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Treatment resistant late-life depression: A narrative review of psychosocial risk factors, non-pharmacological interventions, and the role of clinical phenotyping.
Patrick, Regan E; Dickinson, Rebecca A; Gentry, Melanie T; Kim, Joseph U; Oberlin, Lauren E; Park, Soohyun; Principe, Jessica L; Teixeira, Antonio L; Weisenbach, Sara L.
Afiliação
  • Patrick RE; Department of Neuropsychology, McLean Hospital, Belmont, MA, United States of America; Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America. Electronic address: rpatrick@mclean
  • Dickinson RA; Department of Neuropsychology, McLean Hospital, Belmont, MA, United States of America; Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States of America.
  • Gentry MT; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States of America.
  • Kim JU; Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States of America.
  • Oberlin LE; Department of Psychiatry, Weill Cornell Medicine, New York, NY, United States of America; AdventHealth Research Institute, Neuroscience, Orlando, FL, United States of America.
  • Park S; Department of Psychiatry, Tufts Medical Center, Boston, MA, United States of America.
  • Principe JL; Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry,
  • Teixeira AL; Department of Psychiatry & Behavioral Sciences, UT Health Houston, Houston, TX, United States of America.
  • Weisenbach SL; Department of Neuropsychology, McLean Hospital, Belmont, MA, United States of America; Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America.
J Affect Disord ; 356: 145-154, 2024 Jul 01.
Article em En | MEDLINE | ID: mdl-38593940
ABSTRACT

BACKGROUND:

Treatment resistant depression (TRD) is a subset of major depressive disorder (MDD) in which symptoms do not respond to front line therapies. In older adults, the assessment and treatment of TRD is complicated by psychosocial risk factors unique to this population, as well as a relative paucity of research.

METHODS:

Narrative review aimed at (1) defining TRLLD for clinical practice and research; (2) describing psychosocial risk factors; (3) reviewing psychological and non-pharmacological treatments; (4) discussing the role of clinical phenotyping for personalized treatment; and (5) outlining research priorities.

RESULTS:

Our definition of TRLLD centers on response to medication and neuromodulation in primary depressive disorders. Psychosocial risk factors include trauma and early life adversity, chronic physical illness, social isolation, personality, and barriers to care. Promising non-pharmacological treatments include cognitive training, psychotherapy, and lifestyle interventions. The utility of clinical phenotyping is highlighted by studies examining the impact of comorbidities, symptom dimensions (e.g., apathy), and structural/functional brain changes.

LIMITATIONS:

There is a relative paucity of TRLLD research. This limits the scope of empirical data from which to derive reliable patterns and complicates efforts to evaluate the literature quantitatively.

CONCLUSIONS:

TRLLD is a complex disorder that demands further investigation given our aging population. While this review highlights the promising breadth of TRLLD research to date, more research is needed to help elucidate, for example, the optimal timing for implementing risk mitigation strategies, the value of collaborative care approaches, specific treatment components associated with more robust response, and phenotyping to help inform treatment decisions.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Fenótipo / Transtorno Depressivo Resistente a Tratamento Limite: Aged / Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Fenótipo / Transtorno Depressivo Resistente a Tratamento Limite: Aged / Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article