Depression a challenge for seniors, but there’s hope
New study seeks solutions for older people with difficult-to-treat mental-health issue
Depression can be a challenge to treat in older people. As people age, they develop more physical problems, take more medications and can become more forgetful, all of which can have an impact on how well a person can tolerate and respond to treatment for depression. Seniors may find they have to be more patient as their doctors try different combinations and doses of antidepressant medication.
Almost one in10 seniors suffers from clinical depression. In long-term care homes, this rate of depression doubles.
And a growing body of research suggests if you suffer from depression, you’re at a higher risk of developing memory loss or dementia.
Depression can worsen the distress and disability associated with physical problems such as a stroke or symptoms related to heart disease or arthritis. It can also impede your recovery from physical ailments. Persistent depression also contributes to an increased risk of death from both natural causes and suicide.
As a geriatric psychiatrist, my goal is to help relieve people of their symptoms. But, we know at least half of older adults with depression won’t fully benefit from standard drug treatment, leaving them suffering in the present and at a higher risk of their symptoms returning in the future.
One of the main types of treatment is medication. But, unfortunately, there’s no single prescription or combination of drugs that will help everyone.
As a result of aging, it can become more difficult to tolerate certain medications. As we get older, our bodies start to handle drugs differently than they did in our youth. This can have an impact on how well a medication works for us and whether or not we’re able to take the proper dose required for therapeutic benefit.
There’s also an increased risk of adverse effects from taking medications. Older people tend to take more medications than younger people and there can be drug interactions that can lead to adverse effects.
And, the more medications a person takes, the more likely they’ll start to miss doses of medicines. They might prioritize certain medicines and take only their blood pressure drugs or heart medications and forgo the pills they think are less important. Or, they may have so many medications, they just aren’t taking all of their prescriptions at the right dosages. The increasing prevalence of cognitive impairment in older people can also contribute to forgetting to take their medications.
My colleagues and I are working to find solutions to help people with difficult-to-treat depression. About six months ago, we launched the OPTIMUM study, which will explore the risks and benefits of two common strategies for treating older adults with difficult-to-treat depression.
One is to switch to a new medication. The other is to continue the first medication and add a second one. Right now, we don’t really have any evidence to show which is the best approach to help older adults, so my colleagues and I want to fix that.
In the study’s first phase, participants will be assigned at random to add a different medication to their treatment plan or switch altogether to a new medication. Then, our team will follow their progress bi-weekly for 10 weeks. People whose depression persists can take part in a second phase of the study, where a different set of medication is either added or switched.
Afterward, we’ll continue to follow the group every four months for a year.
Our team is working with scientists across five sites in Canada and the U.S. Our research is already underway and we hope to recruit 1,500 seniors with treatment-resistant depression to participate over the five-year study period.
With patience and persistence, most seniors with depression can recover with treatment. The hope of OPTIMUM is that treatment will become more precise, more streamlined and more effective. And that is hope indeed. Dr. Alastair Flint is a professor in the Department of Psychiatry at the University of Toronto’s Faculty of Medicine. He is also a geriatric psychiatrist at the University Health Network and a Senior Scientist in the Toronto General Hospital Research Institute. For more information about the OPTIMUM Study, call 1-866-539-3510, extension 1or send an email to: optimum@camh.ca Doctors’ Notes is a weekly column by members of the University of Toronto’s Faculty of Medicine. Email doctorsnotes@thestar.ca.
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Unfortunately, there’s no single prescription or combination of drugs that will help everyone