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Biomedical subjects

S L Rifat

Publications and source records attributed to S L Rifat.

At least 19 recordsLinked to original sources
PubMed2001

Nonresponse to first-line pharmacotherapy may predict relapse and recurrence of remitted geriatric depression.

The authors examined whether nonresponse to first-line pharmacotherapy was associated with an increased probability of relapse or recurrence following remission of an episode of geriatric depression. The study group consisted of 74 elderly patients whose index episode of nonpsychotic unipolar major depression had responded to antidepressant pharmacotherapy. In 6 of these patients, the depressive episode had not responded to first-line pharmacotherapy (8 weeks of nortriptyline, including 2 weeks of adjunctive lithium) but it had responded to second-line treatment (phenelzine with or without adjunctive lithium). The 74 patients were maintained on acute doses of the medications that had led to response and were followed for 2 years or until relapse or recurrence, whichever occurred first. The cumulative probability of relapse or recurrence was 67% for patients who responded to second-line treatment compared with 18% for patients who responded to first-line treatment (P = 0.0003). As expected, mean time to response was significantly longer for patients who responded to second-line treatment but this factor did not account for the difference in outcome between the two groups. These findings suggest that pharmacotherapy resistance may constitute a risk factor for relapse or recurrence of remitted geriatric depression, even when patients are maintained on the medication that they eventually respond to.

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PubMed2000

Maintenance treatment for recurrent depression in late life. A four-year outcome study.

The authors examined the 4-year outcome of elderly patients who were given open-label maintenance treatment for recurrent depression. Thirty-eight patients, age 60 years or older, who had recovered from an episode of recurrent nonpsychotic unipolar major depression were maintained on full-dose antidepressant medication and, if necessary, adjunctive lithium. They were followed on a regular basis for 4 years or until recurrence, whichever occurred first. The cumulative probability of remaining well without recurrence was 70%. Longer time to respond to treatment and higher anxiety scores at the time of response predicted shorter time to recurrence.

Aged↗
PubMed1999

Recurrence of first-episode geriatric depression after discontinuation of maintenance antidepressants.

OBJECTIVE: Later age at onset of depression appears to be a risk factor for early recurrence. Therefore, the authors examined the 2-year outcomes of elderly patients with first-episode major depression following discontinuation of their maintenance antidepressant medication. METHOD: The study group consisted of 21 elderly patients who had recovered from a first lifetime episode of major depression. They had taken maintenance antidepressant medication for 2 years and had not had a relapse or recurrence during that time. The antidepressant was then withdrawn, and patients were followed for another 2 years or until recurrence, whichever occurred first. RESULTS: The cumulative probability of suffering a recurrence of major depression was 61%. Eleven of the 12 patients who suffered a recurrence restarted the antidepressant, and 10 responded. CONCLUSIONS: Elderly patients with first-episode major depression were at high risk of recurrence following discontinuation of maintenance antidepressant medication. However, the vast majority of patients who experienced a recurrence responded to reinstated treatment.

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PubMed1998

Two-year outcome of psychotic depression in late life.

OBJECTIVE: The purpose of this study was to determine whether elderly patients with psychotic depression differed in long-term outcome from patients with nonpsychotic depression. METHOD: The study group consisted of 19 patients with psychotic major depression who had responded to ECT (N = 15), nortriptyline and perphenazine (N = 2), or nortriptyline, perphenazine, and adjunctive lithium (N = 2) and 68 nonpsychotic depressed patients who had responded to either nortriptyline alone (N = 61) or nortriptyline and lithium (N = 7). All patients were maintained on regimens of full-dose nortriptyline. When prescribed for the index episode, adjunctive lithium was also maintained, but perphenazine was withdrawn 16 weeks after response. Patients were followed on a monthly basis for 2 years or until relapse or recurrence, whichever occurred first. RESULTS: Patients with psychotic depression had a substantially higher frequency of relapse or recurrence of depression and a shorter time to these events than nonpsychotic depressed patients. At index assessment, patients with psychosis were more severely depressed and had had more prior episodes of depression, but these factors did not account for the difference in outcome between the two groups. Furthermore, before entering the study, none of the psychotic patients had received adequate treatment for the index episode of depression, and so their poor outcome could not be attributed to prior treatment resistance. CONCLUSIONS: Even when they achieved remission and were maintained on a regimen of full-dose antidepressant medication, older patients with psychotic depression were at greater risk of relapse or recurrence than were their nonpsychotic counterparts. In particular, continuation/maintenance treatment with tricyclic monotherapy following response to ECT had limited efficacy in this group of patients. These findings raise important questions about the optimal treatment of psychotic depression in late life.

Age Factors↗
PubMed1998

The treatment of psychotic depression in later life: a comparison of pharmacotherapy and ECT.

