Sleep changes in late-life depression may be permanent or may recover only slowly. Hence, to clarify the relation of persistent sleep abnormalities, pathogenesis, and illness course, we propose three related longitudinal studies of: Study I - 200 elderly(60-80 yo) patients with recurrent unipolar depression participating in an already funded maintenance therapies research protocol (MH43832-01, C.F. Reynolds, .P. I.) ; Study 2 - 80 elderly subjects (60-80 yo) with spousal bereavement (n=40) and bereavement-related depression (n=40); and Study 3 - 60 healthy elderly (60-80 yo) non-depressed, non-bereaved controls. Participants in all three studies will have repeated (four to seven) sleep EEG assessments over a two to three year period to determine if, as hypothesized: la)abnormal pretreatment (T1) measures of REM sleep cyclicity/density predict elevated risk of relapse and recurrence of major depression; lb)EEG sleep abnormalities persisting into continuation therapy (T2) and into maintenance therapy (T3-T7) predict elevated risk of relapse and recurrence, respectively; 2a)depressed bereaved differ from non-depressed bereaved elderly in baseline (T1) and followup (T2-T5) measures of REM sleep cyclicity/density; 2b)baseline (T1) and followup (T2-T5) abnormalities of REM sleep in bereavement predict a more protracted course (and need for psychiatric intervention); and 3)longitudinal changes in sleep/sleep quality (T1-T4) of healthy elderly controls are related to subclinical depressed mood. Multiple logistic regression and survival analyses will model the hypothesized relation of REM sleep abnormalities (independent variable) to outcome: recurrence/ non-recurrence of depression (Study 1); or presence/absence of RDC-defined major depression ,at 1 and at 2 years after spousal bereavement. A repeated-measures MANOVA will contrast the long-term evolution of selected sleep variables (sensitive to aging, depressed mood, or both) in recurrent depression, bereavement, bereavement-related depression and controls. Exploratory data analyses will assess possible interrelations among biological REM sleep abnormalities, severity of psychopathology, and disruption in social rhythms.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
2R01MH037869-08
Application #
3376344
Study Section
Life Course and Prevention Research Review Committee (LCR)
Project Start
1983-04-01
Project End
1993-03-31
Budget Start
1990-04-01
Budget End
1991-03-31
Support Year
8
Fiscal Year
1990
Total Cost
Indirect Cost
Name
University of Pittsburgh
Department
Type
Schools of Medicine
DUNS #
053785812
City
Pittsburgh
State
PA
Country
United States
Zip Code
15213
Khalaf, Alexander; Edelman, Kathryn; Tudorascu, Dana et al. (2015) White Matter Hyperintensity Accumulation During Treatment of Late-Life Depression. Neuropsychopharmacology 40:3027-35
Rej, Soham; Begley, Amy; Gildengers, Ariel et al. (2015) Psychosocial Risk Factors for Cognitive Decline in Late-Life Depression: Findings from the MTLD-III Study. Can Geriatr J 18:43-50
Diniz, Breno S; Reynolds 3rd, Charles F; Butters, Meryl A et al. (2014) The effect of gender, age, and symptom severity in late-life depression on the risk of all-cause mortality: the BambuĂ­ Cohort Study of Aging. Depress Anxiety 31:787-95
Diniz, Breno Satler; Reynolds 3rd, Charles F; Begley, Amy et al. (2014) Brain-derived neurotrophic factor levels in late-life depression and comorbid mild cognitive impairment: a longitudinal study. J Psychiatr Res 49:96-101
Germain, Anne; Shear, Katherine M; Walsh, Colleen et al. (2013) Dream content in complicated grief: a window into loss-related cognitive schemas. Death Stud 37:269-84
Troxel, Wendy M; Kupfer, David J; Reynolds 3rd, Charles F et al. (2012) Insomnia and objectively measured sleep disturbances predict treatment outcome in depressed patients treated with psychotherapy or psychotherapy-pharmacotherapy combinations. J Clin Psychiatry 73:478-85
Reynolds 3rd, Charles F; Butters, Meryl A; Lopez, Oscar et al. (2011) Maintenance treatment of depression in old age: a randomized, double-blind, placebo-controlled evaluation of the efficacy and safety of donepezil combined with antidepressant pharmacotherapy. Arch Gen Psychiatry 68:51-60
Andreescu, Carmen; Wu, Minjie; Butters, Meryl A et al. (2011) The default mode network in late-life anxious depression. Am J Geriatr Psychiatry 19:980-3
Reynolds 3rd, Charles F; Dew, Mary Amanda; Martire, Lynn M et al. (2010) Treating depression to remission in older adults: a controlled evaluation of combined escitalopram with interpersonal psychotherapy versus escitalopram with depression care management. Int J Geriatr Psychiatry 25:1134-41
Rogers, Joan C; Holm, Margo B; Raina, Ketki D et al. (2010) Disability in late-life major depression: patterns of self-reported task abilities, task habits, and observed task performance. Psychiatry Res 178:475-9

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