Effect of Metabolic Syndrome on Late‐Life Depression: Associations with Disease Severity and Treatment Resistance
Background/Objectives Metabolic syndrome (MetS) is the co‐occurrence of obesity and metabolic derangements. Prior research implicates MetS in prolongation of the course of depression in older adults, but its effect on antidepressant response is unknown in this population. The objective was to determ...
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| Veröffentlicht in: | Journal of the American Geriatrics Society (JAGS) 2017-12, Vol.65 (12), p.2651-2658 |
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| creator | Mulvahill, John S. Nicol, Ginger E. Dixon, David Lenze, Eric J. Karp, Jordan F. Reynolds, Charles F. Blumberger, Daniel M. Mulsant, Benoit H. |
| description | Background/Objectives
Metabolic syndrome (MetS) is the co‐occurrence of obesity and metabolic derangements. Prior research implicates MetS in prolongation of the course of depression in older adults, but its effect on antidepressant response is unknown in this population. The objective was to determine whether MetS and related metabolic dyscrasias are associated with decreased rate of remission from depression in older adults treated pharmacologically for depression.
Design
Secondary analysis of a randomized controlled trial.
Setting
Three academic medical centers in North America.
Participants
Adults aged 60 and older (mean age 69.1) with major depressive disorder (MDD) (N = 435).
Intervention
Open‐label, protocolized treatment with extended‐release venlafaxine for 12 or more weeks.
Measurements
Time to remission from depression, with remission defined as a Montgomery‐Åsberg Depression Rating Scale (MADRS) score of 10 or less at last two visits.
Results
Two hundred twenty‐two participants (51%) met criteria for MetS at baseline; MetS was associated with greater severity (MADRS score) and chronicity of depression at baseline. Remission was achieved in 182 participants (42%). In the unadjusted analysis, MetS was associated with prolonged time to remission (hazard ratio for remission = 0.71, 95% confidence interval = 0.52–0.95), but this relationship was not significant in the adjusted model; greater number of MetS components and lower high‐density lipoprotein cholesterol had similar effects. Only diastolic blood pressure (DBP) was a significant predictor of time to remission before and after adjustment, with higher DBP predicting longer time to remission. Insulin sensitivity did not predict time to remission.
Conclusion
The presence of MetS in older adults with depression was associated with greater symptom severity and chronicity of depression, which appears to have accounted for the poorer antidepressant response observed in those with MetS. Additionally, our preliminary finding of an association between higher DBP and poorer antidepressant response bears further examination and replication. |
| doi_str_mv | 10.1111/jgs.15129 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_1975953905</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1975953905</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3889-ec5be67403de4fdb73153302a88c739430d8f52bdccd470b067d5bc80372efec3</originalsourceid><addsrcrecordid>eNp1kMtOGzEUhi1UVALtgheoLHXFYsCXccbTHSLhplSVGliPPPaZ1lEyTn0c0Ox4BJ6RJ8EQyo6zOTrSp__o_wg55OyY5zlZ_MFjrriod8iIKykKVXL1iYwYY6LQY17ukX3EBWNcMK0_kz1RC6nGqh4RnHYd2ERDR39CMm1YekvnQ-9iWAENPZ2ZBE8PjzPfAZ3AOgKiD_0PeooYrDcpH0jvffpLJx7BINA53EH0aaCmd_Qmgkkr6BP9Degxmd7CF7LbmSXC17d9QG7Ppzdnl8Xs18XV2emssFLrugCrWhhXJZMOys61lczdJBNGa1vJupTM6U6J1lnryoq1bFw51VrNZCUgl5IH5Ps2dx3Dvw1gahZhE_v8suF1pWola6YydbSlbAyIEbpmHf3KxKHhrHnR22S9zavezH57S9y0K3Dv5H-fGTjZAvd-CcPHSc31xXwb-Qw4qoYG</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1975953905</pqid></control><display><type>article</type><title>Effect of Metabolic Syndrome on Late‐Life Depression: Associations with Disease Severity and Treatment Resistance</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Mulvahill, John S. ; Nicol, Ginger E. ; Dixon, David ; Lenze, Eric J. ; Karp, Jordan F. ; Reynolds, Charles F. ; Blumberger, Daniel M. ; Mulsant, Benoit H.</creator><creatorcontrib>Mulvahill, John S. ; Nicol, Ginger E. ; Dixon, David ; Lenze, Eric J. ; Karp, Jordan F. ; Reynolds, Charles F. ; Blumberger, Daniel M. ; Mulsant, Benoit H.</creatorcontrib><description>Background/Objectives
Metabolic syndrome (MetS) is the co‐occurrence of obesity and metabolic derangements. Prior research implicates MetS in prolongation of the course of depression in older adults, but its effect on antidepressant response is unknown in this population. The objective was to determine whether MetS and related metabolic dyscrasias are associated with decreased rate of remission from depression in older adults treated pharmacologically for depression.