OBJECTIVE: Response to combination pharmacotherapy and to electroconvulsive therapy (ECT) was evaluated in elderly patients with psychotic depression. METHOD: Twenty-five patients, aged 60 years and older, with DSM-III-R unipolar psychotic major depression, were treated in an open, non-randomized fashion with either 6 weeks of nortriptyline and perphenazine (N = 8) or ECT (N = 17). Response was defined as a Hamilton score of < or = 10 and the absence of delusions and hallucinations. Patients who failed to respond to combined antidepressant-antipsychotic medication underwent 2 weeks of lithium augmentation. RESULTS: Two (25.0%) patients responded to the first 6 weeks of pharmacotherapy whereas 15 (88.2%) patients responded to ECT (Fisher's exact test, p = 0.004). Even after lithium augmentation, there was a trend for patients to be less responsive to medication than to ECT (50.0% versus 88.2%, Fisher's exact test, p = 0.059). Survival analysis, based on 8 weeks of observation, demonstrated that patients took longer to respond to pharmacotherapy than to ECT (mean (SE) of 7(0) weeks versus 4(0) weeks; log rank chi2 = 10.43, df = 1, p = 0.001). CONCLUSIONS: We found that elderly patients with psychotic depression had a significantly lower frequency of response to nortriptyline and perphenazine than to ECT. However, patients responded more slowly to pharmacotherapy than to ECT and longer duration of treatment may have improved the outcome of the medication group. These findings suggest the need for a randomized controlled trial comparing the efficacies of drug treatment and ECT in late life psychotic depression.

Age Distribution↗
PubMed1997

Two-year outcome of elderly patients with anxious depression.

The purpose of this study was to determine whether there was a difference in the long-term outcome between elderly patients with anxious depression and those with non-anxious depression. Eighty-three patients with non-bipolar, non-psychotic major depression who had responded to treatment of the index episode were maintained on full-dose antidepressant medication and followed on a monthly basis over a period of 2 years. Anxiety status at index assessment was not related to outcome as defined by rates of relapse and recurrence or time to these events. However, the few patients who remained anxious at the point of remission of the index episode had a significantly shorter time to relapse/recurrence. These findings suggest that, once they achieve remission and are given adequate prophylactic treatment, most older patients with anxious depression have a similar long-term outcome to patients without anxiety.

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PubMed1997

Effect of demographic and clinical variables on time to antidepressant response in geriatric depression.

The authors examined the effect of demographic and clinical variables on time to treatment response in geriatric depression. One hundred and one patients, aged 60-92 years, with nonpsychotic, nonbipolar major depression were treated in an open fashion with 6 weeks of nortriptyline followed, if necessary, by 2 weeks of lithium augmentation. Univariate Cox proportional hazards analyses showed that 3 of 19 variables predicted time to response: high baseline anxiety was associated with delayed response (median of 5 weeks vs. 4 weeks for patients with low anxiety scores), whereas hospitalization for the index episode of depression and attempted suicide predicted shorter time to response. In the final multivariate Cox regression model, baseline anxiety and inpatient status were most predictive of outcome; attempted suicide did not significantly improve the predictive power of the model. Our findings strengthen existing evidence that concomitant anxiety can adversely affect the outcome of geriatric depression.

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PubMed1997

The effect of treatment on the two-year course of late-life depression.

BACKGROUND: The purpose of this study was to examine the effect of treatment on the long-term course of geriatric depression. METHOD: Eighty-four elderly patients who had responded to treatment of the index episode of major depression were maintained on full-dose antidepressant medication and followed on a monthly basis for two years. Relapse and recurrence were treated in a systematic manner. RESULTS: The cumulative probability of surviving for two years without relapse or recurrence was 74%. Of the 14 patients who suffered recurrence following recovery from the index episode, all responded to a change of treatment, and 71% remained well for the remainder of the study. The risk of recurrence was significantly increased by a delayed response to treatment of the index episode. CONCLUSIONS: Continuation and maintenance treatment with full-dose antidepressant medication, frequent follow-up, and vigorous treatment of relapses and recurrences, were associated with a good outcome in this group of elderly patients.

Age of Onset↗
PubMed1997

Anxious depression in elderly patients. Response to antidepressant treatment.

The authors asked whether elderly patients with anxious depression were less responsive to antidepressant treatment than nonanxious depressed patients. A group of 101 depressed patients were treated with 6 weeks of nortriptyline and then, if necessary, 2 weeks of adjunctive lithium. Patients who did not respond to or were intolerant of this first line of treatment were then given 6 weeks of phenelzine (+/- lithium augmentation). Finally, patients failing this second line of treatment were given either a course of electroconvulsive therapy or 6 weeks of fluoxetine (+/- lithium augmentation). Based on their score on the Hospital Anxiety and Depression Scale at index assessment, subjects were divided into anxious and nonanxious groups. Anxious depressed patients were significantly less responsive to nortriptyline on both intent-to-treat and efficacy analyses. They were also more likely to discontinue treatment and, as a result, were significantly less responsive on the intent-to-treat analysis for overall treatment. These results suggest that concurrent symptoms of anxiety have prognostic importance in geriatric depression.

