De­pres­sion a chal­lenge for se­niors, but there’s hope

New study seeks so­lu­tions for older peo­ple with dif­fi­cult-to-treat men­tal-health is­sue

Toronto Star - - LIFE - ALAS­TAIR FLINT

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: op­ti­ Doc­tors’ Notes is a weekly col­umn by mem­bers of the Univer­sity of Toronto’s Fac­ulty of Medicine. Email doc­torsnotes@thes­


Yoga Moves will re­turn . . .

Un­for­tu­nately, there’s no sin­gle pre­scrip­tion or com­bi­na­tion of drugs that will help ev­ery­one


As a per­son gets older, it can be­come more dif­fi­cult to tol­er­ate cer­tain med­i­ca­tions, in­clud­ing those for de­pres­sion. Aging bod­ies start to han­dle drugs dif­fer­ently.

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