Design
Secondary analysis of a randomized controlled trial.
Setting
Three academic medical centers in North America.
Participants
Adults aged 60 and older (mean age 69.1) with major depressive disorder (MDD) (N = 435).
Intervention
Open‐label, protocolized treatment with extended‐release venlafaxine for 12 or more weeks.
Measurements
Time to remission from depression, with remission defined as a Montgomery‐Åsberg Depression Rating Scale (MADRS) score of 10 or less at last two visits.
Results
Two hundred twenty‐two participants (51%) met criteria for MetS at baseline; MetS was associated with greater severity (MADRS score) and chronicity of depression at baseline. Remission was achieved in 182 participants (42%). In the unadjusted analysis, MetS was associated with prolonged time to remission (hazard ratio for remission = 0.71, 95% confidence interval = 0.52–0.95), but this relationship was not significant in the adjusted model; greater number of MetS components and lower high‐density lipoprotein cholesterol had similar effects. Only diastolic blood pressure (DBP) was a significant predictor of time to remission before and after adjustment, with higher DBP predicting longer time to remission. Insulin sensitivity did not predict time to remission.
Conclusion
The presence of MetS in older adults with depression was associated with greater symptom severity and chronicity of depression, which appears to have accounted for the poorer antidepressant response observed in those with MetS. Additionally, our preliminary finding of an association between higher DBP and poorer antidepressant response bears further examination and replication.</description><identifier>ISSN: 0002-8614</identifier><identifier>EISSN: 1532-5415</identifier><identifier>DOI: 10.1111/jgs.15129</identifier><identifier>PMID: 29235659</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Age Factors ; Aged ; Antidepressive Agents, Second-Generation - therapeutic use ; Blood pressure ; Cholesterol ; Depression - drug therapy ; Depression - etiology ; Disease resistance ; Drug Resistance ; elderly ; Female ; Humans ; Insulin ; late‐life depression ; major depressive disorder ; Male ; Mental depression ; Metabolic syndrome ; Metabolic Syndrome - complications ; Older people ; Remission ; Severity of Illness Index ; Treatment resistance ; Venlafaxine ; Venlafaxine Hydrochloride - therapeutic use</subject><ispartof>Journal of the American Geriatrics Society (JAGS), 2017-12, Vol.65 (12), p.2651-2658</ispartof><rights>2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society</rights><rights>2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.</rights><rights>2017 American Geriatrics Society and Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3889-ec5be67403de4fdb73153302a88c739430d8f52bdccd470b067d5bc80372efec3</citedby><cites>FETCH-LOGICAL-c3889-ec5be67403de4fdb73153302a88c739430d8f52bdccd470b067d5bc80372efec3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjgs.15129$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjgs.15129$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29235659$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mulvahill, John S.</creatorcontrib><creatorcontrib>Nicol, Ginger E.</creatorcontrib><creatorcontrib>Dixon, David</creatorcontrib><creatorcontrib>Lenze, Eric J.</creatorcontrib><creatorcontrib>Karp, Jordan F.</creatorcontrib><creatorcontrib>Reynolds, Charles F.</creatorcontrib><creatorcontrib>Blumberger, Daniel M.</creatorcontrib><creatorcontrib>Mulsant, Benoit H.</creatorcontrib><title>Effect of Metabolic Syndrome on Late‐Life Depression: Associations with Disease Severity and Treatment Resistance</title><title>Journal of the American Geriatrics Society (JAGS)</title><addtitle>J Am Geriatr Soc</addtitle><description>Background/Objectives
Metabolic syndrome (MetS) is the co‐occurrence of obesity and metabolic derangements. Prior research implicates MetS in prolongation of the course of depression in older adults, but its effect on antidepressant response is unknown in this population. The objective was to determine whether MetS and related metabolic dyscrasias are associated with decreased rate of remission from depression in older adults treated pharmacologically for depression.
Design
Secondary analysis of a randomized controlled trial.
Setting
Three academic medical centers in North America.
