Treatment Of Geriatric Depression A Randomized Controlled - amazonia.fiocruz.br

Diagram of the study protocol. Assessments of psychometry and hypothalamic-pituitary axis function and parameters of sleep and circadian rhythmicity were conducted before the start of 3 weeks of light treatment T0after 3 weeks of treatment T1and 3 weeks after Trextment of treatment T2. Wrist actigraphy was continuously measured. Flow of study patients. Every randomized patient started treatment.

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Five patients discontinued the read article and refused follow-up. Analyses fulfill intention-to-treat characteristics because none of the patients assigned to a condition switched to another condition and because analyses involved all available observations of all patients.

Bars indicate standard deviations. T1 indicates after 3 weeks of treatment; T2, 3 weeks after discontinuation of treatment. Treatment consisted of bright light treatment BLT or placebo. Points that fall below the solid diagonal represent patients who improved. Effects of bright light treatment BLT and placebo in elderly patients with nonseasonal major depressive disorder. Absolute values are given on the left side, and the percentage of change from baseline T0 is shown on the right side.

Mean change from baseline T0 in patients receiving bright light treatment BLT and placebo by effects on hour urinary free cortisol UFC levels. Supplemental information on depression characteristics, intervention, and compliance.

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Supplemental information on evening melatonin level rise. Supplemental information on urinary cortisol excretion and saliva cortisol levels. Arch Gen Psychiatry. It is accompanied by circadian rhythm disturbances associated with impaired functioning of the suprachiasmatic nucleus, the biological clock of the brain. Circadian rhythm disturbances are common in the elderly. Suprachiasmatic nucleus stimulation using bright light treatment BLT may, therefore, improve mood, sleep, and hormonal rhythms in elderly patients with MDD. In addition, BLT produced continuing improvement in mood and an attenuation of cortisol hyperexcretion after discontinuation of treatment.

Major depressive disorder MDD is frequently accompanied by symptoms suggestive of circadian dysfunction, 1 such as abnormal sleep-wake patterns, 2 altered social rhythms, 3 and diurnal mood swings.

The beneficial effect of BLT in seasonal affective disorder is well accepted, 26 with early onset of action 27 and mild adverse-effect profiles. Our hypotheses were 2-fold. First, we expected BLT to lower depressive symptoms.

Second, we expected this to be mediated by improved circadian functioning, as indirectly indicated by enhanced sleep and hormone rhythms. Therefore, we conducted a double-blind, placebo-controlled, randomized clinical trial that included assessment of SCN function from Geriqtric profiles, rise in evening melatonin levels, and actigraphic sleep estimates. The present study was executed in accordance with the Helsinki Declaration. In particular, the medical ethical committee consented to the blinding procedure and the way information was provided to the patients.

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Based on the literature, a moderate response was expected. Inclusion started on January 22,and lasted until August 22, 4. By then, 89 patients were included for depression characteristics, see eTable 1. Taking into account the conservative power analysis and the limiting resources and perspectives for subsequent inclusion rates, it was decided not to include more patients. We recruited Controlldd participants from outpatient clinics, advertisements, and referrals by general practitioners. Candidates were 60 years or older and first selected using the item read article of the Geriatric Depression Scale. In addition, 52 individuals refused to participate.

Interviews were performed by a trained physician R. We used a randomized, double-blind, placebo-controlled design to compare the antidepressive effects of BLT and placebo.]