The Investigation of Response to Antidepressant and the Related Factors of Prognosis in Geriatric Depression

• Main Authors: Te-Jen, 賴德仁
• Other Authors: 周明智
• Format: Others
• Language: zh-TW
• Published: 2007
• Online Access: http://ndltd.ncl.edu.tw/handle/67518350262626203271

博士 === 中山醫學大學 === 醫學研究所 === 95 === With the rapid increase of elderly population in Taiwan, geriatric depression has become a focus in geriatric psychiatry and public health. This study is an observational study, and the objectives of this study were to evaluate the therapeutic effects of patients with geriatric depression receiving antidepressant for 12 weeks, and to detect the related factors of treatment response and remission. Subjects in our study were enrolled from the clinics of Chang Shan Medical University Hospital and Taichung Veteran General Hospital, who were older than 65 years old and diagnosed as major depression according to DSM-IV. Dementia was excluded by Mini-Mental State Examination (MMSE). Subjects received the antidepressant, sertraline, for 12 weeks. The tools we used included Mini-Mental State Examination (MMSE), Hamilton Depression Rating Scale (HDRS), MINI International Neuropsychiatric Interview, Caregiver Burden Inventory and WHOQOL-BRED. The brain image of MRI was arranged before the treatment, whereas the immune markers, inflammatory proteins and neuropsychological test were evaluated before treatment and 12 weeks after treatment. Data were analyzed by non-parametric tests due to a few cases. The differences in different kind of geriatric depression, such as remission and non-remission, response and non-response, early-onset and late-onset depression were compared. Thirty seven subjects were enrolled, but only 29 subjects completed the 12-week treatment. Anxiety disorders are the most common comorbid psychiatric illness in the 29 subjects. Sixty nine percent (20/29) of subjects achieved remission after taking antidepressant for 12 weeks and suicide idea was also significantly improved after 12-week treatment. Short-term memory, executive function and quality of life significantly improved after 12-week treatment. In the biochemistry tests, only low density lipoprotein cholesterol (LDLC) level and total cholesterol (TCHO) level were significantly increased after 12-week treatment. Before treatment, 1-month responders and 1-month remitters got better scores in some items of neuropsychological test compared to their counterparts respectively. However, before and after 12-week treatment, there was no difference in the neuropsychological test in the responders and remitters compared to their counterparts. Only 3 early-onset geriatric depressive subjects were enrolled. Compared with the late-onset geriatric depressive subjects, these 3 early-onset subjects had significantly higher HDRS scores after 12-week treatment. Simple logistic regression was used to analyze the possible variables which were related to remission or response. The results showed the subjects with high baseline HDRS score would have significantly lower remission rate after 4-week treatment. However, the baseline HDRS score did not affect the remission rate after 12-week treatment. The results also showed the elderly depressive patients without other psychiatric diagnosis would have better remission in the 12-week treatment. The caregivers’ burden and quality of life did not have any significant change after 12-week treatment for the depressive subjects. Results of this study re-emphasize the importance of aggressive treatment for geriatric depression, although only 29 subjects completed 12-week treatment in this study. After 12-week treatment, not only the depressive symptoms and suicide idea significantly improved, but also the life quality improved. Especially for the worse depressive elders, the treatment response may be not significant after 4-week treatment, however, they finally got good response after 12-week treatment. Results of this study may provide good information for the treatment response of geriatric depression and suicide prevention program in Taiwan.