International Journal of Geriatric Psychiatry, 2020
ObjectivesAge‐related hearing loss (ARHL) is a prevalent condition associated with increased risk... more ObjectivesAge‐related hearing loss (ARHL) is a prevalent condition associated with increased risk for depression and cognitive decline. This 12‐week prospective, double‐blind pilot randomized controlled trial (RCT) of hearing aids (HAs) for depressed older adults with ARHL evaluated the feasibility of a novel research design.Methods/DesignN = 13 individuals aged ≥60 years with Major Depressive Disorder or Persistent Depressive Disorder and at least mild hearing loss (pure tone average ≥ 30 dB) were randomized to receive full‐ (active) vs low‐amplification (sham) HAs added to psychiatric treatment as usual. Duration of HA use in hours/day, adverse events frequency, attrition rate, and maintenance of the study blinding were the primary outcome measures.ResultsCompliance with HAs was excellent (>9 hours/day for both groups) and rates of adverse events and drop‐outs did not differ between groups. Preliminary data demonstrated differential improvement for active vs sham HAs on hearing...
International Journal of Geriatric Psychiatry, Jul 1, 2023
ObjectiveTo examine whether psychological well‐being, sleep, and suicidality improved with treatm... more ObjectiveTo examine whether psychological well‐being, sleep, and suicidality improved with treatment with intravenous (IV) ketamine for late‐life treatment‐resistant depression (TRD).MethodsThis is an analysis of secondary outcomes in an open‐label late‐life TRD study examining the safety, tolerability, and feasibility of IV ketamine infusions. In the acute phase, participants (N = 25) aged 60 years or older received twice‐a‐week IV ketamine for 4 weeks. Then, participants with Montgomery‐Asberg Depression Rating Scale (MADRS) total score <10 or ≥ 30% reduction from baseline proceeded to the continuation phase, an additional four weeks of once‐a‐week IV ketamine. The secondary outcomes analyzed here are based on the National Institute of Health Toolbox Psychological Well‐Being subscales for Positive Affect and General Life Satisfaction, the Pittsburgh Sleep Quality Index, and the Scale for Suicidal Ideation.ResultsPsychological well‐being, sleep, and suicidality improved during the acute phase and those improvements were sustained during the continuation phase. Greater improvements in measures of psychological well‐being and sleep were seen in participants who had greater improvements in MADRS scores and moved onto the continuation phase. All but one of the few participants with high suicidality at baseline improved; there were no cases of treatment‐emergent suicidality.ConclusionsPsychological well‐being, sleep, and suicidality improved in participants with late‐life TRD who received IV ketamine for 8 weeks. A future larger and longer controlled trial is needed to confirm and extend these findings.RegistrationClinicalTrials.gov identifier: NCT04504175.
American Journal of Geriatric Psychiatry, Jul 1, 2021
Objective:Slowed processing speed and executive dysfunction are associated with poor outcomes in ... more Objective:Slowed processing speed and executive dysfunction are associated with poor outcomes in Late Life Depression (LLD), though it is unclear why. We investigated whether these variables interfere with the development of positive treatment expectancies in an antidepressant trial.Methods:Depressed older subjects were randomized to Open (intended to increase patient expectancy) or Placebo-controlled (termed ‘Hidden,’ intended to decrease expectancy) administration of antidepressant medication for 8 weeks. Analysis of covariance analyzed the between-group difference on expectancy (Credibility and Expectancy Scale [CES]) and depression (Hamilton Rating Scale for Depression [HRSD], Clinical Global Impressions [CGI] Severity). Moderator analyses examined whether these Open vs. Hidden differences varied based on higher vs. lower processing speed and executive function.Results:Among the 108 participants, a significant between-group difference was observed on expectancy (effect size [ES, Cohen’s d]=0.51 on CES Item 2; ES=0.64 on Item 4), indicating the manipulation was effective. Processing speed as measured by the Stroop Color-Word Test (number color-words named in congruent condition) was a significant moderator of the Open vs. Hidden effect on expectancy. Depressive symptom improvement was greater on average for Open vs. Hidden participants who received active drug (CGI-severity ES=1.25, HRSD ES=0.41), but no neurocognitive moderators of the between-group difference reached statistical significance.Conclusions:Slowed processing speed impairs the development of expectancies in antidepressant trials for LLD, which may help explain lower antidepressant response among older adults. Future studies may address whether interventions to optimize treatment expectancies are capable of improving treatment outcomes.
