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PCORI depression grant

Treatment-resistant depression is a big problem for older adults. More than half of seniors with clinical depression don’t get relief from standard antidepressant medications. To address that problem, psychiatrists at Washington University School of Medicine in St. Louis are helming a multicenter study to evaluate the efficacy of supplementing current therapies with additional drugs, or changing medications altogether. The study will follow 1,500 people with depression from St. Louis and rural Missouri, Los Angeles, Western Pennsylvania, New York City, Toronto and rural Ontario. Study subjects will be 60 or older, and all will have failed to respond to treatment involving at least two antidepressants. Some subjects will take additional drugs during the study, and others will be switched to different medications. After treatment, the researchers will attempt to evaluate which types of patients respond best to specific treatment strategies.

TREATMENT-RESISTANT DEPRESSION IS A PARTICULAR PROBLEM FOR OLDER ADULTS. LESS THAN HALF OF SENIORS WITH CLINICAL DEPRESSION RESPOND COMPLETELY TO THE MOST COMMONLY USED ANTIDEPRESSANT DRUGS. SO NOW, RESEARCHERS AT WASHINGTON UNIVERSITY SCHOOL OF MEDICINE IN ST. LOUIS ARE LEADING A STUDY TO IDENTIFY BETTER WAYS TO PROVIDE RELIEF FOR THOSE WHO DON’T CURRENTLY GET COMPLETE RELIEF FROM COMMON ANTIDEPRESSANT MEDICATIONS. JIM DRYDEN HAS THE STORY…

IT’S CALLED THE OPTIMUM STUDY — AN ACRONYM FOR OPTIMIZING OUTCOMES OF TREATMENT-RESISTANT DEPRESSION IN OLDER ADULTS — AND RESEARCHERS ARE RECRUITING 1500 PEOPLE OVER THE AGE OF 60 WHOSE DEPRESSION HASN’T RESPONDED COMPLETELY TO DRUGS CALLED SELECTIVE SEROTONIN REUPTAKE INHIBITORS, OR SSRIs. WASHINGTON UNIVERSITY PSYCHIATRIST ERIC LENZE IS LEADING THE OPTIMUM STUDY.

(act) :26 o/c these medications

Most older adults get either an incomplete benefit or an

insufficient benefit. You’ll almost always receive a medication

that we call an SSRI. These are medications like Prozac or Paxil

or Zoloft or Lexapro. Half, or more, of older adults will have, as

I said, either an incomplete or a very insufficient benefit from

these medications.

SOME PEOPLE IN THE STUDY WILL REMAIN ON WHATEVER DRUG THEY’RE CURRENTLY USING, AND A SECOND DRUG WILL BE ADDED, TOO. ADDING A SECOND DRUG IS KNOWN AS AUGMENTATION, AND LENZE SAYS IT’S A COMMON WAY TO TREAT MANY DISORDERS.

(act) :22 o/c first one

Many people might have high blood pressure or diabetes, and

they take one medication for it. And that helps some but not

enough, so they need to take a second medication. So in

depression treatment, if one treatment isn’t enough, add a

second one that seems to work well with that first one.

OTHERS IN THE STUDY WILL GET A DIFFERENT DRUG ENTIRELY. THAT’S A STRATEGY THAT LENZE CALLS A SWITCH.

(act) :13 o/c of medication

The other line of thinking is, well if this medication isn’t

working, don’t stay on that medication because it’s not working

very well. So try switching to a different kind of medication.

THE REASON SWITCHING IS ATTRACTIVE, PARTICULARLY FOR OLDER ADULTS, IS THAT IT LIMITS THE NUMBER OF PILLS A PATIENT HAS TO TAKE.

(act) :14 o/c to do

If you get augmentation treatment, that means you’re going to

be on two medications, so you might have more side effects.

You might have more risks, simply because you’re on two

Medications, and right now, we don’t know which is the best

thing to do.

THE AUGMENTATION AND SWITCH PATIENTS WILL BE EVALUATED AFTER 10 WEEKS OF TREATMENT, AND IF SOME STILL HAVE DEPRESSION, THEY’LL BE PLACED INTO ANOTHER ARM OF THE STUDY IN WHICH OLDER, HARDER-TO-USE DRUGS MAY BE INTRODUCED AS TREATMENTS.

(act) :25 o/c like that

You might benefit from your doctor adding lithium. And in fact,

decades ago, that’s what psychiatrists used to do. And this isn’t

done very much anymore, in part because lithium can be difficult

to prescribe. You need to check someone’s kidney function. You need

to do blood levels of the medication, instruct them on how to stay

hydrated, and things like that.

OTHERS IN THE STUDY WILL GET AN OLDER TYPE OF ANTIDEPRESSANT DRUG CALLED NORTRIPTYLINE. LENZE SAYS THE RESEARCHERS HOPE THAT BY STUDYING ALL OF THESE DIFFERENT COMBINATIONS OF AUGMENTATION AND SWITCHING, THEY MAY BE ABLE TO IDENTIFY EFFECTIVE THERAPIES THAT CAN BE PERSONALLY TAILORED TO INDIVIDUAL PATIENTS. I’M JIM DRYDEN…

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