Older adults with depression sought for treatment study

Researchers at Washington University School of Medicine in St. Louis are studying people age 60 and older to determine whether augmenting medication for depression with a second drug might help older patients break free of clinical depression.

Both study drugs are FDA-approved therapies for depression in younger adults, but the benefits need to be examined in older adults, according to principal investigator Eric Lenze, MD.

“Late-life depression can be a problem that people have lived with for many years, or it can be a new onset of depression that comes with the new stresses and challenges of older age, such as grief, social isolation or disability,” Lenze says. “It’s very important for older adults to get treatment because in older adults, untreated depression harms memory and attention and greatly increases disability.”

Lenze is enrolling older adults with depression but without dementia or other psychiatric illness to determine whether combining the drug therapies can alleviate depression.

“Many treatments work in older adults,” says Lenze, an associate professor of psychiatry. “They can help improve symptoms, but it’s difficult to get patients back to a complete state of wellness and to the level of function they had before they became depressed. That’s our goal. We want them to get well.”

The study, funded by the National Institutes of Health, lasts between 12 and 36 weeks, depending upon how individual patients respond to treatment. All who qualify begin treatment with the antidepressant drug venlafaxine XR, commercially known as Effexor XR. If depression persists, investigators will add a second medication — either aripiprazole, sold as Abilify, or a placebo. Aripiprazole is effective as a depression treatment in younger adults when added to an antidepressant drug.

No antidepressant drugs relieve depression in 100 percent of patients, but Lenze and other investigators say it may be possible to increase the benefits by adding the second drug. He says alleviating depression in older adults does more than improve mood and quality of life. It also improves overall health.

“There is a strong relationship between physical and mental well-being in older adults,” he says. “Older adults who get good treatment for depression actually have lower mortality rates over the long term with likely decreases in deaths from cancer and other age-related diseases such as diabetes.”

In addition to regularly monitoring volunteers’ levels of depression during the study, investigators also will perform blood tests to monitor cholesterol and blood sugar, as well as other metabolic tests. Volunteers will have weight and blood pressure measured at every visit, and investigators will communicate with patients’ family doctors to ensure that other health concerns are managed appropriately.

With many older people already taking medication for other conditions, investigators take great care to monitor every aspect of a study subject’s health because both study drugs can sometimes cause unwanted side effects.

“It’s more complicated to treat depression in older adults, in part because you have to consider all of the other medications a person is likely to be taking,” Lenze says. “It’s important to do a thorough examination of an individual’s medical issues to make sure there’s nothing that would interfere with depression treatment.”

For more information or to volunteer for the study, call Jennifer Anger at (314) 362-7354, or e-mail her at angerj@wustl.edu.

Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked fourth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.