Katarina Arandjelovic1, Harris A Eyre2, Helen Lavretsky3. 1. the IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia. 2. the IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia; Semel Institute for Neuroscience and Human Behaviour, University of California, Los Angeles, CA, USA; the Discipline of Psychiatry, University of Adelaide, Adelaide, South Australia, Australia. 3. Semel Institute for Neuroscience and Human Behaviour, University of California, Los Angeles, CA, USA. Electronic address: hlavretsky@mednet.ucla.edu.
Abstract
BACKGROUND: There is a relative paucity of information on both empirical and subjective treatment strategies for treatment-resistant depression (TRD), especially in late life. This paper reviews the findings from two 2016 surveys conducted through the American Psychiatric Association publication the Psychiatric Times and via a member survey by the American Association for Geriatric Psychiatry (AAGP). METHODS: We present the results of the two surveys in terms of descriptive frequencies and percentages and discuss the strengths and weaknesses of various approaches to late-life TRD. RESULTS: The Psychiatric Times survey received 468 responses, and the AAGP survey received 117 responses, giving an overall sample of 585 responses. The majority (76.3%) of respondents from both groups believed that a large randomized study comparing the risks and benefits of augmentation and switching strategies for TRD in patients aged 60 years and older would be helpful, and 80% of clinicians believed their practice would benefit from the findings of such a study. Of the treatment strategies that need evidence of efficacy, the most popular options were augmentation/combination strategies, particularly augmentation with aripiprazole (58.7%), bupropion (55.0%), and lithium (50.9%). CONCLUSIONS: Late-life TRD constitutes a large proportion of clinical practices, particularly of geriatric psychiatry, with lacking evidence of efficacy of most treatment strategies. These surveys indicate a clear need for a large randomized study that compares risks and benefits of augmentation and switching strategies.
BACKGROUND: There is a relative paucity of information on both empirical and subjective treatment strategies for treatment-resistant depression (TRD), especially in late life. This paper reviews the findings from two 2016 surveys conducted through the American Psychiatric Association publication the Psychiatric Times and via a member survey by the American Association for Geriatric Psychiatry (AAGP). METHODS: We present the results of the two surveys in terms of descriptive frequencies and percentages and discuss the strengths and weaknesses of various approaches to late-life TRD. RESULTS: The Psychiatric Times survey received 468 responses, and the AAGP survey received 117 responses, giving an overall sample of 585 responses. The majority (76.3%) of respondents from both groups believed that a large randomized study comparing the risks and benefits of augmentation and switching strategies for TRD in patients aged 60 years and older would be helpful, and 80% of clinicians believed their practice would benefit from the findings of such a study. Of the treatment strategies that need evidence of efficacy, the most popular options were augmentation/combination strategies, particularly augmentation with aripiprazole (58.7%), bupropion (55.0%), and lithium (50.9%). CONCLUSIONS: Late-life TRD constitutes a large proportion of clinical practices, particularly of geriatric psychiatry, with lacking evidence of efficacy of most treatment strategies. These surveys indicate a clear need for a large randomized study that compares risks and benefits of augmentation and switching strategies.
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