Background: Age-related hearing loss (HL) has been associated with dementia, though the neurocogn... more Background: Age-related hearing loss (HL) has been associated with dementia, though the neurocognitive profile of individuals with HL is poorly understood. Objective: To characterize the neurocognitive profile of HL. Methods: N = 8,529 participants from the National Alzheimer’s Coordinating Center ≥60 years and free of cognitive impairment who were characterized as Untreated-, Treated-, or No HL. Outcomes included executive function (Trail Making Test [TMT] Part B), episodic memory (Immediate/Delayed Recall), language fluency (Vegetables, Boston Naming Test), and conversion to dementia. Regression models were fit to examine associations between HL and neurocognitive performance at baseline. Cox proportional hazards models examined the links between HL, neurocognitive scores, and development of dementia over follow-up. Results: At baseline, those with Untreated HL (versus No HL) had worse neurocognitive performance per standardized difference on executive function (TMT Part B [mean d...
By and large the tricyclic antidepressants are safe drugs. The adverse events associated with the... more By and large the tricyclic antidepressants are safe drugs. The adverse events associated with them often have more to do with the individual patient and any preexisting medical conditions or co-administered medications than with the particular tricyclic drug used. Only rarely will it prove unwise to treat major affective disorders with a tricyclic. The vast majority of the time the benefits of drug treatment will outweigh the risks. In milder cases or in patients whose depression is a symptom rather than a syndrome, the situation is more complex. Because a drug response becomes less certain and a placebo response more likely, one must very carefully balance the risks involved against the likely benefits of specific antidepressant treatment. While there are more frequent indications for the use of an antidepressant drug in a geriatric population than in a younger group, the risk of tricyclic antidepressant treatment undoubtedly increases as patients grow older. But even in the elderly, if a patient is healthy the drug is probably safe. Only when a patient has preexisting conduction disease, far advanced cardiovascular disease, or is on multiple other drugs are the risks of tricyclic treatment high. Here in particular, a careful understanding of the underlying pharmacology of the tricyclic drugs and their adverse reactions can produce a more rational and safe basis for treatment.
In recent years several lines of evidence have emerged suggesting that eating disorders in genera... more In recent years several lines of evidence have emerged suggesting that eating disorders in general, and bulimia in particular, are in some way linked to affective illness. However, there are few data on the frequency of affective syndromes among patients who have anorexia nervosa or bulimia. This report describes the results of semistructured interviews using the Schedule for Affective Disorders and Schizophrenia (SADS) to evaluate the frequency of the current and lifetime diagnoses of affective illness among 50 female patients meeting DSM-III criteria for bulimia. Seventy percent of the patients had, at some time during their lives, met Research Diagnostic Criteria (RDC) for an episode of major depression and 88% had met RDC at some time during their lives for some affective disturbance. The implications of this high frequency of affective disturbance among patients with bulimia are discussed.
American Journal of Geriatric Psychiatry, Sep 1, 2000
... Nobler, Mitchell SMD; Roose, Steven PMD; Prohovnik, Isak Ph.D.; Moeller, James R. Ph.D.; Loui... more ... Nobler, Mitchell SMD; Roose, Steven PMD; Prohovnik, Isak Ph.D.; Moeller, James R. Ph.D.; Louie, Judy BA; Van Heertum, Ronald LMD ... Normal-control subjects had Beck Depression Inventory (BDI) 16 scores <9 and were free of any current or past history of psychiatric illness ...
