This symposium will be of great value to any APA attendee with an interest in gaining knowledge and improving their skills for treating older adults with difficult-to-treat depression, as it will provide new information from a large, recently-completed comparative effectiveness trial, and practical recommendations for treatment. Treatment resistance is the norm, not the exception, in older depressed adults, as most fail to remit with first-line antidepressant pharmacotherapies (SSRIs and SNRIs). Many next-line treatments exist -- including the common augmentation strategies with aripiprazole and bupropion, and the switch strategy to bupropion. Additionally, lithium augmentation and a switch to a secondary amine tricyclic are well-known strategies, albeit less often used because of their added complexity (such as drug level monitoring). Yet, until now, no comparative effectiveness or safety data have existed in older adults for these strategies. Understanding the benefits vs. risk of medication is crucial for this population, which has high morbidity from depression but also greater risks from pharmacotherapy. The "Optimizing antidepressants for TRD in older adults" (OPTIMUM ) study, funded by the Patient-Centered Outcomes Research Institute, is a 5-center collaboration that randomized 746 depressed individuals aged 60+ with TRD. It is the largest-ever clinical trial of TRD in older adults, akin to the STAR-D and VAST-D studies in younger adults. The OPTIMUM trial was a pragmatic trial conducted in the community, in collaboration with patients'' own physicians, with decision support from the OPTIMUM team to guide them through acute treatment. This pivotal study will provide information that helps older adults get effective treatment while improving their quality of life and minimizing risks of medications. The study''s recruitment is now complete, and this symposium will be the first international presentation of results, including comparative remission rates, changes in quality of life, and safety issues such as falls and serious adverse events. The symposium chair will begin the symposium by introducing the concept of TRD and the rationale for OPTIMUM. The next speaker will present the results from STEP 1: the comparison of aripiprazole augmentation, bupropion augmentation, and bupropion switch.

**This content was captured at the 2021 APA Annual Meeting and may reference information from various sources and terminology from previous editions of the DSM.

Learning Objectives

• The audience will learn about the devastating consequences on morbidity of Treatment Resistant Depression (TRD) in older adults
• The audience will learn the comparative benefits and risks of three common first-line treatment strategies for TRD in older adults.
• The audience will learn the comparative benefits and risks of two second-line strategies for TRD in older adults.
• The audience will gain an understanding of the proper and safe use of common and less common treatment strategies for TRD in older adults.

Target Audience

Psychiatrists, Residents/Fellows

Estimated Time to Complete

Estimated Duration: 75 minutes
Begin Date: December 1, 2022
End Date: December 1, 2025

How to Earn Credit

Participants who wish to earn AMA PRA Category 1 Credit ™ or a certificate of participation may do so by completing all sections of the course including the evaluation. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians) or certificate of participation (non-physicians) showing the completion date and hours earned. 

Continuing Education Credit

The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

The APA designates this enduring CME activity for a maximum of 1.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Faculty and Planner Disclosures

Program Presenters

• Jordan Karp, MD, University of Pittsburg. Reports no financial relationships with commercial interests. 
• Eric Lenze, MD, Director of the Healthy Mind Lab. Reports no financial relationships with commercial interests. 
• Helen Lavretsky, MD, UCLA. Reports no financial relationships with commercial interests. 

Program Planners

• Jacqueline Maus Feldman, M.D., Chairperson, Scientific Program Committee, Reports no financial relationships with commercial interests.
• Robert O. Cotes, M.D., Vice-Chairperson, Scientific Program Committee, Reports no financial relationships with commercial interests. 
• Uchenna Okeye, M.D., Vice-Chairperson, Scientific Program Committee, Reports no financial relationships with commercial interests. 

Accessibility for Participants with Disabilities

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Technical Requirements

This internet-based CME activity is best experienced using any of the following:

• The latest and 2nd latest public versions of Google Chrome, Mozilla Firefox, or Safari
• Internet Explorer 11+

This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Acrobat Reader, Microsoft PowerPoint, and Windows Media Player.

Optimal System Configuration:

• Browser: Google Chrome (latest and 2nd latest version), Safari (latest and 2nd latest version), Internet Explorer 11.0+, Firefox (latest and 2nd latest version), or Microsoft Edge (latest and 2nd latest version)
• Operating System: Windows versions 8.1+, Mac OS X 10.5 (Leopard) +, Android (latest and 2nd latest version), or iOS/iPad OS (latest and 2nd latest version)
• Internet Connection: 1 Mbps or higher

Minimum Requirements:

• Windows PC: Windows 8.1 or higher; 1 GB (for 32-bit)/2 GB (for 64-bit) or higher RAM; Microsoft DirectX 9 graphics device with WDDM driver; audio playback with speakers for programs with video content
• Macintosh: Mac OS X 10.5 or higher with latest updates installed; Intel, PowerPC G5, or PowerPC G4 (867MHz or faster) processor; 512 MB or higher RAM; audio playback with speakers for programs with video content

For assistance: Contact educme@psych.org for questions about this activity | Contact learningcenter@psych.org for technical assistance