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| |  Depressive Subtype May Influence Antidepressant Impact on Cognition in Older Adults: Presented at AAGP By Carole VanSickle Ellis SAVANNAH, Ga -- March 7, 2010 -- While selective-serotonin reuptake inhibitors (SSRIs) are among the most commonly prescribed medications for depression, some subtypes of depression appear to respond more favourably to tricyclic antidepressants (TCAs), US researchers reported here on March 6 at the 2010 Annual Meeting of the American Association for Geriatric Psychiatry (AAGP). The research team, headed by Michelle Culang, PhD, Queens College at City University of New York, New York, New York, aimed to determine how antidepressants impact cognition. To do so, they assembled pre-post neuropsychological data collected during a 12-week, randomised, double-blind, parallel-group study. The study compared the SSRI sertraline with the TCA nortriptyline in the treatment of depression in older adults, defined in this study as individuals aged >=45 years. At baseline, the patients had non-psychotic, unipolar major depression and a Hamilton Rating Scale for Depression score of >=16. The researchers measured verbal learning, reaction time, attention, and executive functioning at baseline and study endpoint using the Mini-Mental State Examination, Buschke Selective Reminding Test (SRT), the Purdue Pegboard, Trails Making Tests (TMT) A and B, Continuous Performance Test (CPT), and Stroop tests were conducted to measure. Patients were randomised to sertraline or nortriptyline and stratified as either melancholic (n = 28) or nonmelancholic (n = 35). “There were no differences between treatment conditions at baseline on any clinical or demographic characteristic,” reported Dr. Culang. Changes in the neuropsychological test performances of the patients depended on their responder status and their depressive subtype. Among the melancholic subgroup, sertraline was associated with less cognitive impairment. Sertraline-treated patients and sertraline responders scored significantly higher on the Buschke SRT at study endpoint compared with nortriptyline-treated patients (P = .05) and nortriptyline responders (P = .003). Additionally, nortriptyline nonresponders scored significantly better than nortriptyline responders on the TMT A at endpoint (P = .04). Among the nonmelancholic sub-group, nortriptyline was associated with less cognitive impairment. Patients treated with sertraline performed significantly more slowly on the CPT at endpoint compared with those treated with nortriptyline (P = .02). In addition, nortriptyline responders performed significantly faster on the CPT at endpoint, versus the sertraline nonresponders (P = .005). The group concluded that their findings “indicate that a change in cognitive performance depends on antidepressant medication class, depressive subtype, and response.” However, the team did acknowledge some limitations to the study, given the small sample size, the lack of a control condition, and missing data that was filled in using multiple imputation. [Presentation title: Change in Cognitive Functioning Following Antidepressant Treatment in Late-Life Depression. Abstract NR09]
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