July 19, 2023

Treating depression in older adults can be complex, but we shouldn’t accept depression as a natural part of aging.

When we’re depressed or anxious, how well we respond to antidepressant medications may depend on how our brains are wired. Dr. Warren Taylor, a psychiatrist at the Vanderbilt Adult Psychiatry Outpatient Clinic, is investigating this idea with his research on depression in adults, because he is working toward a future when we are better able to find the right treatment for every individual.

“Currently, the success rate for the first medication a person tries is only about 40-60 percent,” Taylor said. “That’s just not good enough, and the frustrating result for many patients is that they go months or years trying different medications to find one that works. On top of that, even when we’re successful and someone responds well, many patients relapse in time and have another depressive episode. Sometimes that next episode is harder to treat. We still have a lot to learn about how best to help people.”

Part of the problem is that there is much to be discovered about the complexity of the human brain. We know antidepressants work for many people, but we don’t always know exactly why. With more research, Taylor believes psychiatrists could do a better job of matching the right medication to the right patient. This has been the subject of his research for the last 20 years.

How is depression different for seniors?

In Taylor’s latest research, he has been focusing on depression in older adults and changes in the brain, along with when and how antidepressants can help. Aging and mental health are a complicated topic, and depression in seniors can be difficult to treat. There are several issues at play:

  • The brain changes as we age.
  • Older adults might have other medical conditions that cause depression or make symptoms worse, including disabilities.
  • Seniors may be on many different medications at once, which is called “polypharmacy.” This can lead to side effects and drug interactions.

“It can be tempting to think we should just accept depression as a natural part of aging, but that’s not right,” Taylor said. “However, there are factors that make depression difficult to treat as we get older. Navigating these can take close partnership between the patient and a skilled psychiatrist. It can be complex, but it certainly still needs to be treated, and the sooner the better.”

Treating depression in older adults

“This study is one more step toward a future where we can offer people what is called ‘personalized medicine’ – the idea that someday we will be able to pinpoint the exact right medication for everyone.”

Among a group of research participants, Taylor was able to pinpoint what was happening in the brains of those who saw benefit from antidepressants. Individuals with certain patterns of connections between key brain regions did better when they received antidepressants. The study used the type of antidepressants that are typically prescribed as a first attempt at treating depression. In contrast, patients who did not respond well to the antidepressant had different patterns of brain connectivity. Taylor proposed that those individuals might benefit from other depression treatments.

“This study is one more step toward a future where we can offer people what is called ‘personalized medicine’ – the idea that someday we will be able to pinpoint the exact right medication for everyone,” Taylor said. “We are always working to improve the treatment of depression for everyone.”

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