Late-life Depression: Potential Prevalance Rates and Treatment Options

Late-life depression is a cause of concern for families, caregivers, and mental health professionals. However, because most elderly patients visit their primary care physicians (PCPs) about their depression, and not mental health specialists, it is imperative that PCPs be aware of both the prevalence of depression in these patients as well as treatment options.

Jeffrey M. Lyness, MD, and colleagues from the University of Rochester, New York, studied 617 subjects >65 years of age who were not suffering from major depressive disorder (MDD) at baseline. Of this study group, 405 subjects completed the 1-year follow-up evaluation. Patients were evaluated for major depressive incident rates using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. They aimed at identifying those patients who are at the highest risk to develop depression. This identification would then allow physicians to know which patient populations to specifically target in future preventive intervention research studies.

“In recent years, many in the field are considering how we might best prevent the onset of depression, an approach holding promise for better patient outcomes than waiting to treat after depression develops,” Dr. Lyness said.

Upon follow-up, Lyness and colleagues found that 5.3% of patients developed MDD. Patients in the high-risk subgroup were found to have minor or subsyndromal depression, functional disability, and a history of MDD or minor depression. The researchers believe that for every five patients in the high-risk group treated, this would prevent one episode of incident MDD. The researchers also believe that pharmacotherapy with antidepressants and psychosocial treatments should be considered for this patient population.

“We were not surprised, but pleased to learn that such easy-to-identify risks do identify a group at high enough risk to make cost-effective preventive interventions a possibility,” Dr. Lyness said. “The next research steps are to develop innovative interventions that are acceptable and inexpensive enough to deliver, and to test them in rigorous research studies.”

Funding for this research was provided by the National Institute of Mental Health. (Am J Psychiatry. 2009 Oct 15 [epub ahead of print].) –CN


Second-Generation Antipsychotics Associated with Weight Gain in Youths

Psychiatric disorders in youths are often treated with second-generation antipsychotics, but recent research indicates that these medications cause significant weight gain and other metabolic adverse effects on cholesterol and triglyceride levels.

Christoph U. Correll, MD, at Zucker Hillside Hospital at North Shore-Long Island Jewish Health System in Glen Oaks and The Feinstein Institute for Medical Research in Manhasset, New York, and colleagues, studied weight and metabolic changes in 272 pediatric patients 4–19 years of age who had no past treatment with antipsychotics. The non-randomized cohort study was conducted from December 2001–September 2007 at semi-urban, tertiary care, academic inpatient and outpatient clinics in Queens, New York. Among the patients, 47.8% (n=130) had mood spectrum disorders, 30.1% (n=82) had schizophrenia spectrum disorders, and 22.1% (n=60) had disruptive or aggressive behavior spectrum disorders. The comparison group included 15 patients who refused to participate or who were nonadherent to medications.

Aripiprazole, olanzapine, quetiapine, and risperidone were administered for 12 weeks. After a median of 10.8 weeks of treatment, the average weight gain increase (fat mass and weight circumference) was 18.7 lbs with olanzapine (n=45), 13.4 lbs with quetiapine (n=36), 11.7 lbs with risperidone (n=135), and 9.7 lbs with aripiprazole (n=41) compared to 0.4 lbs in the comparison group (n=15). Olanzapine and quetiapine showed significant mean level increases for total cholesterol, triglycerides, non-high-denisity lipoprotein (HDL) cholesterol, and ratio of triglycerides to HDL cholesterol. Trigylcerides increased significantly with risperidone. There were insignificant metabolic baseline-to-end-point changes with aripiprazole or in the comparison group.

The researchers concluded that biannual cardiometabolic monitoring should be conducted after the first 3 months of treatment. In addition, the benefits of second-generation antipsychotics should be balanced against cardiometabolic risks, and lower-risk alternatives as well as proactive adverse effect monitoring and management should be considered. (JAMA. 2009;302(16):1765-1773.) –DC


Suicide and All-Cause Mortality Rates: New Findings in Eating Disorders

Anorexia nervosa (AN) is historically associated with higher mortality risks relative to bulimia nervosa (BN) and eating disorders not otherwise specified (EDNOS). A large study using national data found that all-cause and suicide mortality rates are better associated with different eating disorders than previously believed.

Scott J. Crow, MD, at the University of Minnesota, Minneapolis, and colleagues, analyzed mortality data in 1,885 subjects with AN (N=177), BN (N=906), or EDNOS (N=802). These subjects had all been outpatients between 1979 and 1997 at an eating disorders clinic at the University of Minnesota. The majority of the patients were female (95.1%).

The most common diagnoses were BN (48.1%), EDNOS (42.5%), and AN (9.4%).

Researchers accessed mortality information via the National Death Index, categorizing deaths as medical, substance use related, suicide, or traumatic. EDNOS patients had the highest all-cause mortality rate (5.2%), followed by AN (4.0%), and BN (3.9%).

Suicide rates were highest in patients with BN, with suicide accounting for 0.9% of deaths. AN and EDNOS accounted for 0.6% and 0.5% of suicide deaths, respectively. (Am J Psychiatry. 2009 Oct 15. [Epub ahead of print].) –LS

-Psychiatric dispatches is written by Dena Croog, Christopher Naccari, and Lonnie Stoltzfoos.