This month's brainbuzz™ includes updates on new research about treatment-resistant depression in older adults, contextual factors associated with higher rates of suicide, and CAMH's new fundraising campaign for the future Research & Discovery Centre. Please reach out if you have any questions or feedback.
Aristotle Voineskos VP Research, CAMH
Hope for older adults with
treatment-resistant depression
New study finds that combining antidepressants and antipsychotic medications can increase remission rates.
The largest study of treatment-resistant depression in older adults has found that augmenting commonly used antidepressants with the antipsychotic drug aripiprazole can induce remission of depressive symptoms in 30 per cent of patients.
CAMH and the University of Toronto collaborated with leading institution the Washington University School of Medicine and several other research centres
on the study, which included 742 participants over the age of 60 with treatment-resistant depression, meaning that at least two courses of treatment had been unsuccessful in improving symptoms. Up to one in three people diagnosed with depression are considered treatment resistant.
“There are a lot of myths about depression in older people. It is a myth that older people have higher rates of depression and it is a myth that depression in older people is more resistant to treatment,” said study co-author Dr. Benoit Mulsant, Clinician Scientist at CAMH. “This study shows that there are effective
treatments for older people and they can recover and live happier, healthier lives.”
The study compared the efficacy of different medications: One group had aripiprazole (brand name Abilify) added to their existing anti-depressant. Another group had the drug bupropion (brand names Wellbutrin and Zyban) added instead. A third group had lithium added while a fourth and fifth group tapered off the anti-depressant they were using and switched to bupropion or nortriptyline.
Participants in each group reported improvement in their mental health over the 10-week course of treatment, but those who were given aripiprazole improved the most, with 30 per cent of participants showing remission in symptoms, compared to 20 per cent who improved when switched to bupropion.
Typically, when patients do not respond positively to a first course of treatment for mental illness, physicians will try one treatment after another until they find something that works and does not have debilitating side-effects. For example, problems with balance can be a risk factor for some anti-depressants that increase the risk of falls and injury and have a devastating impact on older patients. The OPTIMUM study found that while patients who received aripiprazole or bupropion both showed similar improvements in mental health, those taking bupropion were at greater risk for serious injury due to falls.
"By establishing the likelihood that different treatment options will be effective, and the risks attached to each treatment, we can ensure that we are choosing the best option to help patients
with treatment-resistant depression,” said co-author Dr. Daniel Blumberger, Clinician Scientist at CAMH and Director of the Temerty Centre for Therapeutic Brain Intervention. "We may not know for certain which treatments will work, but we know which ones are most likely to. In this way, we can quantify that we are making the best choices for our patients."
Dr. Mulsant says that research into mental illness treatments for older adults has been lacking compared to other age groups. He and Dr. Blumberger are two of a small number of senior scientists in the world specializing in
treatment-resistant depression in late life.
“Over the past 15 years CAMH has become a leader in North America in research into geriatric depression,” said Dr. Mulsant. “That is why colleagues from places like Columbia University and UCLA want to work with us.”
CAMH study first to examine contextual factors associated with higher rates of suicide
Social determinants of health among factors affecting suicide rates
A CAMH-led study of national suicide rates in 33 countries in the Americas over the past 20 years has found several key contextual factors associated with national rates of suicide. The authors state that while suicide rates in the rest of the world have been going down in the past two decades, they have been increasing in North, Central and South America, highlighting what they say is an urgent need for more enhanced and targeted suicide prevention efforts.
The study, just published in The Lancet Regional Health – Americas, is believed to be the first of its kind to examine the impact of specific contextual factors associated with national suicide rates in the Americas. Using public health data from the World Health Organization Global Health Estimates database from 2000 to 2019, the authors found eight population-level factors associated with suicide rates: alcohol use, education inequality, health expenditure, homicide rate, intravenous drug use, number of employed doctors, population density and unemployment rate.
“By quantifying the associations between these specific factors and country-level suicide rates, we can provide decision-makers with the evidence they need to create effective national suicidal prevention strategies,” said author Dr. Shannon Lange, Independent Scientist at the Institute for Mental Health Policy Research at CAMH. “Our results indicate that multi-sectoral measures targeting health and social well-being
should be emphasized.” Overall, the study found that there are some significant differences in the factors associated with male and female suicide rates. For example, when education inequality (unequal distribution of academic resources) increased the suicide rate increased among females, in particular.
“Our findings highlight the vital importance of considering gender differences when developing, adapting and testing suicide risk reduction initiatives,” said Dr. Lange. “Gender norms and expectations are likely to influence
suicide risk factors so it can’t be a one-size fits all approach.”
Overall, Canadian men and women had the 6th highest suicide rate among the 33 countries studied in North, Central and South America.
No one left behind
“No one left behind” is a rallying cry. To stand together, to bring one another strength and to search for answers that don’t yet exist. And if we can’t find what we need, we build it.
As Canada’s largest mental health hospital and one of the world’s leading research centres in its field, CAMH is prepared to go further than ever to support those facing mental illness.
By the time Canadians reach 40 years of age, 1 in 2 have—or have had—a mental illness. And globally, every 40 seconds, someone loses their life to the worst-case outcome. We’ll need a world of support to take on this crisis until there’s no one left behind.
CAMH is pursuing the world's largest fundraising campaign in support of hospital-based mental health research and to build the state-of-the-art CAMH Research & Discovery Centre. It will be a home for groundbreaking research. A place for dreamers and innovators. All united by one goal: no one left behind.
The CAMH Research & Discovery Centre will consist of 7 storeys and will consolidate current CAMH research from across the city into one centralized location. This building is essential to our redevelopment, as it will help advance research currently being conducted to influence the future of mental health care. As a global leader in mental health research, we know that with the construction of this new facility we can continue to be at the forefront of research discoveries and developments that will improve the lives of those living with mental illness. It will be a place that drives breakthroughs and transforms patient care. Where CAMH researchers can search for answers that don’t yet exist.
Research has shown that during pregnancy, the brain undergoes a reorganization known informally as "mommy brain." Our own Dr. Liisa Galea joined The Washington Post to share why people should rethink the negative perception of this natural process. https://twitter.com/CAMHnews/status/1628794158159654914?cxt=HHwWhMCzlYfq0ZotAAAA
New research from CAMH clinician scientist Dr. Nikki Bozinoff and Robert Kleinman suggests that eliminating telephone-based care will decrease access to telemedicine services for vulnerable Canadians and exacerbate existing disparities. https://twitter.com/NikkiBozinoff/status/1630942197561303042
