Document Detail


A review of the effectiveness of antidepressant medications for depressed nursing home residents.
MedLine Citation:
PMID:  22019084     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Antidepressant medications are the most common psychopharmacologic therapy used to treat depressed nursing home (NH) residents. Despite a significant increase in the rate of antidepressant prescribing over the past several decades, little is known about the effectiveness of these agents in the NH population.
OBJECTIVE: To conduct a systematic review of the literature to examine and compare the effectiveness of antidepressant medications for treating major depressive symptoms in elderly NH residents.
METHODS: The following databases were searched with searches completed prior to January 2011 and no language restriction: MEDLINE, Embase, PsycINFO, CINHAL, CENTRAL, LILACS, ClinicalTrials.gov, International Standard Randomized Controlled Trial Number Register, and the WHO International Clinical Trial Registry Platform. Additional studies were identified from citations in evidence-based guidelines and reviews as well as book chapters on geriatric depression and pharmacotherapy from several clinical references. Studies were included if they described a clinical trial that assessed the effectiveness of any currently-marketed antidepressant for adults aged 65 years or older, who resided in the NH, and were diagnosed by DSM criteria and/or standardized validated screening instruments with Major Depressive Disorder, minor depression, dysthymic disorder, or Depression in Alzheimer's disease.
RESULTS: A total of eleven studies, including four randomized and seven non-randomized open-label trials, met all inclusion and exclusion criteria. It was not feasible to conduct a meta-analysis because the studies were heterogeneous in terms of study design, operational definitions of depression, participant characteristics, pharmacologic interventions, and outcome measures. Of the four randomized trials, two had a control group and did not demonstrate a statistically-significant benefit for antidepressant pharmacotherapy over placebo. While six of the seven non-randomized studies identified a response to an antidepressant, their results must be interpreted with caution as they lacked a comparison group.
CONCLUSIONS: The limited amount of evidence from randomized and non-randomized open-label trials suggests that depressed NH residents have a modest response to antidepressant medications. Further research using rigorous study designs are needed to examine the effectiveness and safety of antidepressants in depressed NH residents, and to determine the various facility, provider, and patient factors associated with response to treatment.
Authors:
Richard D Boyce; Joseph T Hanlon; Jordan F Karp; John Kloke; Ahlam Saleh; Steven M Handler
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Intramural; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.; Review     Date:  2011-10-21
Journal Detail:
Title:  Journal of the American Medical Directors Association     Volume:  13     ISSN:  1538-9375     ISO Abbreviation:  J Am Med Dir Assoc     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-04-30     Completed Date:  2012-09-05     Revised Date:  2014-09-13    
Medline Journal Info:
Nlm Unique ID:  100893243     Medline TA:  J Am Med Dir Assoc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  326-31     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Antidepressive Agents / adverse effects,  therapeutic use*
Depression / diagnosis,  drug therapy*,  epidemiology*
Depressive Disorder / diagnosis,  drug therapy,  epidemiology
Dose-Response Relationship, Drug
Drug Administration Schedule
Female
Geriatric Assessment / methods
Homes for the Aged*
Humans
Male
Nursing Homes*
Prognosis
Risk Assessment
Severity of Illness Index
Treatment Outcome
Grant Support
ID/Acronym/Agency:
1R01HS018721-01/HS/AHRQ HHS; 3 UL1 R024153-04S4//PHS HHS; 3U01 AG012553/AG/NIA NIH HHS; AG033575/AG/NIA NIH HHS; K07 AG033174/AG/NIA NIH HHS; K07 AG033174-01A1/AG/NIA NIH HHS; K07AG033174/AG/NIA NIH HHS; K12HS019461/HS/AHRQ HHS; KL2 RR024154/RR/NCRR NIH HHS; KL2 RR024154/RR/NCRR NIH HHS; KL2 RR024154-07/RR/NCRR NIH HHS; P30 AG024827/AG/NIA NIH HHS; P30 AG024827-01/AG/NIA NIH HHS; P30AG024827/AG/NIA NIH HHS; R01 AG033575/AG/NIA NIH HHS; R01 AG033575-03/AG/NIA NIH HHS; R01 AG034056/AG/NIA NIH HHS; R01 AG034056-02/AG/NIA NIH HHS; R01 NR010135/NR/NINR NIH HHS; R01 NR010135/NR/NINR NIH HHS; R01 NR010135-04/NR/NINR NIH HHS; R01-HS017695/HS/AHRQ HHS; R01AG034056/AG/NIA NIH HHS; R34 MH082682/MH/NIMH NIH HHS; R34 MH082682/MH/NIMH NIH HHS; R34 MH082682-02/MH/NIMH NIH HHS; R56 AG027017-04/AG/NIA NIH HHS; R56AG027017/AG/NIA NIH HHS; T32 AG021885/AG/NIA NIH HHS; T32 AG021885-01/AG/NIA NIH HHS; U01 AG012553-18/AG/NIA NIH HHS; UL1 RR024153/RR/NCRR NIH HHS; UL1 RR024153-04S4/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Antidepressive Agents
Comments/Corrections

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