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Metabolic syndrome in older adults associated with resistance to depression treatments

Older adults with metabolic syndrome have more severe symptoms and chronicity of depression and take longer to respond to antidepressant medications, according to research published in the Journal of the American Geriatrics Society.

“Prior research implicates [metabolic syndrome] in prolongation of the course of depression in older adults, but its effect on antidepressant response is unknown in this population,” John S. Mulvahill, MD, from the department of psychiatry at Washington University, St. Louis, Missouri, and colleagues wrote.

Mulvahill and colleagues conducted a secondary analysis of a randomized controlled trial to investigate the effect of metabolic syndrome on time to remission from depression in older adults being treated with antidepressant medication. The researchers recruited 435 adults aged 60 years or older (mean age, 69.1 years) with major depressive disorder who were taking extended-release venlafaxine for at least 12 weeks. If a participant’s depression levels remained high after 6 weeks of treatment, they were given a higher dose. Follow-up visits were conducted every 1 to 2 weeks.

Remission from depression was defined as having a Montgomery-Åsberg Depression Rating Scale score of 10 or less during the final two visits.

Results indicated that 222 participants had metabolic syndrome at baseline. These participants also displayed greater severity and chronicity of depression at baseline. A total of 182 participants achieved remission of depression.

Participants with metabolic syndrome experienced a longer time to remission (HR = 0.71; 95% CI, 0.52-0.95) in the unadjusted analysis; however, this association was not significant in the adjusted analysis.

In both the adjusted and unadjusted analysis, the only significant predictor of time to remission was diastolic BP. Participants with a higher diastolic BP were more likely to have longer time to remission. The researchers noted that time to remission could not be predicted by insulin sensitivity.

“The results of this study should be interpreted with caution,” Mulvahill and colleagues concluded. “We do not recommend that clinicians treat older adults with depression differently in the face of co-occurring [metabolic syndrome]. Further verication of these ndings is indicated using more reliable markers of insulin resistance and other classes of antidepressants in racially diverse populations in the hopes of better informing treatment decisions in [late-life depression].” – by Alaina Tedesco

Disclosure: Mulvahill reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.