This application requests support for an Intervention Research Center in Late-Life Mood Disorders (IRC/LLMD) (PAR-98-020) and is the competing continuation of P30 MH52247 (MHCRC for Late-Life Mood Disorders), funded since March 1, 1995. The IRC/LLMD consists of six cores: 1) Administrative, Data Management, and Information Dissemination; 2) Methodology; 3) Recruitment, Assessment and Follow- up; 4) Health and Behavior; 5) Geriatric Psychopharmacology; and 6) Functional Brain Imaging. The goal of the IRC/LLMD is to understand and reduce treatment response variability in geriatric depression and related disorders. This theme encompasses several broad issues: 1) what is treatment response in late-life depression? 2) how can treatment response by accelerated? 3) How can treatment response be maintained? 4) Why does age matter as a source of short- and long-term treatment-response variability? 5) How can the identification and management of treatment-resistant depression in later life be improved? And 6) What are the costs and benefits of combined treatment (either polypharmacy or medication plus psychotherapy) versus monotherapy? The IRC/LLMD will provide infrastructure support to a portfolio of research projects, career development, and training grant awards aimed at: 1) improving treatment of elderly patients in the general medical sector and ameliorating risk factors for suicide risk factors for resistance and developing strategies for improving response in such patients; 4) finding maintenance treatments with long term efficacy, especially for patients over age 70; 5) developing preventive interventions to reduce the liability to late-onset depression; 6) developing strategies for minimizing residual disability and facilitating full recovery; and 7) developing cost-benefit information for combined treatments versus monotherapy. The growing significance of global illness burden attributable to depression and suicide over the next 20 years, as reported by the World Health Organization (1996), undergoes the central rationale for the IRC/LLMD: to develop clinical preventive strategies to reduce the incidence of geriatric expression; to develop treatment strategies to accelerate treatment response; to improve early recognition and management of treatment resistance; to maintain treatment response; to minimize residual disability; to improve quality of life in elderly persons afflicted with depressions.
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