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MECHANISMS INFORMING INTERVENTIONS: NEW APPROACHES TO TREATING LATE-LIFE DEPRESSION
AAGP Annual Meeting 2019 MECHANISMS INFORMING INTERVENTIONS: NEW APPROACHES TO TREATING LATELIFE DEPRESSION Session 107 1 2 3 4 Eric Lenze ; Faith Gunning ; Jordan F Karp ; Warren D Taylor 1
Washington University in St Louis, St. Louis, MO Weill Cornell Medicine, White Plains, NY 3 University of Pittsburgh, Pittsburgh, PA 4 Vanderbilt University Medical Center 2
Abstract: Late-life depression is characterized by medical comorbidity and deficits in cognitive function, specifically in cognitive control deficits. These medical and cognitive factors are associated with poor antidepressant responses, and even when response occurs, rates are often poor and limited. Moreover, remission may not persist and depressed elders are at a high risk of recurrence. Current antidepressant treatments are not only limited in the benefit they provide to affective symptoms, but typically do not benefit the comorbid medical problems and cognitive deficits common in this population. There is a substantial need for new treatment approaches that are both more robust and benefit these comorbid medical and cognitive domains. Across presentations, this symposium focuses on novel treatment approaches for late-life depression. Sessions will be framed within NIMH’s Experimental Therapeutics paradigm, with discussions on the underlying mechanism and proposed targets for engagement. Given the clinical population, sessions will further integrate how treatments may provide benefit beyond mood symptoms. The first sessions will examine novel pharmacological treatments of drugs that may be repurposed for late-life depression. This includes findings from a recent trial examining the clinical effect and mechanisms of treatment response of buprenorphine in older adults with treatment resistant depression. Next will be a presentation of results from a pilot trial of transdermal nicotine patches in depressed elders with subjective cognitive decline. These results include clinical and cognitive results, but also pilot neuroimaging results examining potential drug mechanisms. We then shift to discuss a computerized cognitive remediation approach, examining a video game intervention targeting the cognitive control network with the goal of improving both mood and executive function. Finally, the panel discussant will put these findings in context of past intervention studies in late-life depression. This will include a discussion on how to optimize current antidepressant medications and discuss the rationale of the PCORIfunded OPTIMUM study of treatment-resistant older adults. Faculty Disclosures Eric Lenze Nothing to disclose Faith Gunning Nothing to disclose Jordan Karp Pfizer—receipt of medication supplies for investigator initiated trial Indivior—receipt of medication supplies for investigator initiated trial Warren Taylor Nothing to disclose
NEW INSIGHTS INTO LONELINESS AND ITS TREATMENT IN OLDER ADULTS Session 108 1 2 3 4 Joanna McHugh Power ; Kelsey Drew Biddle ; Nancy J Donovan ; Phaedra Bell 1
National College of Ireland, Dublin, Ireland, and Queen’s University, Belfast, UK Brigham and Women’s Hospital 3 Brigham and Women’s Hospital 4 University of California San Francisco 2
Abstract: Loneliness is a well-studied construct in the social sciences, in the epidemiology of aging and increasingly in gerontology but it is a relatively uncommon focus in psychiatric research. Loneliness is a perceived state of social and emotional isolation that is distinct from objective social isolation. Loneliness is understood to be both a perception and an emotion and may be a form of psychosocial stress. In large population-based studies, there is strong evidence that both loneliness and lower social engagement are
S8
Am J Geriatr Psychiatry 27:3S, March 2019
Washington University in St Louis, St. Louis, MO Weill Cornell Medicine, White Plains, NY 3 University of Pittsburgh, Pittsburgh, PA 4 Vanderbilt University Medical Center 2
Abstract: Late-life depression is characterized by medical comorbidity and deficits in cognitive function, specifically in cognitive control deficits. These medical and cognitive factors are associated with poor antidepressant responses, and even when response occurs, rates are often poor and limited. Moreover, remission may not persist and depressed elders are at a high risk of recurrence. Current antidepressant treatments are not only limited in the benefit they provide to affective symptoms, but typically do not benefit the comorbid medical problems and cognitive deficits common in this population. There is a substantial need for new treatment approaches that are both more robust and benefit these comorbid medical and cognitive domains. Across presentations, this symposium focuses on novel treatment approaches for late-life depression. Sessions will be framed within NIMH’s Experimental Therapeutics paradigm, with discussions on the underlying mechanism and proposed targets for engagement. Given the clinical population, sessions will further integrate how treatments may provide benefit beyond mood symptoms. The first sessions will examine novel pharmacological treatments of drugs that may be repurposed for late-life depression. This includes findings from a recent trial examining the clinical effect and mechanisms of treatment response of buprenorphine in older adults with treatment resistant depression. Next will be a presentation of results from a pilot trial of transdermal nicotine patches in depressed elders with subjective cognitive decline. These results include clinical and cognitive results, but also pilot neuroimaging results examining potential drug mechanisms. We then shift to discuss a computerized cognitive remediation approach, examining a video game intervention targeting the cognitive control network with the goal of improving both mood and executive function. Finally, the panel discussant will put these findings in context of past intervention studies in late-life depression. This will include a discussion on how to optimize current antidepressant medications and discuss the rationale of the PCORIfunded OPTIMUM study of treatment-resistant older adults. Faculty Disclosures Eric Lenze Nothing to disclose Faith Gunning Nothing to disclose Jordan Karp Pfizer—receipt of medication supplies for investigator initiated trial Indivior—receipt of medication supplies for investigator initiated trial Warren Taylor Nothing to disclose
NEW INSIGHTS INTO LONELINESS AND ITS TREATMENT IN OLDER ADULTS Session 108 1 2 3 4 Joanna McHugh Power ; Kelsey Drew Biddle ; Nancy J Donovan ; Phaedra Bell 1
National College of Ireland, Dublin, Ireland, and Queen’s University, Belfast, UK Brigham and Women’s Hospital 3 Brigham and Women’s Hospital 4 University of California San Francisco 2
Abstract: Loneliness is a well-studied construct in the social sciences, in the epidemiology of aging and increasingly in gerontology but it is a relatively uncommon focus in psychiatric research. Loneliness is a perceived state of social and emotional isolation that is distinct from objective social isolation. Loneliness is understood to be both a perception and an emotion and may be a form of psychosocial stress. In large population-based studies, there is strong evidence that both loneliness and lower social engagement are
S8
Am J Geriatr Psychiatry 27:3S, March 2019