Journal of Clinical Psychopharmacology, Feb 1, 1988
The observation that fatalities from tricyclic antidepressant (TCA) overdose are associated with ... more The observation that fatalities from tricyclic antidepressant (TCA) overdose are associated with heart block and/or arrhythmias has led to concern about the cardiovascular effects of TCAs. Contrary to expectations, studies have shown TCAs to be relatively safe in patients without heart disease. However, it is unclear whether these drugs are also safe in patients with heart disease. This prospective study compared the risk of cardiovascular complication at therapeutic plasma concentrations of TCAs in 196 depressed patients, 155 with normal electrocardiograms and 41 with either prolonged PR interval and/or bundle-branch block. The prevalence of second-degree atrioventricular block was significantly greater in patients with preexisting bundle-branch block (9%) than in patients with normal electrocardiograms (0.7%). Orthostatic hypotension occurred significantly more frequently with imipramine than with nortriptyline, and in patients with heart disease.
International Journal of Geriatric Psychiatry, May 2, 2022
Objectives:Accumulating evidence suggests that hearing loss (HL) treatment may benefit depressive... more Objectives:Accumulating evidence suggests that hearing loss (HL) treatment may benefit depressive symptoms among older adults with Major Depressive Disorder (MDD), but the specific individual characteristics of those who stand to improve most are unknown.Methods:N=37 patients ≥60 years with HL and MDD received either active or sham hearing aids in this 12-week double-blind randomized controlled trial. A combined moderator approach was utilized in the analysis in order to examine multiple different pretreatment individual characteristics to determine the specific qualities that predicted the best depressive symptom response to hearing aids. Pretreatment characteristics included: Hearing Handicap Inventory for the Elderly (HHIE-S), pure tone average (PTA), speech reception threshold (SRT), Short Physical Performance Battery (SPPB), cognition (Repeatable Battery for the Assessment of Neuropsychological Status).Results:The analysis revealed a combined moderator, predicting greater improvement with active versus sham hearing aids, that had a larger effect size than any individual moderator (combined effect size [ES]=0.49 [95% CI: 0.36, 0.76]). Individuals with worse hearing-related disability (HHIE-S: individual ES=−0.16), speech recognition (SRT: individual ES=−0.14), physical performance (SPPB: individual ES=0.41), and language functioning (individual ES=0.19) but with relatively less severe audiometric thresholds (PTA: individual ES=0.17) experienced greater depressive symptom improvement with active hearing aids.Conclusions:Older adults with relatively worse HL-related, physical, and cognitive functioning may stand to benefit most from hearing aids. Given the large number of older adults experiencing HL and MDD, a non-invasive and scalable means of targeting those most likely to respond to interventions would be valuable.
Early animal work with the tricyclic antidepressants indicated that these drugs are cardiotoxic a... more Early animal work with the tricyclic antidepressants indicated that these drugs are cardiotoxic and, more specifically, that they adversely affect cardiac contractility. This has been a consistent finding across a large number of clinical studies looking at a variety of tricyclic drugs in a variety of test animals (Kaumann et al., 1965; Laddu and Somani, 1969; Langslet et al., 1971). However, as is so commonly the problem with such data, these studies implied, but in no way could definitively establish, what these drugs would do in humans. An uncertainty remained because of the difficulty in interpreting concentration and metabolic differences between man and various experimental animals. During the 1960s a number of investigators reported cases of tricyclic overdose where myocardial failure was a major clinical problem (Laddu and Somani, 1969; Sigg et al., 1963). These reports cite the animal data as evidence to explain the clinical symptomatology of these patients and then concluded that the clinical symptomatology of these patients was prima facie evidence for the existence of a direct negative inotropic effect from tricyclic drugs. Unfortunately, these reports did not include direct measurements of left ventricular performance.
