Incomplete response in late-life depression: Getting to remission

Eric J. Lenze, Meera Sheffrin, Henry C. Driscoll, Benoit H. Mulsant, Bruce G. Pollock, Mary Amanda Dew, Frank Lotrich, Bernie Devlin, Robert Bies, Charles F. Reynolds

Research output: Contribution to journalArticle

47 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)419-430
Number of pages12
JournalDialogues in Clinical Neuroscience
Volume10
Issue number4
StatePublished - Dec 1 2008
Externally publishedYes

Keywords

  • Aripiprazole
  • Incomplete response
  • Old-age depression
  • Pharmacologic augmentation
  • Remission

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

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  • Cite this

    Lenze, E. J., Sheffrin, M., Driscoll, H. C., Mulsant, B. H., Pollock, B. G., Dew, M. A., Lotrich, F., Devlin, B., Bies, R., & Reynolds, C. F. (2008). Incomplete response in late-life depression: Getting to remission. Dialogues in Clinical Neuroscience, 10(4), 419-430.