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• W2912672627 abstract "Event Abstract Back to Event “Does Age Affect Treatment of Depressive Disorders? A systematic review of antidepressants versus placebo studies.” Paolo Ossola1, Maria Lidia Gerra1*, Antonio Piacente1, Carlo Marchesi1 and Jonathan W. Stewart2 1 University of Parma, Department of Neuroscience, Italy 2 Columbia University, Depression Evaluation Service, United States INTRODUCTION Multiple lines of evidences suggest that the diagnosis of Major Depressive Disorder (MDD) encompass a heterogeneous group of disorders with various genetic patterns, neurobiological mechanisms, symptoms profiles, course-trajectories and ultimately differential treatment responses. We hypothesized that age-related neurobiological differentiation could underlie different treatment responses across depressive disorders: previous research suggested that the balance of serotonin and norepinephrine favours serotonin in younger and norepinephrine in older people, therefore deficits in serotoninergic function might be more likely in younger people, whereas deficit in noradrenergic function might be more evident in oldsters. Consequently, we reviewed the literature on MDD looking for evidence of greater response to serotoninergic drugs (selective serotonin reuptake inhibitors- SSRI) early in life and to more noradrenergic treatment (tricyclic antidepressants- TCA) later on. METHODS Studies were identified on MEDLINE through December 31 2016, searching for three-arms RCTs comparing SSRIs, TCAs and placebo. For the included studies, we computed the proportion of females and the mean age for each harm. We then classified the studies according to the in responders, if any, between the SSRIs and TCAs. Three possible outcome therefore emerged: trials in which the response was significantly greater in the SSRIs group (i.e. SSRI wins); in the TCAs group (i.e. TCA wins), or trials in which the difference did not reach a statistically significant threshold, independently from the difference with Placebo (i.e. TCA=SSRI). Moreover, we computed the Effect Size (ES) (i.e. Observed Risk Difference) defined as the difference between the percentage of responders to SSRIs and to TCAs in each trial. Finally, we evaluated the relationship between the aforementioned outcomes and the ES with age, controlling for confounding variables. RESULTS Nine-thousands-eight-hundred-and-fifty potential studies were identified from searching the MEDLINE database and references of relevant articles. Thirty articles were considered eligible in the systematic review. 23 studies (76.67%) reported the rate of response. The mean age of the trials in which SSRIs win was significantly lower than in those in which TCAs wins (p=.017). Age was still the best predictor (B=-.663; 95%CI=-1.353, -.002; p=.05) of the responders to SSRIs or to TCAs (i.e. ES), even when controlling for gender and sample size, baseline severity, rate of recurrence and placebo responders. CONCLUSION This systematic review suggests a different efficacy of TCAs and SSRIs across ages: SSRIs seem more effective than TCA in children and adolescents, whereas TCAs show a better response in older adults. For the non-elderly adult, neither drug class seems preferable, independently from gender, baseline severity and recurrence of depressive episodes. Therefore age might be a critical factor to determine the efficacy of antidepressants: noradrenergic drugs (e.g. TCAs) may be less effective in adolescent depression, while noradrenergic effects would relatively be more important for treating depression in the elderly. This specific response of MDD at different ages to different treatment modalities strengthen the hypothesis that the depressive illnesses in youth and elderly might have biological underpinnings. In order to have clearer diagnostic entities and to choose the best-individualized treatment, the clinicians should consider not only the symptomatic profile, but also the age effects on the depressive subtype. References Parker G. Managing melancholic depression: a personal perspective. Australas Psychiatry. 2016 Jul 12. pii: 1039856216657697. [Epub ahead of print] Stewart JW, McGrath PJ, Quitkin FM. Do age of onset and course of illness predict different treatment outcome among DSM IV depressive disorders with atypical features? Neuropsychopharmacology. 2002 Feb;26(2):237-45. Stewart JW, Bruder GE, McGrath PJ, Quitkin FM. Do age of onset and course of illness define biologically distinct groups within atypical depression? J Abnorm Psychol. 2003 May;112(2):253-62. Qin B, Zhang Y, Zhou X, Cheng P, Liu Y, Chen J, Fu Y, Luo Q, Xie P. Selective serotonin reuptake inhibitors versus tricyclic antidepressants in young patients: a meta-analysis of efficacy and acceptability. Clin Ther. 2014 Jul 1;36(7):1087-1095.e4. doi: 10.1016/j.clinthera.2014.06.001. Parker G. Differential effectiveness of newer and older antidepressants appears mediated by an age effect on the phenotypic expression of depression. Acta Psychiatr Scand. 2002 Sep;106(3):168-70. Joyce PR, Mulder RT, Luty SE, McKenzie JM, Rae AM. A differential response to nortriptyline and fluoxetine in melancholic depression: the importance of age and gender. Acta Psychiatr Scand. 2003 Jul;108(1):20-3. Murrin LC, Sanders JD, Bylund DB. Comparison of the maturation of the adrenergic and serotonergic neurotransmitter systems in the brain: implications for differential drug effects on juveniles and adults. Biochem Pharmacol. 2007 Apr 15;73(8):1225-36. Mulder RT, Watkins WG, Joyce PR, Luty SE. Age may affect response to antidepressants with serotonergic and noradrenergic actions. J Affect Disord. 2003 Sep;76(1-3):143-9. Entsuah AR, Huang H, Thase ME. Response and remission rates in different subpopulations with major depressive disorder administered venlafaxine, selective serotonin reuptake inhibitors, or placebo. J Clin Psychiatry. 2001 Nov;62(11):869-77. Keywords: age, Antidepressants Efficacy, Depressive subtypes, placebo, Depressive Disorder, Major Conference: ISAD LONDON 2017: Perspectives on Mood and Anxiety Disorders: Looking to the future, London, United Kingdom, 6 Jul - 7 Jul, 2017. Presentation Type: Poster Topic: Pharmacological / Somatic treatments Citation: Ossola P, Gerra M, Piacente A, Marchesi C and Stewart JW (2019). “Does Age Affect Treatment of Depressive Disorders? A systematic review of antidepressants versus placebo studies.”. Front. Psychiatry. Conference Abstract: ISAD LONDON 2017: Perspectives on Mood and Anxiety Disorders: Looking to the future. doi: 10.3389/conf.fpsyt.2017.48.00031 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 26 May 2017; Published Online: 25 Jan 2019. * Correspondence: Dr. Maria Lidia Gerra, University of Parma, Department of Neuroscience, Parma, Italy, marialidiagerra@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Paolo Ossola Maria Lidia Gerra Antonio Piacente Carlo Marchesi Jonathan W Stewart Google Paolo Ossola Maria Lidia Gerra Antonio Piacente Carlo Marchesi Jonathan W Stewart Google Scholar Paolo Ossola Maria Lidia Gerra Antonio Piacente Carlo Marchesi Jonathan W Stewart PubMed Paolo Ossola Maria Lidia Gerra Antonio Piacente Carlo Marchesi Jonathan W Stewart Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page." @default.
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