Change in cognitive functioning following acute antidepressant treatment in late-life depression
Item
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Title
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Change in cognitive functioning following acute antidepressant treatment in late-life depression
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Identifier
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d_2009_2013:52600d9bd2c1:11889
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identifier
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12553
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Creator
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Reinlieb, Michelle Erin,
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Contributor
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Joel Sneed
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Date
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2013
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Language
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English
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Publisher
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City University of New York.
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Subject
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Psychology | Clinical psychology | Cognitive psychology | Antidepressant Medication | Cognitive Functioning | Late-Life Depression | Neuropsychology
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Abstract
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The purpose of this dissertation was to examine the cognitive impact of antidepressant medication among depressed older adults. We explored the following questions in a series of 3 studies: 1) what impact does medication have on cognition (Study 1); 2) is there a differential impact of antidepressant medication on cognitive functioning depending on medication class (Study 2); 3) is there a differential impact of antidepressant medication on cognitive functioning depending on diagnostic subtype (Study 3)? Across all three studies, we examined whether change in cognition following antidepressant treatment depended on medication response. In Study 1, an 8-week placebo-controlled trial of citalopram in the treatment of depressed adults 75 years and older (mean age = 79.6), we found that medication non-response was associated with a decline in verbal learning and psychomotor speed. In Study 2, a 12-week randomized, double-blind, parallel-group design comparing sertraline and nortriptyline in the treatment of depressed older adults (mean age = 64.2), we found that sertraline responders showed significantly more improvement in verbal learning compared to nortriptyline responders; to our surprise, nortriptyline responders were the only treatment by responder status group to show no improvement in verbal learning from baseline to endpoint. Finally, in Study 3, an 8-week, open treatment trial of antidepressant medication in depressed older adults (mean age = 62.3), we found that change in cognition by diagnostic status depended on response. Specifically, vascular depressed non-responders declined in one aspect of executive functioning (i.e., set-shifting) relative to the improvement observed across all other patient groups.;Overall, these findings suggest that antidepressant medication may be cognitively benign among `young-old' depressed patients, particularly in the absence of significant cerebrovascular disease. The presence of extensive cerebrovascular disease may negatively interact with medication non-response to influence cognitive outcomes. Among `old-old' patients, medication may have a deleterious effect on cognition, but only among those who do not respond to treatment. This supports the contention that `old-old' patients, or depressed older adults with extensive cerebrovascular disease, should not be maintained on a medication if they have not responded following an adequate trial as it may negatively impact some aspects of cognition.
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Type
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dissertation
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Source
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2009_2013.csv
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degree
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Ph.D.
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Program
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Psychology
