Comparative Effectiveness of Medication Strategies for Treatment Resistant Depression in Late-Life: Results From the Optimum Study-View Presentation

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The OPTIMUM study is the largest-ever clinical trial for treatment-resistant depression in older adults. The study aims to assess the benefits and risks of different antidepressant strategies in this population. The study consists of two steps: in step one, participants were randomized to augmentation with aripiprazole, bupropion, or a switch to bupropion. In step two, non-responders were further randomized to augmentation with lithium or a switch to nortriptyline. The study found that augmentation arms showed greater improvement in symptoms of depression compared to monotherapy arms. However, there were no significant differences in serious adverse events or falls between the treatment arms. The study did not report any suicides during the study period. The researchers recommended considering psychotherapy, such as problem-solving psychotherapy, interpersonal psychotherapy, and cognitive-behavioral therapy, as alternative treatment options. They also highlighted the importance of addressing medical comorbidities and assessing cognitive impairment in older adults with depression. Future research directions include exploring the use of non-oral antidepressant options, such as intranasal escitalopram, IV ketamine, transcranial magnetic stimulation, and the potential use of psychedelics for treatment-resistant depression. Overall, the OPTIMUM study provides insights into the treatment of depression in older adults and highlights the need for tailored approaches to address the unique challenges and risks associated with this population.

Keywords

OPTIMUM study

treatment-resistant depression

older adults

antidepressant strategies

aripiprazole

bupropion

lithium

nortriptyline

psychotherapy

medical comorbidities

cognitive impairment