Journal
AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY
Volume 29, Issue 7, Pages 619-630Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jagp.2020.11.001
Keywords
executive dysfunction; processing speed; Late life depression; antidepressants; expectancy
Categories
Funding
- National Institute for Mental Health [R01 MH102293]
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This study investigated the impact of slowed processing speed and executive dysfunction on the development of positive treatment expectancies in late-life depression (LLD) patients. The results suggest that slowed processing speed impairs the development of expectancies in antidepressant trials for LLD, which may explain lower antidepressant response among older adults.
Objective: Slowed processing speed and executive dysfunction are associated with poor outcomes in Late Life Depression (LLD), though it is unclear why. We investigated whether these variables interfere with the development of positive treatment expectancies in an antidepressant trial. Methods: Depressed older subjects were randomized to Open (intended to increase patient expectancy) or Placebo-controlled (termed 'Hidden,' intended to decrease expectancy) administration of antidepressant medication for 8 weeks. Analysis of covariance analyzed the between-group difference on expectancy (Credibility and Expectancy Scale [CES]) and depression (Hamilton Rating Scale for Depression [HRSD], Clinical Global Impressions [CGI] Severity). Moderator analyses examined whether these Open versus Hidden differences varied based on higher versus lower processing speed and executive function. Results: Among the 108 participants, a significant between-group difference was observed on expectancy (effect size [ES, Cohen's d] = 0.51 on CES Item 2; ES = 0.64 on Item 4), indicating the manipulation was effective. Processing speed as measured by the Stroop Color-Word Test (number color-words named in congruent condition) was a significant moderator of the Open versus Hidden effect on expectancy. Depressive symptom improvement was greater on average for Open versus Hidden participants who received active drug (CGI-severity ES =1.25, HRSD ES = 0.41), but no neurocognitive moderators of the between-group difference reached statistical significance. Conclusions: Slowed processing speed impairs the development of expectancies in antidepressant trials for LLD, which may help explain lower antidepressant response among older adults. Future studies may address
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