropriate diagnosis and treatment of depression. Physical frailty and diminishing social resources further complicate the treatment of depression in the elderly. Elderly individuals respond well to standard pharmacotherapy and psychotherapy treatments for depression. However, due to the high rate of relapse of depression in this population, continuous treatment is often warranted. This monograph will review depression in the elderly in the context of social disruptions, such as bereavement, caregiver strain, interpersonal conflict, role transitions, and social isolation; late-onset vascular depression and cognitive impairment; and physical illness including disability.
List of contributors
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- By Jimmy N. Avari, Joshua Berman, David A. Brent, Benjamin D. Brody, Carolyn Broudy, Gerard E. Bruder, Deborah L. Cabaniss, Megan S. Chesin, Melissa P. DelBello, Davangere P. Devanand, Jordan W. Eipper, Jean Endicott, Eric A. Fertuck, Michael B. First, Benicio N. Frey, Emily Gastelum, Lucas Giner, Barbara L. Gracious, David J. Hellerstein, Aerin M. Hyun, David A. Kahn, Jürgen Kayser, S. Aiden Kelly, James H. Kocsis, Robert A. Kowatch, Gonzalo Laje, Martin J. Lan, Kyle A. B. Lapidus, Frances R. Levin, Sarah H. Lisanby, J. John Mann, Sanjay J. Mathew, Patrick J. McGrath, Francis J. McMahon, Barnett S. Meyers, Luciano Minuzzi, Diana E. Moga, Philip R. Muskin, Edward V. Nunes, Maria A. Oquendo, Ramin V. Parsey, Joan Prudic, Annie E. Rabinovitch, Drew Ramsey, Steven P. Roose, Moacyr A. Rosa, Bret R. Rutherford, Roberto Sassi, Peter A. Shapiro, Margaret G. Spinelli, Barbara H. Stanley, Meir Steiner, Jonathan W. Stewart, M. Elizabeth Sublette, Craig E. Tenke, Jiuan Su Terman, Michael Terman, Michael E. Thase, Helen Verdeli, Myrna M. Weissman
- Edited by J. John Mann, Columbia University, New York
- Edited in association with Patrick J. McGrath, Columbia University, New York, Steven P. Roose, Columbia University, New York
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- Book:
- Clinical Handbook for the Management of Mood Disorders
- Published online:
- 05 May 2013
- Print publication:
- 09 May 2013, pp vii-x
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A randomized, prospective pilot study of patient expectancy and antidepressant outcome
- B. R. Rutherford, S. M. Marcus, P. Wang, J. R. Sneed, G. Pelton, D. Devanand, N. Duan, S. P. Roose
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- Journal:
- Psychological Medicine / Volume 43 / Issue 5 / May 2013
- Published online by Cambridge University Press:
- 13 September 2012, pp. 975-982
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Background
This study is a randomized, prospective, investigation of the relationships between clinical trial design, patient expectancy and the outcome of treatment with antidepressant medication.
MethodAdult out-patients with major depressive disorder (MDD) were randomized to either placebo-controlled (PC, 50% probability of receiving active medication) or comparator (COMP, 100% probability of receiving active medication) administration of antidepressant medication. Independent-samples t tests and analysis of covariance (ANCOVA) were used to determine whether the probability of receiving active medication influenced patient expectancy and to compare medication response in the PC v. COMP conditions. We also tested the correlations between baseline expectancy score and final improvement in depressive symptoms across study groups.
ResultsSubjects randomized to the COMP condition reported greater expectancy of improvement compared to subjects in the PC condition (t = 2.60, df = 27, p = 0.015). There were no statistically significant differences in the analyses comparing antidepressant outcomes between subjects receiving medication in the COMP condition and those receiving medication in the PC condition. Higher baseline expectancy of improvement was correlated with lower final depression severity scores (r = 0.53, p = 0.021) and greater improvement in depressive symptoms over the course of the study (r = 0.44, p = 0.058).
ConclusionsThe methods described represent a promising way of subjecting patient expectancy to scientific study. Expectancy of improvement is affected by the probability of receiving active antidepressant medication and seems to influence antidepressant response.
Contributors
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- By Avishek Adhikari, Susanne E. Ahmari, Anne Marie Albano, Carlos Blanco, Desiree K. Caban, Jonathan S. Comer, Jeremy D. Coplan, Ana Alicia De La Cruz, Emily R. Doherty, Bruce Dohrenwend, Amit Etkin, Brian A. Fallon, Michael B. First, Abby J. Fyer, Angela Ghesquiere, Jay A. Gingrich, Robert A. Glick, Joshua A. Gordon, Ethan E. Gorenstein, Marco A. Grados, James P. Hambrick, James Hanks, Kelli Jane K. Harding, Richard G. Heimberg, Rene Hen, Devon E. Hinton, Myron A. Hofer, Matthew J. Kaplowitz, Sharaf S. Khan, Donald F. Klein, Karestan C. Koenen, E. David Leonardo, Roberto Lewis-Fernández, Jeffrey A. Lieberman, Michael R. Liebowitz, Sarah H. Lisanby, Antonio Mantovani, John C. Markowitz, Patrick J. McGrath, Caitlin McOmish, Jeffrey M. Miller, Jan Mohlman, Elizabeth Sagurton Mulhare, Philip R. Muskin, Navin Arun Natarajan, Yuval Neria, Nicole R. Nugent, Mayumi Okuda, Mark Olfson, Laszlo A. Papp, Sapana R. Patel, Anthony Pinto, Kristin Pontoski, Jesse W. Richardson-Jones, Carolyn I. Rodriguez, Steven P. Roose, Moira A. Rynn, Franklin Schneier, M. Katherine Shear, Ranjeeb Shrestha, Helen Blair Simpson, Smit S. Sinha, Natalia Skritskaya, Jami Socha, Eun Jung Suh, Gregory M. Sullivan, Anthony J. Tranguch, Hilary B. Vidair, Tor D. Wager, Myrna M Weissman, Noelia V. Weisstaub
- Edited by Helen Blair Simpson, Columbia University, New York, Yuval Neria, Columbia University, New York, Roberto Lewis-Fernández, Columbia University, New York, Franklin Schneier, Columbia University, New York
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- Book:
- Anxiety Disorders
- Published online:
- 10 November 2010
- Print publication:
- 26 August 2010, pp vii-xii
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