More than half of older adults who are treated for depression find that eventually their treatments are no longer effective. When depression persists, these people are at greater risk of accelerated aging, declining mental health and even suicide.
To help address this, UCLA and four other institutions have been awarded a $13.9 million grant to evaluate treatment strategies for older adults with depression who have not responded to medications. UCLA psychiatry professor Dr. Helen Lavretsky will serve as principal investigator on this new study.
"No more than 30 to 40 percent of people respond to first-line treatments," said Lavretsky, director of the Late-life Depression, Stress and Wellness Research Program at the Semel Institute for Neuroscience and Human Behavior at the David Geffen School of Medicine at UCLA. Usually first-line treatments are a type of antidepressant called a selective serotonin reuptake inhibitor. Such persistent depression decreases older adults' quality of life more than any other illness, Lavretsky said.
The study will provide clinicians with evidence on the comparative effectiveness of switching people to a new medication, or augmenting their current medication with a second drug. It will also explore how aging-related factors affect the benefits and risks of different antidepressant strategies. The researchers will recruit 300 people age 60 and older who have had at least two rounds of antidepressant treatment and are deemed to be "treatment-resistant."
People will be recruited using electronic medical records to identify those age 60 and older who are taking antidepressants or who took them in the recent past. In addition, referrals will be elicited from clinicians who are treating people for depression. Participants will receive either the drug aripiprazole (Abilify) or bupropion (Wellbutrin), in addition to their existing antidepressant medications, or, at the discretion of the clinician, will switch from their existing antidepressant medication to bupropion alone. Those people who do not respond to treatment during the first three-month phase will be given either lithium or nortriptyline during a second phase. All people will be monitored weekly.
Monitoring is important, said Lavretsky, since there are safety concerns about the use of antidepressants in older adults. These can include death, cardiovascular risks, cognitive decline and falls.
"Understanding the risks and benefits of antidepressant strategies in older adults could vastly improve the quality of life of seniors and save billions of dollars each year in health care costs," she said. "This public health issue is one that will rapidly grow with the aging of the U.S. and world populations."
The project aligns with UCLA's Depression Grand Challenge, a university-wide research initiative that aims to reduce the health and economic impacts of depression by half by the year 2050.
The UCLA arm of the study will involve UCLA primary care and psychiatry clinics, and affiliated programs with the Los Angeles County Department of Mental Health and the West Los Angeles Veterans Administration Medical Center.
The study is funded by the Patient-Centered Outcomes Research Institute, an independent, non-profit organization that funds evidence-based research to help people make better-informed health care decisions. In addition to the 300 participants from UCLA, a total of 1,500 people will be recruited and studied at four other sites -- Washington University in St. Louis, the University of Pittsburgh, the University of Toronto and Columbia University -- making the trial the largest-ever study of treatment-resistant depression in older adults.