@article{e9dbd54d1ae14d88b9df4ef75a5c1f91,
title = "Effect of Metabolic Syndrome on Late-Life Depression: Associations with Disease Severity and Treatment Resistance",
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-{\AA}sberg 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.",
keywords = "elderly, late-life depression, major depressive disorder, metabolic syndrome, venlafaxine",
author = "Mulvahill, {John S.} and Nicol, {Ginger E.} and David Dixon and Lenze, {Eric J.} and Karp, {Jordan F.} and Reynolds, {Charles F.} and Blumberger, {Daniel M.} and Mulsant, {Benoit H.}",
note = "Funding Information: Conflict of Interest: GEN receives research support from Otsuka America, Inc. for an investigator-initiated study. EJL has received support from the National Institutes of Health (NIH), the Food and Drug Administration, Takeda, Lundbeck, Janssen, Alkermes, Taylor Family Institute for Innovative Psychiatric Research, McKnight Brain Research Foundation, Barnes/Jewish Foundation, and the Patient-Centered Outcomes Research Institute. JFK has received medication supplies from Indivior and Pfizer within the past 5 years for investigator-initiated studies. DMB receives research support from the Canadian Institutes of Health Research, Brain Canada, Weston Brain Institute, NIH, Temerty Family through the Centre for Addiction and Mental Health (CAMH) Foundation, and the Campbell Family Research Institute. He received non-salary operating funds and in-kind equipment support from Brainsway Ltd. for an investigator-initiated study. He is the site principal investigator for three sponsor-initiated clinical trials from Brainsway Ltd. He received in-kind equipment support from Tonika/Magventure for an investigator-initiated study. He received medication supplies from Indivior for an investigator-initiated trial. BHM receives research support from Brain Canada, the Canadian Institutes of Health Research, the CAMH Foundation, the Patient-Centered Outcomes Research Institute, NIH, Eli Lilly (medications for a NIH-funded clinical trial), Pfizer (medications for a NIH-funded clinical trial), Capital Solution Design LLC (software used in a study founded by CAMH Foundation), and HAPPYneuron (software used in a study founded by Brain Canada). Within the past 3 years, he has also received research support from Bristol-Myers Squibb (medications for a NIH-funded clinical trial) and Pfizer/Wyeth (medications for a NIH-funded clinical trial). He directly own stocks of General Electric (less than $5,000). All other authors declare no conflict of interest. Funding Information: Financial Disclosure: This research was also supported by R01 MH083648 to Washington University, and R01 MH083643 to University of Toronto), with additional funding provided by the University of Pittsburgh Medical Center Endowment in Geriatric Psychiatry, the Taylor Family Institute for Innovative Psychiatric Research (at Washington University), Washington University Institute of Clinical and Translational Sciences Grant UL1 TR000448 from the National Center for Advancing Translational Sciences, and the Campbell Family Mental Health Research Institute at the Centre for Addiction and Mental Health in Toronto. Funding Information: The authors would like to thank the participants, clinical research staff, and data and safety monitoring board members of the original IRL GRey study. We also thank Phil Miller for his assistance with data analysis techniques. Financial Disclosure: This research was also supported by R01 MH083648 to Washington University, and R01 MH083643 to University of Toronto), with additional funding provided by the University of Pittsburgh Medical Center Endowment in Geriatric Psychiatry, the Taylor Family Institute for Innovative Psychiatric Research (at Washington University), Washington University Institute of Clinical and Translational Sciences Grant UL1 TR000448 from the National Center for Advancing Translational Sciences, and the Campbell Family Mental Health Research Institute at the Centre for Addiction and Mental Health in Toronto. Publisher Copyright: {\textcopyright} 2017, Copyright the Authors Journal compilation {\textcopyright} 2017, The American Geriatrics Society",
year = "2017",
month = dec,
doi = "10.1111/jgs.15129",
language = "English (US)",
volume = "65",
pages = "2651--2658",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "12",
}