While many people ages 60 and older anticipate their “golden years,” factors related to aging — physical ailments, loss of relationships, isolation — can usher in debilitating depression. UCLA researchers are working to find better ways to identify and treat people with depression, says Helen Lavretsky, MD, director of UCLA’s Late-Life Mood, Stress, and Wellness Research Program. Dr. Lavretsky has long studied the unique elements of depression in older adults.
In 2016, she was one of the recipients of a $13.9 million grant to study treatment-resistant depression in people ages 60 and older.
Depression often is overlooked in older adults, even though an estimated one-in-four meets the criteria for clinical depression in a medical setting, Dr. Lavretsky says. “People under-report depression to their primary care physicians, and the physicians tend to be focused on their patients’ medical symptoms,” she says. “Also, there still is a stigma of mental illness in this cohort of older adults that keeps them from disclosing symptoms to their doctors.”
Risk factors for late-life depression include financial stress, retirement, the loss of a spouse, changes in relationships, physical ailments and chronic pain, the loss of independence and isolation. “Loneliness now is a well-recognized risk factor for depression,” Dr. Lavretsky says. Untreated depression can lead to suicide, which is more common among older adults.
Identifying the disorder is only one part of the challenge. Studies show older adults may not respond as well to anti-depressant medications. About 40-to-50 percent of younger adults are helped by antidepressants, but the response rate drops to 30-to-40 percent in older adults. Many older adults remain ill even after trying several antidepressants, a phenomenon known as treatment resistance. “The drugs don’t treat psycho-social factors very well,” she says. “Patients are worried about financial situations or relationships or losing their houses. Without addressing psycho-social stresses, it’s very hard to treat geriatric depression.”
The new study is the largest ever to assess depression treatment in a geriatric population. The OPTIMUM study involves five sites, including UCLA Health and the West Los Angeles Veterans Administration Medical Center, and is enrolling 300 people ages 60 and older whose depression has not abated after trying two or more antidepressants.
In one phase of the study, researchers will add either the drug aripiprazole or bupropion to the patients’ current antidepressant or will switch the patient to bupropion. They will compare how each treatment helps to resolve symptoms. Another phase of the study will look at adding the drug lithium to the patient’s current antidepressant regimen or switching the patient to a drug called nortriptyline.
Researchers are hopeful the strategy of either augmenting the patient’s antidepressant with another drug or switching the patient to a new drug will determine which will be more effective. “We hope we can translate our findings to clinical practice, so patients aren’t wasting time trying six different drugs or trying five different drugs of the same class, and, predictably, they would fail instead of moving to a new strategy,” Dr. Lavretsky says.
Adults who don’t qualify for the study can take steps to address their depression, Dr. Lavretsky says. She recommends talking with one’s physician about symptoms and suggests that family members and friends of older adults look for signs of depression, such as poor sleep and loss of interest in activities, and encourage their loved ones to speak to a doctor. She says that simple activities such as exercising, spending time outside in the sun, enjoying nature and music positively affect mood. “Experience joy on a daily basis despite anything else going on,” she says.