Treatment Course With Antidepressant Therapy in Late-Life Depression

ObjectiveIn order to assess the effect of gray matter volumes and cortical thickness on antidepressant treatment response in late-life depression, the authors examined the relationship between brain regions identified a priori and Montgomery-Åsberg Depression Rating Scale (MADRS) scores over the cou...

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Bibliographic Details
Published in:	The American journal of psychiatry 2012-11, Vol.169 (11), p.1185-1193
Main Authors:	Sheline, Yvette I, Disabato, Brianne M, Hranilovich, Jennifer, Morris, Carrie, D’Angelo, Gina, Pieper, Carl, Toffanin, Tommaso, Taylor, Warren D, MacFall, James R, Wilkins, Consuelo, Barch, Deanna M, Welsh-Bohmer, Kathleen A, Steffens, David C, Krishnan, Ranga R, Doraiswamy, P. Murali
Format:	Article
Language:	eng
Subjects:	Adult and adolescent clinical studies Aged Amygdala - drug effects Amygdala - pathology Antidepressants Antidepressive Agents - therapeutic use Biological and medical sciences Brain - drug effects Brain - pathology Caudate Nucleus - drug effects Caudate Nucleus - pathology Cerebral Cortex - drug effects Cerebral Cortex - pathology Cognition Disorders - drug therapy Cognition Disorders - pathology Depression Depressive Disorder, Major - drug therapy Depressive Disorder, Major - pathology Drug therapy Female Frontal Lobe - drug effects Frontal Lobe - pathology Geriatrics Hippocampus - drug effects Hippocampus - pathology Humans Image Interpretation, Computer-Assisted Magnetic Resonance Imaging Male Medical sciences Mental depression Middle Aged Mood disorders Neural Pathways - drug effects Neural Pathways - pathology Neuropharmacology Neuropsychological Tests - statistics & numerical data Neuropsychology Older people Organ Size - drug effects Parahippocampal Gyrus - drug effects Parahippocampal Gyrus - pathology Personality Inventory - statistics & numerical data Pharmacology. Drug treatments Prospective Studies Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease) Psychology. Psychoanalysis. Psychiatry Psychometrics Psychopathology. Psychiatry Psychopharmacology Reaction Time - drug effects Sertraline - therapeutic use Treatment Outcome
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Summary:	ObjectiveIn order to assess the effect of gray matter volumes and cortical thickness on antidepressant treatment response in late-life depression, the authors examined the relationship between brain regions identified a priori and Montgomery-Åsberg Depression Rating Scale (MADRS) scores over the course of an antidepressant treatment trial.MethodIn a nonrandomized prospective trial, 168 patients who were at least 60 years of age and met DSM-IV criteria for major depression underwent MRI and were enrolled in a 12-week treatment study. Exclusion criteria included cognitive impairment or severe medical disorders. The volumes or cortical thicknesses of regions of interest that differed between the depressed group and a comparison group (N=50) were determined. These regions of interest were used in analyses of the depressed group to predict antidepressant treatment outcome. Mixed-model analyses adjusting for age, education, age at depression onset, race, baseline MADRS score, scanner, and interaction with time examined predictors of MADRS scores over time.ResultsSmaller hippocampal volumes predicted a slower response to treatment. With the inclusion of white matter hyperintensity severity and neuropsychological factor scores, the best model included hippocampal volume and cognitive processing speed to predict rate of response over time. A secondary analysis showed that hippocampal volume and frontal pole thickness differed between patients who achieved remission and those who did not.ConclusionsThese data expand our understanding of the prediction of treatment course in late-life depression. The authors propose that the primary variables of hippocampal volume and cognitive processing speed, subsuming other contributing variables (episodic memory, executive function, language processing) predict antidepressant response.
ISSN:	0002-953X 1535-7228