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PubMed1996

The effect of sequential antidepressant treatment on geriatric depression.

This study evaluated the outcome of elderly depressed patients who were refractory to, or intolerant of, an initial trial of nortriptyline and who then underwent systematic treatment with other antidepressant therapies. 101 patients entered the study and 61% responded to nortriptyline, 64% of patients who did not improve with nortriptyline eventually responded to other antidepressant treatments. Response to second-line treatment (phenelzine) was significantly slower than response to the tricyclic antidepressant. Treatment nonresponders were more likely to have a longer episode length at index assessment and higher baseline anxiety scores compared with responders. This study demonstrates the importance of persisting with systematic antidepressant therapy in elderly patients who do not respond to the first trial of treatment.

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PubMed1996

Risk for neuropathologically confirmed Alzheimer's disease and residual aluminum in municipal drinking water employing weighted residential histories.

We investigated a possible relation between aluminum concentration ([Al]) in public drinking water and Alzheimer's disease (AD), with AD cases and controls defined on the basis of strict neuropathologic criteria. Using the case/control odds ratio as an estimate of relative risk and [Al] > or = 100 microgram/L as the cutoff point, elevated risks for histopathologically verified AD were associated with higher [Al]. Comparing all AD cases with all non-AD controls, and using the [Al] of public drinking water at last residence before death as the measure of exposure, the estimated relative risk associated with [Al] > or = 100 microgram/L was 1.7 (95% CI: 1.2-2.5). Estimating aluminum exposure from a 10-year weighted residential history resulted in estimates of relative risk of 2.5 or greater. The public health implications of the observed relationship between [Al] in drinking water and AD prevalence in the population depend in large measure on population exposure characteristics. In Ontario, it is estimated that 19% of the population was exposed to residual [Al] greater than or equal to 100 microgram/L. Based on the estimated relative risk and the assumption of causality, this translates to an etiologic fraction of 0.23. Although the potential contributions of confounding and mitigating factors are not defined in this report, the merit of limiting residual aluminum in drinking water supplies deserves serious attention.

Aged↗
PubMed1994

A prospective study of lithium augmentation in antidepressant-resistant geriatric depression.

This open, prospective study investigated the efficacy of lithium augmentation in elderly patients who had failed to respond to a 6-week course of antidepressant medication. Twenty-one patients (age range, 64 to 88 years) with DSM-III-R unipolar, nonpsychotic major depression refractory to a 6-week course of nortriptyline, fluoxetine, or phenelzine underwent a minimum of 2 weeks of lithium augmentation. Five patients had a complete response, 3 had a partial response, and 13 did not respond. Half of the patients developed dose-limiting side effects, most commonly neuromuscular or neurologic. Patients developing side effects were significantly older (p = 0.05), and there was a tendency for side effects to occur more frequently in patients treated with fluoxetine. The rate of response to lithium augmentation in this elderly population was lower than that reported for most open and controlled studies in younger patients. Possible reasons for this are discussed.

Aged↗
PubMed1991

The epidemiology of dementia in North America.

In this brief review, the epidemiology of dementia in North America is examined. The areas covered are prevalence and incidence studies, longitudinal studies, risk factors, distribution of types of dementia, cross-cultural factors and current research programmes.

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PubMed1990

Effect of exposure of miners to aluminium powder.

'McIntyre Powder' (finely ground aluminium and aluminium oxide) was used as a prophylactic agent against silicotic lung disease between 1944 and 1979 in mines in northern Ontario. To find out whether the practice produced neurotoxic effects a morbidity prevalence study was conducted between 1988 and 1989. There were no significant differences between exposed and non-exposed miners in reported diagnoses of neurological disorder; however, exposed miners performed less well than did unexposed workers on cognitive state examinations; also, the proportion of men with scores in the impaired range was greater in the exposed than non-exposed group. Likelihood of scores in the impaired range increased with duration of exposure. The findings are consistent with putative neurotoxicity of chronic aluminium exposure.

Aluminum↗
PubMed1989

Mood disorder following cerebrovascular accident.

Depression appears to be common after stroke, and therefore may have a bearing upon rehabilitation. To examine whether the depression is due to a specific brain lesion, or is reactive to the consequent disability, this study looked at the frequency and associations of depressed mood in a stroke rehabilitation unit in-patient population, unselected for site of lesion. Depression affected 50% of the patients; history of previous psychiatric disorder and cerebrovascular accident appeared to be important risk factors. There were hemispheric differences in the relationships between measures, with both the site-of-lesion and reactive viewpoints being upheld.

Brain↗