Participants
Adults aged 60 and older (mean age 69.1) with major depressive disorder (MDD) (N = 435).
Intervention
Open‐label, protocolized treatment with extended‐release venlafaxine for 12 or more weeks.
Measurements
Time to remission from depression, with remission defined as a Montgomery‐Åsberg Depression Rating Scale (MADRS) score of 10 or less at last two visits.
Results
Two hundred twenty‐two participants (51%) met criteria for MetS at baseline; MetS was associated with greater severity (MADRS score) and chronicity of depression at baseline. Remission was achieved in 182 participants (42%). In the unadjusted analysis, MetS was associated with prolonged time to remission (hazard ratio for remission = 0.71, 95% confidence interval = 0.52–0.95), but this relationship was not significant in the adjusted model; greater number of MetS components and lower high‐density lipoprotein cholesterol had similar effects. Only diastolic blood pressure (DBP) was a significant predictor of time to remission before and after adjustment, with higher DBP predicting longer time to remission. Insulin sensitivity did not predict time to remission.
Conclusion
The presence of MetS in older adults with depression was associated with greater symptom severity and chronicity of depression, which appears to have accounted for the poorer antidepressant response observed in those with MetS. Additionally, our preliminary finding of an association between higher DBP and poorer antidepressant response bears further examination and replication.</description><subject>Age Factors</subject><subject>Aged</subject><subject>Antidepressive Agents, Second-Generation - therapeutic use</subject><subject>Blood pressure</subject><subject>Cholesterol</subject><subject>Depression - drug therapy</subject><subject>Depression - etiology</subject><subject>Disease resistance</subject><subject>Drug Resistance</subject><subject>elderly</subject><subject>Female</subject><subject>Humans</subject><subject>Insulin</subject><subject>late‐life depression</subject><subject>major depressive disorder</subject><subject>Male</subject><subject>Mental depression</subject><subject>Metabolic syndrome</subject><subject>Metabolic Syndrome - complications</subject><subject>Older people</subject><subject>Remission</subject><subject>Severity of Illness Index</subject><subject>Treatment resistance</subject><subject>Venlafaxine</subject><subject>Venlafaxine Hydrochloride - therapeutic use</subject><issn>0002-8614</issn><issn>1532-5415</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kMtOGzEUhi1UVALtgheoLHXFYsCXccbTHSLhplSVGliPPPaZ1lEyTn0c0Ox4BJ6RJ8EQyo6zOTrSp__o_wg55OyY5zlZ_MFjrriod8iIKykKVXL1iYwYY6LQY17ukX3EBWNcMK0_kz1RC6nGqh4RnHYd2ERDR39CMm1YekvnQ-9iWAENPZ2ZBE8PjzPfAZ3AOgKiD_0PeooYrDcpH0jvffpLJx7BINA53EH0aaCmd_Qmgkkr6BP9Degxmd7CF7LbmSXC17d9QG7Ppzdnl8Xs18XV2emssFLrugCrWhhXJZMOys61lczdJBNGa1vJupTM6U6J1lnryoq1bFw51VrNZCUgl5IH5Ps2dx3Dvw1gahZhE_v8suF1pWola6YydbSlbAyIEbpmHf3KxKHhrHnR22S9zavezH57S9y0K3Dv5H-fGTjZAvd-CcPHSc31xXwb-Qw4qoYG</recordid><startdate>201712</startdate><enddate>201712</enddate><creator>Mulvahill, John S.</creator><creator>Nicol, Ginger E.</creator><creator>Dixon, David</creator><creator>Lenze, Eric J.</creator><creator>Karp, Jordan F.</creator><creator>Reynolds, Charles F.</creator><creator>Blumberger, Daniel M.</creator><creator>Mulsant, Benoit H.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>NAPCQ</scope></search><sort><creationdate>201712</creationdate><title>Effect of Metabolic Syndrome on Late‐Life Depression: Associations with Disease Severity and Treatment Resistance</title><author>Mulvahill, John S. ; Nicol, Ginger E. ; Dixon, David ; Lenze, Eric J. ; Karp, Jordan F. ; Reynolds, Charles F. ; Blumberger, Daniel M. ; Mulsant, Benoit H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3889-ec5be67403de4fdb73153302a88c739430d8f52bdccd470b067d5bc80372efec3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Age Factors</topic><topic>Aged</topic><topic>Antidepressive Agents, Second-Generation - therapeutic use</topic><topic>Blood pressure</topic><topic>Cholesterol</topic><topic>Depression - drug therapy</topic><topic>Depression - etiology</topic><topic>Disease resistance</topic><topic>Drug Resistance</topic><topic>elderly</topic><topic>Female</topic><topic>Humans</topic><topic>Insulin</topic><topic>late‐life depression</topic><topic>major depressive disorder</topic><topic>Male</topic><topic>Mental depression</topic><topic>Metabolic syndrome</topic><topic>Metabolic Syndrome - complications</topic><topic>Older people</topic><topic>Remission</topic><topic>Severity of Illness Index</topic><topic>Treatment resistance</topic><topic>Venlafaxine</topic><topic>Venlafaxine Hydrochloride - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mulvahill, John S.