Pitt research targets depression’s ties to drug treatment and dementia
Carol Wiercinski of Hermitage has spent most of the past three decades battling depression, one of the many older adults for whom the right mood-altering drug treatment can be elusive.
The 71-year-old former bank teller says her condition brightened inrecent months with participation in a national study involving the University of Pittsburgh as one of five research sites. The OPTIMUM study focuses on the difficulty of treating late-life depression, with the participants given new drugs as either a replacement or supplement for the medications they have been taking.
For Ms. Wiercinski, who has been on Effexor, Prozac and other medications for years without achieving any long-term relief from bouts of crying and other symptoms, the new drug therapy has offered hope.
“It’s been amazing to me, amazing to my friends,” she said. “I was ready to go out again. I didn’t lay around the house all day long and watch TV. I wanted to do things and go places,” which includes such activities as working on stained-glass projects and meetups for coffee.
She’s one of about 70 Pittsburgharea depression sufferers thus far in a study that is supposed to eventually include 300 people age 60 or older locally and 1,500 nationally over five years. The $13.5 million project is funded by the PatientCentered Outcomes Research Institute.
“Treatment-resistant depression is really the norm, not the exception, in older adults,” explained Jordan Karp, the associate professor of psychiatry leading Pitt’s OPTIMUM role. “We’re trying to find the safest approach in terms of reliability in treatment without serious side effects, in particular avoiding falls.”
Participants such as Ms. Wiercinski are put into different groups to receive one of two drugs new to them — either bupropion or
aripiprazole — instead of or in addition to whatever medications they were previously prescribed. Their progress is monitored over a year’s time through personal visits and phone calls, with either of two additional drugs — nortriptyline and lithium — given to them if the others spark no improvement. The participants remain under the care of their primary care physicians, who are informed of the drug changes.
Dr. Karp said it is too soon to know how many people are benefiting in the way Ms. Wiercinski has, but he indicated that both patients and their physicians have appreciated the potential to solve a challenging problem without expensive and often-hardto-access psychiatric care. The patients frequently have other medical problems that go untreated when they are consumed by their depression, he noted, which means finding the right drug for them can provide multiple benefits.
Depression is also linked to increased likelihood of developing dementia, which has resulted in a new spinoff study called OPTIMUMNeuro at Pitt and the other four sites. All OPTIMUM participants are invited to join the second study, which involves cognitive and physical testing, MRI imaging and bloodwork in hopes of finding markers that might explain which depression sufferers are apt to suffer a decline in mental functioning.
Meryl Butters, a Pitt associate professor of psychiatry leading the Pittsburgh segment of OPTIMUM-Neuro, said the depression patients who agree to the second study will be monitored and tested periodically over 24 months. That’s too short a span to develop dementia, typically, but sufficient to see milder, measurable signs of the cognitive decline that frequently leads into Alzheimer’s or related diseases.
Ms. Butters noted depression joins physical inactivity and cardiovascular disease among the biggest risk factors for dementia, so the hope is that any success with OPTIMUM participants’ depression will also translate to maintaining their cognitive abilities. The National Institute of Mental Health is devoting more than $10 million to OPTIMUM-Neuro to determine if that is so, and what the impact is of failure to remedy the depression.
“Having an episode of depression doubles the risk [of dementia] in ensuing years, even if someone’s not cognitively impaired to start,” Ms. Butters said. “While we know that, we don’t know who among all the people with depression who are older are going to decline. This study represents the opportunity for us to see whether resistance to treatment [by the failure of medications] may be a marker. Maybe those are people at greater risk,” who thus should be treated even more aggressively for the depression.
Ms. Wiercinski, who is cognitively fine, is among those participating also in OPTIMUM-Neuro,saying, “I went into the OPTIMUM study with the idea if it would help one other person not go through what I have gone through [with depression] I would be satisfied, and I feel the same way about dementia.”
Individuals 60 and older who have taken anti-depressant medications and have no signs of dementia are accepted into the OPTIMUM studies, with more information available at www.optimumstudy.org or by calling 412-586-9851.