April 12, 2024

Combination Therapy Shows Promise for Treatment-Resistant Depression in Older Adults

Treatment-resistant depression, a condition where individuals do not respond to two different treatments over an eight-week period, is a common challenge in older adults. According to a review published in the New England Journal of Medicine by UConn Health psychiatrist David Steffens, treating stubborn cases of depression requires a comprehensive approach.

Depression affects approximately 5% of adults worldwide, as reported by the World Health Organization. Estimates suggest that 20-70% of individuals do not respond to the initial two treatments. The general response rate to the first treatment is only 30-40%, indicating the need for multiple attempts before finding an effective solution.

Steffens, who primarily works with older adults over the age of 60, emphasizes the importance of carefully assessing baseline symptoms of depression to track improvement. The Patient Health Questionnaire-9 (PHQ-9) is a widely used scale that measures the level of depression based on responses to questions regarding low mood, diminished energy, and loss of interest in pleasurable activities. Higher scores indicate more severe depression.

Regular reassessment using the PHQ-9 allows healthcare professionals to objectively measure a patient’s progress. In some cases, individuals may partially respond to a single medication but still consider themselves to be depressed. Adjusting medication dosage or combining it with psychotherapy can help improve their symptoms.

Steffens also highlights the significance of evaluating a patient’s medical history to identify underlying conditions that may contribute to their depression. Common co-existing conditions in older adults, such as high blood pressure, heart disease, or diabetes, can worsen depressive symptoms. By addressing and managing these conditions, overall well-being can be enhanced.

The choice of antidepressant medication should also take into account the specific symptoms experienced by the patient. For instance, patients with insomnia and agitation may benefit from different medications than those who experience excessive sleepiness and lack of motivation. Additionally, individuals with chronic pain may find relief with antidepressants known for their pain-reducing properties.

In cases of severe treatment-resistant depression, combining two different antidepressant drugs has shown promising results. While dosage adjustments should be made gradually, older adults can generally tolerate similar therapeutic doses as younger individuals. Healthcare professionals should not hesitate to increase the dose or combine medications when necessary.

Steffens emphasizes the serious implications of depression in older adults, not only on mood and overall interest in life but also on the management of other medical conditions, particularly vascular diseases. Depression can increase the risk of heart disease and mortality following a heart attack. However, appropriate and comprehensive treatment can make a significant difference in these individuals’ lives.

1. Source: Coherent Market Insights, Public sources, Desk research
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