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Emerging genetic, ex-vivo, and clinical trial evidence indicates that calcium channel blockers (CCB) can improve mood and cognitive function. The objective of this study was to examine the effect of selective serotonin reuptake inhibitor (SSRI) therapy augmented with CCB on depression and cognitive decline in an elderly population with hypertension.
Prospective study of 296 persons treated with SSRI and antihypertensive drugs. Baseline and two year clinic assessments were used to categorize participants as users of SSRI + CCB (n = 53) or users of SSRI + other antihypertensives (n = 243). Clinic visits were performed up to four times in a ten-year period to assess depression and cognitive function.
The sample mean age was 75.2 ± 5.47 years and 78% of participants were female. At two year follow-up there was a significant group by time interaction showing lower Center for Epidemiological Studies-Depression (CESD) scores in the SSRI + CCB group, F(1,291) = 4.13, p = 0.043, η2p = 0.014. Over ten-years follow-up, SSRI + CCB use was associated with improved general cognitive function (Mini-Mental State Examination: β = 0.97; 95% CI 0.14 to 1.81, p = 0.023) and immediate visual memory (Boston Visual Retention Test: β = 0.69; 95% CI 0.06 to 1.32, p = 0.033).
The findings provide general population evidence that SSRI augmentation with CCB may improve depression and cognitive function.
Complaints about memory are common in older people but their relationship
with underlying brain changes is controversial.
To investigate the relationship between subjective memory impairment and
previous or subsequent changes in white matter lesions and brain
In a community cohort study of 1336 people without dementia, 4-year
changes in brain magnetic resonance imaging measures were investigated as
correlates of subjective memory impairment at baseline and follow-up.
Subjective memory impairment at baseline was associated with subsequent
change in hippocampal volume and at follow-up impairment was associated
with previous change in hippocampal, cerebrospinal fluid and grey matter
volume and with subcortical white matter lesion increases. All
associations with volume changes were U-shaped with significant quadratic
terms – associations between least decline and subjective memory
impairment were potentially explained by lower baseline hippocampal
volumes in the groups with least volume change. Associations between
hippocampal volume change and subjective memory impairment at follow-up
were independent of cognitive decline and depressive symptoms, they were
stronger in participants with the apolipoprotein E (APOE) ∊4 allele and
in those without baseline subjective memory impairment.
Complaints of poor memory by older people, particularly when new, may be
a realistic subjective appraisal of recent brain changes independent of
observed cognitive decline.
Depression may increase the risk of mortality among certain subgroups of
older people, but the part played by antidepressants in this association
has not been thoroughly explored.
To identify the characteristics of older populations who are most at risk
of dying, as a function of depressive symptoms, gender and antidepressant
Adjusted Cox proportional hazards models were used to determine the
association between depression and/or antidepressant use and 4-year
survival of 7363 community-dwelling elderly people. Major depressive
disorder was evaluated using a standardised psychiatric examination based
on DSM-IV criteria and depressive symptoms were assessed using the Center
for Epidemiological Studies Depression scale.
Depressed men using antidepressants had the greatest risk of dying, with
increasing depression severity corresponding to a higher hazard risk.
Among women, only severe depression in the absence of treatment was
significantly associated with mortality.
The association between depression and mortality is gender-dependent and
varies according to symptom load and antidepressant use.
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