International Journal of Geriatric Psychiatry, 2020
ObjectivesAge‐related hearing loss (ARHL) is a prevalent condition associated with increased risk... more ObjectivesAge‐related hearing loss (ARHL) is a prevalent condition associated with increased risk for depression and cognitive decline. This 12‐week prospective, double‐blind pilot randomized controlled trial (RCT) of hearing aids (HAs) for depressed older adults with ARHL evaluated the feasibility of a novel research design.Methods/DesignN = 13 individuals aged ≥60 years with Major Depressive Disorder or Persistent Depressive Disorder and at least mild hearing loss (pure tone average ≥ 30 dB) were randomized to receive full‐ (active) vs low‐amplification (sham) HAs added to psychiatric treatment as usual. Duration of HA use in hours/day, adverse events frequency, attrition rate, and maintenance of the study blinding were the primary outcome measures.ResultsCompliance with HAs was excellent (>9 hours/day for both groups) and rates of adverse events and drop‐outs did not differ between groups. Preliminary data demonstrated differential improvement for active vs sham HAs on hearing...
International Journal of Geriatric Psychiatry, Jul 1, 2023
ObjectiveTo examine whether psychological well‐being, sleep, and suicidality improved with treatm... more ObjectiveTo examine whether psychological well‐being, sleep, and suicidality improved with treatment with intravenous (IV) ketamine for late‐life treatment‐resistant depression (TRD).MethodsThis is an analysis of secondary outcomes in an open‐label late‐life TRD study examining the safety, tolerability, and feasibility of IV ketamine infusions. In the acute phase, participants (N = 25) aged 60 years or older received twice‐a‐week IV ketamine for 4 weeks. Then, participants with Montgomery‐Asberg Depression Rating Scale (MADRS) total score <10 or ≥ 30% reduction from baseline proceeded to the continuation phase, an additional four weeks of once‐a‐week IV ketamine. The secondary outcomes analyzed here are based on the National Institute of Health Toolbox Psychological Well‐Being subscales for Positive Affect and General Life Satisfaction, the Pittsburgh Sleep Quality Index, and the Scale for Suicidal Ideation.ResultsPsychological well‐being, sleep, and suicidality improved during the acute phase and those improvements were sustained during the continuation phase. Greater improvements in measures of psychological well‐being and sleep were seen in participants who had greater improvements in MADRS scores and moved onto the continuation phase. All but one of the few participants with high suicidality at baseline improved; there were no cases of treatment‐emergent suicidality.ConclusionsPsychological well‐being, sleep, and suicidality improved in participants with late‐life TRD who received IV ketamine for 8 weeks. A future larger and longer controlled trial is needed to confirm and extend these findings.RegistrationClinicalTrials.gov identifier: NCT04504175.
American Journal of Geriatric Psychiatry, Jul 1, 2021
Objective:Slowed processing speed and executive dysfunction are associated with poor outcomes in ... more Objective:Slowed processing speed and executive dysfunction are associated with poor outcomes in Late Life Depression (LLD), though it is unclear why. We investigated whether these variables interfere with the development of positive treatment expectancies in an antidepressant trial.Methods:Depressed older subjects were randomized to Open (intended to increase patient expectancy) or Placebo-controlled (termed ‘Hidden,’ intended to decrease expectancy) administration of antidepressant medication for 8 weeks. Analysis of covariance analyzed the between-group difference on expectancy (Credibility and Expectancy Scale [CES]) and depression (Hamilton Rating Scale for Depression [HRSD], Clinical Global Impressions [CGI] Severity). Moderator analyses examined whether these Open vs. Hidden differences varied based on higher vs. lower processing speed and executive function.Results:Among the 108 participants, a significant between-group difference was observed on expectancy (effect size [ES, Cohen’s d]=0.51 on CES Item 2; ES=0.64 on Item 4), indicating the manipulation was effective. Processing speed as measured by the Stroop Color-Word Test (number color-words named in congruent condition) was a significant moderator of the Open vs. Hidden effect on expectancy. Depressive symptom improvement was greater on average for Open vs. Hidden participants who received active drug (CGI-severity ES=1.25, HRSD ES=0.41), but no neurocognitive moderators of the between-group difference reached statistical significance.Conclusions:Slowed processing speed impairs the development of expectancies in antidepressant trials for LLD, which may help explain lower antidepressant response among older adults. Future studies may address whether interventions to optimize treatment expectancies are capable of improving treatment outcomes.
