ABSTRACT
Delusional depression responds poorly to acute antidepressant monotherapy but appears to respond to intensive combination pharmacotherapy, however with poor short-term outcomes after initial improvement, particularly in later life. The authors compared the efficacy and safety of continuation combination therapy to monotherapy among older patients after remission from a delusional depression. Twenty-nine older adults with SCID-diagnosed major depression with delusions received continuation treatment with nortriptyline-plus-perphenazine or nortriptyline-plus-placebo under randomized double-blind conditions after achieving remission after ECT. Of the 28 subjects included in efficacy analyses, 25% suffered relapses. The relapse frequency was nonsignificantly greater in combination therapy than in monotherapy subjects. However, combination subjects had significantly more extrapyramidal symptoms, an increased incidence of tardive dyskinesia, and a greater number of falls. Continuation treatment with a conventional antipsychotic does not decrease relapse rates but is associated with significant untoward adverse events in older persons after recovery from a delusional depression.
Subject(s)
Antidepressive Agents, Tricyclic/therapeutic use , Antipsychotic Agents/therapeutic use , Delusions/drug therapy , Delusions/psychology , Depression/psychology , Depression/therapy , Electroconvulsive Therapy/methods , Nortriptyline/therapeutic use , Perphenazine/therapeutic use , Aged , Combined Modality Therapy , Depression/drug therapy , Double-Blind Method , Drug Therapy, Combination , Female , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
UNLABELLED: OBJECTIVE. Explore the relationships between pain, depression, and functional disability in elderly persons. DESIGN: A cross-sectional, observational study of 228 independently living retirement community residents. METHODS: Self-report measures of pain (adaptation of McGill Pain Questionnaire), depression (Geriatric Depression Scale [GDS]) and physical functioning (Physical performance difficulties, activities of daily living [ADL], independent activities of daily living [IADL], and 3-meter walking speed) were employed. OUTCOME MEASURES: Physical functioning variables were dichotomized. Individuals in the lowest quartiles of functional performance and of walking speed were contrasted to all others; for ADL and IADL, those needing some help were compared with those independent in activities. RESULTS: Pain and depression levels were strongly related to physical performance; depression levels were related to ADL and walking speed. In multivariate analyses, an interaction effect was observed where the effects of pain were a function of level of depression. Individuals reporting activity-limiting pain and slightly elevated depressive symptom levels, sub-threshold depression, or major depression were significantly more likely (AOR 7.8; 95% CI, 3.07-20.03) than non-depressed persons to be in the lowest quartile of self-reported physical performance. CONCLUSIONS: While both pain and depression level affect physical performance, depressive symptoms rather than pain appear the more influential factor. When seeing elderly patients, identifying, evaluating, and treating both pain complaints and depressive symptoms and disorders may reduce functional impairment.
ABSTRACT
BACKGROUND: Decreased dopamine beta-hydroxylase (DBH) activity has been reported in unipolar psychotic depression. DBH comparisons between elderly delusional and nondelusional depressives and controls and determination of whether pretreatment group differences persist have not been reported. Our objective was to compare DBH activity in elderly delusional major depressives with that of nondelusional depressives and normal control subjects before and after hospital treatment. METHODS: Enzyme activity was assessed after hospital admission. A subsample had predischarge assessments. Treatment was not controlled but accounted for in analyses. Electroconvulsive therapy subjects were medication-free for posttreatment assays. RESULTS: Baseline and predischarge DBH assays were lower in subjects with delusional depression than in either comparison group. Despite high intraindividual correlation, treatment was associated with significant increases in activity in the clinical groups. CONCLUSIONS: Patients with late-life delusional depression have lower DBH activity before and after hospital treatment than age-matched nondelusional patients or normal controls.
Subject(s)
Delusions/enzymology , Depressive Disorder/enzymology , Dopamine beta-Hydroxylase/metabolism , Psychotic Disorders/enzymology , Age of Onset , Aged , Analysis of Variance , Case-Control Studies , Delusions/complications , Delusions/therapy , Depressive Disorder/complications , Depressive Disorder/therapy , Female , Humans , Longitudinal Studies , Male , Middle Aged , Psychotic Disorders/complications , Psychotic Disorders/therapy , Treatment OutcomeSubject(s)
Alzheimer Disease/epidemiology , Neoplasms/epidemiology , Aged , Aged, 80 and over , Alzheimer Disease/complications , Autopsy , Female , Humans , Male , Neoplasms/complicationsABSTRACT
The cognitive function scores and subjective memory complaints of eight patients who had each received more than 100 treatments with bilateral modified since wave ECT were equivalent to those of matched patients who had never received ECT. The results suggest that patients given many ECT treatments over several courses do not manifest measurable cognitive impairment at long-term follow-up.