</creatorcontrib><creatorcontrib>Nicol, Ginger E.</creatorcontrib><creatorcontrib>Dixon, David</creatorcontrib><creatorcontrib>Lenze, Eric J.</creatorcontrib><creatorcontrib>Karp, Jordan F.</creatorcontrib><creatorcontrib>Reynolds, Charles F.</creatorcontrib><creatorcontrib>Blumberger, Daniel M.</creatorcontrib><creatorcontrib>Mulsant, Benoit H.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mulvahill, John S.</au><au>Nicol, Ginger E.</au><au>Dixon, David</au><au>Lenze, Eric J.</au><au>Karp, Jordan F.</au><au>Reynolds, Charles F.</au><au>Blumberger, Daniel M.</au><au>Mulsant, Benoit H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Metabolic Syndrome on Late‐Life Depression: Associations with Disease Severity and Treatment Resistance</atitle><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle><addtitle>J Am Geriatr Soc</addtitle><date>2017-12</date><risdate>2017</risdate><volume>65</volume><issue>12</issue><spage>2651</spage><epage>2658</epage><pages>2651-2658</pages><issn>0002-8614</issn><eissn>1532-5415</eissn><abstract>Background/Objectives
Metabolic syndrome (MetS) is the co‐occurrence of obesity and metabolic derangements. Prior research implicates MetS in prolongation of the course of depression in older adults, but its effect on antidepressant response is unknown in this population. The objective was to determine whether MetS and related metabolic dyscrasias are associated with decreased rate of remission from depression in older adults treated pharmacologically for depression.
Design
Secondary analysis of a randomized controlled trial.
Setting
Three academic medical centers in North America.
Participants
Adults aged 60 and older (mean age 69.1) with major depressive disorder (MDD) (N = 435).
Intervention
Open‐label, protocolized treatment with extended‐release venlafaxine for 12 or more weeks.
Measurements
Time to remission from depression, with remission defined as a Montgomery‐Åsberg Depression Rating Scale (MADRS) score of 10 or less at last two visits.
Results
Two hundred twenty‐two participants (51%) met criteria for MetS at baseline; MetS was associated with greater severity (MADRS score) and chronicity of depression at baseline. Remission was achieved in 182 participants (42%). In the unadjusted analysis, MetS was associated with prolonged time to remission (hazard ratio for remission = 0.71, 95% confidence interval = 0.52–0.95), but this relationship was not significant in the adjusted model; greater number of MetS components and lower high‐density lipoprotein cholesterol had similar effects. Only diastolic blood pressure (DBP) was a significant predictor of time to remission before and after adjustment, with higher DBP predicting longer time to remission. Insulin sensitivity did not predict time to remission.
Conclusion
The presence of MetS in older adults with depression was associated with greater symptom severity and chronicity of depression, which appears to have accounted for the poorer antidepressant response observed in those with MetS. Additionally, our preliminary finding of an association between higher DBP and poorer antidepressant response bears further examination and replication.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>29235659</pmid><doi>10.1111/jgs.15129</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of the American Geriatrics Society (JAGS), 2017-12, Vol.65 (12), p.2651-2658 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Age Factors Aged Antidepressive Agents, Second-Generation - therapeutic use Blood pressure Cholesterol Depression - drug therapy Depression - etiology Disease resistance Drug Resistance elderly Female Humans Insulin late‐life depression major depressive disorder Male Mental depression Metabolic syndrome Metabolic Syndrome - complications Older people Remission Severity of Illness Index Treatment resistance Venlafaxine Venlafaxine Hydrochloride - therapeutic use |
| title | Effect of Metabolic Syndrome on Late‐Life Depression: Associations with Disease Severity and Treatment Resistance |
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