Background: Age-related hearing loss (HL) has been associated with dementia, though the neurocogn... more Background: Age-related hearing loss (HL) has been associated with dementia, though the neurocognitive profile of individuals with HL is poorly understood. Objective: To characterize the neurocognitive profile of HL. Methods: N = 8,529 participants from the National Alzheimer’s Coordinating Center ≥60 years and free of cognitive impairment who were characterized as Untreated-, Treated-, or No HL. Outcomes included executive function (Trail Making Test [TMT] Part B), episodic memory (Immediate/Delayed Recall), language fluency (Vegetables, Boston Naming Test), and conversion to dementia. Regression models were fit to examine associations between HL and neurocognitive performance at baseline. Cox proportional hazards models examined the links between HL, neurocognitive scores, and development of dementia over follow-up. Results: At baseline, those with Untreated HL (versus No HL) had worse neurocognitive performance per standardized difference on executive function (TMT Part B [mean d...
By and large the tricyclic antidepressants are safe drugs. The adverse events associated with the... more By and large the tricyclic antidepressants are safe drugs. The adverse events associated with them often have more to do with the individual patient and any preexisting medical conditions or co-administered medications than with the particular tricyclic drug used. Only rarely will it prove unwise to treat major affective disorders with a tricyclic. The vast majority of the time the benefits of drug treatment will outweigh the risks. In milder cases or in patients whose depression is a symptom rather than a syndrome, the situation is more complex. Because a drug response becomes less certain and a placebo response more likely, one must very carefully balance the risks involved against the likely benefits of specific antidepressant treatment. While there are more frequent indications for the use of an antidepressant drug in a geriatric population than in a younger group, the risk of tricyclic antidepressant treatment undoubtedly increases as patients grow older. But even in the elderly, if a patient is healthy the drug is probably safe. Only when a patient has preexisting conduction disease, far advanced cardiovascular disease, or is on multiple other drugs are the risks of tricyclic treatment high. Here in particular, a careful understanding of the underlying pharmacology of the tricyclic drugs and their adverse reactions can produce a more rational and safe basis for treatment.
In recent years several lines of evidence have emerged suggesting that eating disorders in genera... more In recent years several lines of evidence have emerged suggesting that eating disorders in general, and bulimia in particular, are in some way linked to affective illness. However, there are few data on the frequency of affective syndromes among patients who have anorexia nervosa or bulimia. This report describes the results of semistructured interviews using the Schedule for Affective Disorders and Schizophrenia (SADS) to evaluate the frequency of the current and lifetime diagnoses of affective illness among 50 female patients meeting DSM-III criteria for bulimia. Seventy percent of the patients had, at some time during their lives, met Research Diagnostic Criteria (RDC) for an episode of major depression and 88% had met RDC at some time during their lives for some affective disturbance. The implications of this high frequency of affective disturbance among patients with bulimia are discussed.
American Journal of Geriatric Psychiatry, Sep 1, 2000
... Nobler, Mitchell SMD; Roose, Steven PMD; Prohovnik, Isak Ph.D.; Moeller, James R. Ph.D.; Loui... more ... Nobler, Mitchell SMD; Roose, Steven PMD; Prohovnik, Isak Ph.D.; Moeller, James R. Ph.D.; Louie, Judy BA; Van Heertum, Ronald LMD ... Normal-control subjects had Beck Depression Inventory (BDI) 16 scores <9 and were free of any current or past history of psychiatric illness ...
