0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editorial |

Moderators of Remission in Patients With Late-Life Depression Where Do We Go Next?

Warren D. Taylor, MD, MHSc1,2
[+] Author Affiliations
1Center for Cognitive Medicine, Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee
2Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville
JAMA Psychiatry. 2016;73(4):319-320. doi:10.1001/jamapsychiatry.2015.3458.
Text Size: A A A
Published online

Extract

The article by Kaneriya and colleagues1 in this issue of JAMA Psychiatry reports on a randomized double-blind clinical trial examining the moderating factors that influence remission with aripiprazole treatment in an elderly population of participants with treatment-resistant late-life depression. The participants initially received extended-release venlafaxine hydrochloride to establish treatment resistance, and then they were randomly assigned to 12 weeks of augmentation with aripiprazole or placebo.2 Pursuing their a priori hypotheses, the investigators tested for the moderating effects of executive dysfunction (specifically, measures of set shifting and response inhibition), comorbid anxiety, and medical burden. All of these factors have been implicated in contributing to poor antidepressant responses in late-life depression,3,4 but they have not previously been examined in second-line therapies and often not in the context of placebo-controlled trials. The study team found that neither medical morbidity nor response inhibition was related to remission. A higher severity of anxiety predicted an overall lower remission rate but did not specifically moderate aripiprazole efficacy. In contrast, set-shifting performance measured with the Trail Making Test moderated aripiprazole efficacy; participants who performed better were more likely to remit with aripiprazole than with placebo. For participants performing poorly, aripiprazole did not demonstrate a benefit over placebo. These findings have several implications and raise many questions.

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

2,073 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Evidence to Support the Update

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Evidence Summary and Review 2

brightcove.createExperiences();