Yale University School of Medicine Thesis Abstracts — 2009


Antidepressant medications are commonly prescribed for older adults with depressive symptoms who may not have a major depressive disorder. Yet the effect of antidepressants on depressive symptoms in this population over time is largely unknown. We sought to determine whether the use of antidepressant medications is associated with a reduction in the severity of depressive symptoms over time. Participants included 754 community-dwelling adults, aged 70+ years, who were followed at 18-month intervals for 90 months. Depressive symptoms were assessed using the 11-item CESD scale, with a higher score indicating worse depressive symptoms. A linear mixed effects model, adjusted for demographic features, number of chronic conditions, cognitive status, and physical frailty, was used to evaluate the effect of antidepressant use on change in depressive symptoms score over time. In addition, among people with clinically significant depressive symptoms (i.e., CESD score > = 20), we evaluated whether antidepressant use was associated with a transition to a non-depressed state (CESD score < 20) using a Generalized Estimating Equations (GEE) model. At baseline, participants taking an antidepressant (n = 75) had higher mean CESD scores than those not taking an antidepressant (15.1 + 9.2 vs. 8.5 + 8.3; p < 0.001) and were more likely to be female (p < 0.001). Average unadjusted CESD change scores ranged from -3.4 to 1.7 and 0.4 to 1.5 among those taking, and not taking, an antidepressant, respectively (for the different 18-month intervals). Adjusted CESD scores worsened, on average, for participants taking an antidepressant as compared with those not taking an antidepressant. These differences were statistically significant between baseline to 18 months (p = 0.03), 36 to 54 months (p = 0.02), and 72 to 90 months (p = 0.01). The longitudinal findings indicated that CESD scores worsened by 2.2 points, on average, among participants taking an antidepressant as compared with those not taking an antidepressant, although this difference was not statistically significant (p = 0.14). Among participants with clinically significant depressive symptoms, use of antidepressants was not associated with transitioning to a non-depressed state (OR = 0.85, 95 percent CI 0.5-1.4). Our findings raise concerns about the effectiveness of antidepressant medications, as prescribed in clinical practice. Additional research is needed to better understand the realworld use and benefit of antidepressants among older adults.

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@inproceedings{Abou2009YaleUS, title={Yale University School of Medicine Thesis Abstracts — 2009}, author={Janet Jalal Abou and Steven D. Abramowitz and Gary M. Israel and Shirley M. McCarthy and Jeffrey S. Pollak and Robert I. White and Michael G. Tal and Mary E. Air and Ayal Aaron Aizer and Carolyn Avery and Kristina DePeau and Eugene Shapiro and Jeffrey Kahn and Marietta Vazquez and Palav Babaria and Margaret Ann Baumbusch and Naseem Neon Beauchman and Johnathan Alexander Bernard and Sundeep Ram Bhat and Jesse Emory Bible and Debdut Biswas and Rebecca E. Bruccoleri and Lei Chen and Justin A. Chen and Judson A. Brewer and Wendy A. Ciovacco and Carolyn G. Goldberg and Amanda F. Taylor and Justin M. Lemieux and Henry J. Donahue and Ying-Hua Cheng and Mark C. Horowitz and Melissa A. Kacena and Brittany G. Craiglow and Michael H. Bloch and Angeli Landeros-Weisenberger and Philip A. Dombrowski and Kaitlyn E. Panza and Bradley S. Peterson and James F. Leckman and Tanaz Farzan Danialifar and Paul Daniel Di Capua and Laura E. Dichtel and Faina Gurevich and Aldo J. Peixoto and Damien Jon Ellens and Caroline Wagner Engel and Merritt McLean Evans and Samer M. Fadl and Jason E. Frangos and Lyn Duncan and Alexa B. Kimball and Nicholas J. Galante and Lars J. Grimm and Aymen A. Alian and Nina S. Stachenfeld and Kirk H. Shelley and David G. Silverman and Christopher J. Gibson and Jeffrey R. Gruen and Kimberly B. Gold and Stephen Elliot Gordon and Joel Robert Green and Veronique Anne Sabine Griffith and Daniel Cornfeld and Hamid R. Mojibian and Kylene Halloran and Luz Evelyn Jimenez and Adam Harris Kaye and Luis Enrique Kolb and Ninani E. Coyne Kombo and Oathokwa Nkomazana and Caleb Bosler Korngold and Alicia V. Lee and John P. Moriarty and Christopher P. Borgstrom and Leora I. Horwitz and James C. Lee and Jennifer C. Lee and M. Bruce Shields and Sarah Angeline Lee and Justin Michael Lemieux and Gene-Fu F. Liu and Yuen-Jong Liu and Shane Lloyd and Sheng-fu Larry Lo and Jonathan Chun Ting Lu and Michael Joel Martinez and Andrew John Duffy and Sheela Smith-Rohrberg Maru and Susan K. Mathai and Matthew C. McRae and Rossitza Lasova and Bonnie Gould-Rothberg and David Rimm and Fabienne C. Meier-Abt and Bruno J. Strasser and Mallika L. Mendu and Gail McAvay and Rachel Lampert and Jonathan Stoehr and Mary E. Tinetti and Anne K. Merritt and Sarah Allison Milgrom and Erica Rose Menkel Mintzer and Tejaswini K. More and Janelle Katie Moulder and Kudakwashe Mutyambizi and Titilope Oduyebo and Ami Mahendra Parekh and Alexander J. Park and Sahibzada U. Latif and Steven L. Werlin and Allen Hsiao and Dinesh S. Pashankar and Vineet Bhandari and Anil B. Nagar and Sohail Z. Husain and Anup Patel and Rajeshvari Mahesh Patel and Aaron K. Remenschneider and Douglas A. Ross and Maya Roberts and Mark R. Zonfrilloa and James Dziura and Sunkyung Yu and David Spiro and Aviva Jill Romm and Oliver Rothschild and Jennifer Marie Sabino and Mina G. Safain and Kathleen Jessica Samuels and Amanda Mondo{\~n}edo Silverio and Natalie Renee Simmons and Rachel Solomon and Paul Kirwin and Terri Fried and Shreya Sood and Christopher Spock and Robert Stavert and Elisa Long and Jennifer R. Voorhees and Heather Wachtel and Chuan Hua He and Jack A. Elias and Ying Wang and Rachel L. Wattier and Isaac Lazar and Richard A. Martinello and Carla Weibel and Jeffrey S. Kahn and Rachel S. Weston and David J. Bridgett and Linda C. Mayes and Sara Whetstone and Stephen Thung and Jessica Illuzzi and Rachel H. Wolfson and Mark D. Siegel and Tracy M. Wright and Agnes S. Kim and Lawrence H. Young}, year={2009} }