Aging of the population and the increased prevalence of chronic diseases among the elderly are major challenges facing our society and medical community. More than 20% of Americans will experience an episode of depression serious enough to warrant diagnosis and treatment. Treatment of major depressive disorder (MDD) has focused on reduction of symptoms and restoration of functioning. Although antidepressant medication has been particularly effective in this regard, many patients either fail to respond to medication or suffer from significant side effects. Thus, there continues to be a need to identify alternative approaches for treating depression, particularly in the elderly. There is now good reason to believe that exercise may be one such approach. The study proposed in the application will build upon the applicant's previous work in which they demonstrated the feasibility and efficacy of exercise as a treatment for MDD in older men and women. The major aim of this project will be to test the hypothesis that a program of home exercise is as effective as supervised exercise and medication in reducing depression relative to placebo controls. As a further extension of past work, the Principal Investigator proposes to examine the differential effectiveness of exercise for a significant subgroup of patients identified by Magnetic Resonance Imaging of the brain as having """"""""vascular depression."""""""" Two hundred sixteen men and women, aged > 55 years, with MDD will be randomly assigned to supervised exercise, home exercise, drug (sertraline), or placebo. Before and after treatment patients will undergo evaluation of depression and exercise testing, assessment of vascular functioning including endothelial dysfunction and baroreceptor control, and psychometric testing to assess cognitive function and other measures of quality of life. Six month follow-up will assess relapse rates. The data generated from this study will have important practical implications by determining the extent to which exercise may benefit older men and women with MDD. The study also will provide information regarding the relationship between vascular depression and various indices of vascular and neurocognitive function, and the extent to which these indices may be modifiable by treatment.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH049679-10
Application #
6769406
Study Section
Special Emphasis Panel (ZRG1-RPHB-1 (03))
Program Officer
Niederehe, George T
Project Start
1994-04-01
Project End
2007-06-30
Budget Start
2004-07-01
Budget End
2007-06-30
Support Year
10
Fiscal Year
2004
Total Cost
$519,020
Indirect Cost
Name
Duke University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705
Smith, Patrick J; Blumenthal, James A; Hinderliter, Alan L et al. (2018) Microvascular Endothelial Function and Neurocognition Among Adults With Major Depressive Disorder. Am J Geriatr Psychiatry 26:1061-1069
Sherwood, Andrew; Blumenthal, James A; Smith, Patrick J et al. (2016) Effects of Exercise and Sertraline on Measures of Coronary Heart Disease Risk in Patients With Major Depression: Results From the SMILE-II Randomized Clinical Trial. Psychosom Med 78:602-9
Blumenthal, James A; Smith, Patrick J; Hoffman, Benson M (2012) Is Exercise a Viable Treatment for Depression? ACSMs Health Fit J 16:14-21
Hoffman, Benson M; Babyak, Michael A; Craighead, W Edward et al. (2011) Exercise and pharmacotherapy in patients with major depression: one-year follow-up of the SMILE study. Psychosom Med 73:127-33
Hoffman, B M; Sherwood, A; Smith, P J et al. (2010) Cardiovascular disease risk, vascular health and erectile dysfunction among middle-aged, clinically depressed men. Int J Impot Res 22:30-5
Smith, Patrick J; Blumenthal, James A; Hoffman, Benson M et al. (2010) Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials. Psychosom Med 72:239-52
Smith, Patrick J; Blumenthal, James A; Babyak, Michael A et al. (2010) Cerebrovascular risk factors and cerebral hyperintensities among middle-aged and older adults with major depression. Am J Geriatr Psychiatry 18:848-52
Waldman, Silvina V; Blumenthal, James A; Babyak, Michael A et al. (2009) Ethnic differences in the treatment of depression in patients with ischemic heart disease. Am Heart J 157:77-83
Smith, Patrick J; Blumenthal, James A; Babyak, Michael A et al. (2009) Intima-media thickness and age of first depressive episode. Biol Psychol 80:361-4
Blumenthal, James A; Ong, Lephuong (2009) A commentary on 'Exercise and Depression' (): And the Verdict Is… Ment Health Phys Act 2:97-99

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