Journal of Clinical Psychopharmacology, Feb 1, 1988
The observation that fatalities from tricyclic antidepressant (TCA) overdose are associated with ... more The observation that fatalities from tricyclic antidepressant (TCA) overdose are associated with heart block and/or arrhythmias has led to concern about the cardiovascular effects of TCAs. Contrary to expectations, studies have shown TCAs to be relatively safe in patients without heart disease. However, it is unclear whether these drugs are also safe in patients with heart disease. This prospective study compared the risk of cardiovascular complication at therapeutic plasma concentrations of TCAs in 196 depressed patients, 155 with normal electrocardiograms and 41 with either prolonged PR interval and/or bundle-branch block. The prevalence of second-degree atrioventricular block was significantly greater in patients with preexisting bundle-branch block (9%) than in patients with normal electrocardiograms (0.7%). Orthostatic hypotension occurred significantly more frequently with imipramine than with nortriptyline, and in patients with heart disease.
International Journal of Geriatric Psychiatry, May 2, 2022
Objectives:Accumulating evidence suggests that hearing loss (HL) treatment may benefit depressive... more Objectives:Accumulating evidence suggests that hearing loss (HL) treatment may benefit depressive symptoms among older adults with Major Depressive Disorder (MDD), but the specific individual characteristics of those who stand to improve most are unknown.Methods:N=37 patients ≥60 years with HL and MDD received either active or sham hearing aids in this 12-week double-blind randomized controlled trial. A combined moderator approach was utilized in the analysis in order to examine multiple different pretreatment individual characteristics to determine the specific qualities that predicted the best depressive symptom response to hearing aids. Pretreatment characteristics included: Hearing Handicap Inventory for the Elderly (HHIE-S), pure tone average (PTA), speech reception threshold (SRT), Short Physical Performance Battery (SPPB), cognition (Repeatable Battery for the Assessment of Neuropsychological Status).Results:The analysis revealed a combined moderator, predicting greater improvement with active versus sham hearing aids, that had a larger effect size than any individual moderator (combined effect size [ES]=0.49 [95% CI: 0.36, 0.76]). Individuals with worse hearing-related disability (HHIE-S: individual ES=−0.16), speech recognition (SRT: individual ES=−0.14), physical performance (SPPB: individual ES=0.41), and language functioning (individual ES=0.19) but with relatively less severe audiometric thresholds (PTA: individual ES=0.17) experienced greater depressive symptom improvement with active hearing aids.Conclusions:Older adults with relatively worse HL-related, physical, and cognitive functioning may stand to benefit most from hearing aids. Given the large number of older adults experiencing HL and MDD, a non-invasive and scalable means of targeting those most likely to respond to interventions would be valuable.
Early animal work with the tricyclic antidepressants indicated that these drugs are cardiotoxic a... more Early animal work with the tricyclic antidepressants indicated that these drugs are cardiotoxic and, more specifically, that they adversely affect cardiac contractility. This has been a consistent finding across a large number of clinical studies looking at a variety of tricyclic drugs in a variety of test animals (Kaumann et al., 1965; Laddu and Somani, 1969; Langslet et al., 1971). However, as is so commonly the problem with such data, these studies implied, but in no way could definitively establish, what these drugs would do in humans. An uncertainty remained because of the difficulty in interpreting concentration and metabolic differences between man and various experimental animals. During the 1960s a number of investigators reported cases of tricyclic overdose where myocardial failure was a major clinical problem (Laddu and Somani, 1969; Sigg et al., 1963). These reports cite the animal data as evidence to explain the clinical symptomatology of these patients and then concluded that the clinical symptomatology of these patients was prima facie evidence for the existence of a direct negative inotropic effect from tricyclic drugs. Unfortunately, these reports did not include direct measurements of left ventricular performance.
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Papers by Steven Roose