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New criteria target depression in Alzheimer's. (Best Treatment Approaches Still Unclear).

New criteria for diagnosing depression in Alzheimer's patients should increase recognition of the problem, said Dr. Gary Kennedy, president of the American Association of Geriatric Psychiatry.

Developed by a team of researchers led by the National Institute of Mental Health, the criteria are the first to characterize the depression that can occur m the course of Alzheimer's disease.

"It turns out that depression symptoms are relatively frequent in dementia, although that doesn't mean the majority of patients have them," said Dr. Kennedy, who also is director of geriatric psychiatry at Montefiore Medical Center, New York. But for those that do, "major depressive disorders criteria don't capture much of the depression in persons with dementia."

Average estimates of the prevalence of depression of Alzheimer's disease (AD) range from 30% to 50%, but the accuracy of those estimates remains questionable because the way in which symptoms are defined and assessed is inconsistent. The accuracy of the estimates also is clouded by differences in caregiver and patient reporting of symptoms.

The researchers, who developed the criteria using an "iterative consensus process," pointed out that they were not intended to be a model for future DSM terminology Instead, they were designed to spur clinical and pharmacologic research that will allow clinicians to better determine a patient's prognosis and plan treatment strategies (Am. J. Geriatr. Psychiatry 10[2]:125-28, 2002).

The researchers noted that, in addition to all criteria met for Alzheimer's disease, patients who have depression of AD must have three or more of the following symptoms within a 2-week period:

* Clinically significant depressed mood.

* Decreased positive affect or pleasure in response to social contacts and usual activities.

* Social isolation or withdrawal.

* Disruption in appetite.

* Disruption in sleep.

* Psychomotor changes such as agitation or retardation.

* Irritability.

* Fatigue or loss of energy.

* Feelings of worthlessness, hopelessness, or excessive or inappropriate guilt.

* Recurrent thoughts of death or suicidal ideation, plan, or attempt.

For the patient to meet the diagnostic criteria, at least one of the symptoms must be either depressed mood or decreased positive affect or pleasure, according to lead investigator Jason T. Olin, Ph.D., of the adult and geriatric treatment and preventive interventions research branch at NIMH in Bethesda, Md., and his associates. The symptoms also must cause clinically significant distress or disruption in functioning and cannot occur exclusively during the course of a delirium, they said.

Despite the development of the criteria, the best way to treat depression in Alzheimer's remains unclear, Dr. Kennedy said. "It may be that the depression of dementia doesn't really respond well to conventional antidepressant medications."

The largest study conducted to date looked at 694 patients with symptoms of depression and cognitive decline who were randomized to treatment with either the antidepressant moclobemide or placebo (Br. J. Psychiatry 168[2]:149-57, 1996). Patients experienced significant improvement in dementia and depression, as measured on the 17- and 24-item Hamilton Depression Scales.

According to the current rule of thumb, if a depressed Alzheimer's patient has a history of depression before the dementia appeared, the depression symptoms must be treated aggressively Dr. Kennedy said. "And certainly if the patient has suicidal ideas, that's depression until proven otherwise and has to be treated aggressively"
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Author:Frieden, Joyce
Publication:Clinical Psychiatry News
Article Type:Brief Article
Geographic Code:1USA
Date:Jun 1, 2002
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