Larry W. Thompson - US grants

This study is designed to evaluate the efficacy of three different therapies in the treatment of depression in the elderly. The study is an extension of a two year pilot study designed to demonstrate the feasibility of psychotherapy in treating severe depression in older persons. The therapies to be evaluated include: Cognitive Therapy developed by Dr. Aaron Beck; Behavioral Therapy developed by Dr. Peter Lewinsohn; and Brief Psychodynamic Therapy developed by Dr. Mardi Horowitz. Patients in this Study will be diagnosed as having major depressive disorder, and will be over the age of 65. One hundred and eighty patients will be treated in one of the three conditions mentioned above. An additional 40 patients will be included in a wait list control condition for a six week period. The course of therapy is four months. Following therapy, half of the patients in each condition will receive maintenance sessions during a three month period, and the remainder will be followed. All patients will be followed for a one year period, with evaluations occurring at six weeks, three months, six months and one year post treatment.

This study is designed to compare the effectiveness of pharmacotherapy, psychotherapy and the two combined in the treatment of depression in elderly outpatients. Participants will include 120 community volunteers who are in a clinical episode of definite major depressive disorder or probable major depressive disorder over the age of 60. Participants who have evidence of psychotic depression or who are in a suicidal crisis will be excluded and referred elsewhere. Participants will be randomly assigned to cognitive/behavioral therapy, drug therapy using desipramine or cognitive/behavioral therapy plus drugs. Forty subjects will be assigned to each treatment condition. The treatment will continue for 4 months on a once a week basis. At the conclusion of therapy, individuals who are no longer depressed will be assigned to one of two maintenance conditions within the respective treatment modality. For example, the successes in the Cognitive/Behavior condition will be assigned to a Lo or Hi maintenance followup condition of 1 session per month or 2 sessions per month respectively. Successes in the drug condition will be place on Lo or Hi maintenance doses (50% or 100% of treatment dose respectively). Successes in the combined condition will be continued on drug treatment or Lo maintenance psychotherapy alone. Failures in the Cognitive/Behavioral condition will continue to receive psychotherapy; in the drug treatment, psychotherapy will be added; and in the combined condition treatment failures will continue to receive both. The maintenance/failure treatment program will be continued for 4 months. Participants will be evaluated every two months throughout this treatment/maintenance program, and at 6 months and 1 year followup. Evaluations will include both self-report and interviewer ratings of symptoms, measures of functioning in family and other social situations and various measures related to models of depression. These include the Dysfunctional Attitude Scale, Learned Resourcefulness Scale, Pleasant Events Scale, and Measures of Self-Efficacy. Symptom measures include: Hamilton Depression Rating Scale, Mood Assessment Scale and the Beck Depression Inventory. Functioning is assessed with the Katz Social Adjustment Scale. Measures of Morale, Life Satisfaction, Hopelessness and Loneliness are also included. Diagnostic status is determine through use of the SADS interview (Life-time version initially, and SADS-Change subsequently), and Research Diagnostic Criteria classification system.

This proposal will evaluate the effect of treatment for hyperglycemia on cognitive and emotional functioning in elderly patients with Non-Insulin- Dependent Diabetes Mellitus (NIDDM). Evidence is accumulating that poor glycemic control may have untoward effects on cognitive and emotional processes in older diabetics. However, results to date have been correlational. To our knowledge, there have been no treatment studies evaluating the effect of diabetic treatment on higher level cognitive function. Since several studies have suggested that improvement in both neuropathy and retinopathy can occur when good metabolic control is established, one could hypothesize that similar positive changes in behavioral functioning due to treatment might also be expected. This hypothesis will be tested using a two-group (treatment/placebo) double- blind treatment paradigm, including a single-blind partial crossover for the placebo group. Sufficient subjects will be recruited and screened over a five-year period to have 60 patients in each group (with replacement). Male or female NIDDM outpatients (60-80 yrs) will be accepted for the study if they have a Fasting Plasma Glucose (FPG) greater than or equal to 150 mg/dl, are less than 150% of ideal body weight have no history of drug abuse, alcoholism or psychiatric disorder and are able to complete the behavioral measures. They must also have no history of ketoacidosis or insulin treatment, no significant hepatic disease, no significant renal dysfunction or nephropathy, no history of sensitivity to sulfa drugs, and no history or presence of significant medical disorder that could affect the results of the study. Patients meeting criteria will be randomly assigned to the treatment or placebo condition. Pretreatment administration of dependent measures will be completed after which patients will receive glipizide or a placebo for a three month period. Dependent variables include measures of Learning and Memory, Attention, Visual/Motor Functioning, Abstract Reasoning, Depression, Anxiety, General Psychopathology, Social Functioning, HbAlc nad FPG. After post-treatment measures are obtained, patients in the placebo condition will be crossed over to the treatment condition; patients in the treatment condition will continue medication. Dependent measures will be obtained again after three months; two follow-up evaluations will then be completed at three month intervals.