Socioeconomic status and anxiety as predictors of antidepressant treatment response and suicidal ideation in older adults.

BACKGROUND: Separate reports from the maintenance treatment for late-life depression (MTLD) trials have shown that low socioeconomic status (SES) and anxiety symptoms at the time of treatment initiation predict lower levels of response to antidepressant treatment and higher levels of suicidal ideation in older adults. AIM: To determine whether SES and anxiety independently contribute to worse treatment outcomes, as indicated by persistence of depressive symptoms during treatment and the persistence of suicidal ideation. Consistent with prior evidence that sociodemographic factors and clinical history are both prognostic of depression treatment efficacy, we hypothesized that SES and pre-existing anxiety symptoms will both predict lower levels of response to treatment and higher levels of suicidal ideation. METHOD: Secondary analyses of data from the MTLD trials. RESULTS: Regression analyses which controlled for comorbid anxiety indicated that residents of middle- and high-income census tracts were more likely to respond to treatment (HR, 1.63; 95%CI, 1.08-2.46) and less likely to report suicidal ideation during treatment (OR, 0.51; 95%CI, 0.28-0.90) than residents of low income census tracts. The same regression models indicated that pre-existing anxiety symptoms were independently related to lower treatment response (HR, 0.73; 95%CI, 0.60-0.89) and higher risk of suicidal ideation (OR, 1.45; 95%CI, 0.98-2.14). CONCLUSION: These findings demonstrate the importance of treating anxiety symptoms during the course of treatment for late-life depression and, at the same time, addressing barriers to treatment response related to low SES

Mitral valve prolapse syndrome: The effect of adrenergic stimulation

Previous studies demonstrating increased adrenergic tone in symptomatic patients with mitral valve prolapse prompted a study of the response of symptomatic patients with mitral valve prolapse to adrenergic stimulation. Sixteen such patients had plasma catecholamines and 24 hour urinary epinephrine plus norepinephrine values that were greater than those of control subjects (473.3 ± 92.8 pg/ml versus 292 ± 15 and 44.7 ± 2.3 μg/g creatinine versus 29.8 ± 2.3; p < 0.01 and < 0.001, respectively). Twenty-four hour urinary sodium was lower in the patient group than in the control group (75 ± 7.4 versus 141 ±11 mEq; p < 0.01), with an inverse relation between urinary sodium and norephinephrine in the patient group (r = - 0.78) but not in the control group.Isoproterenol infusions, 0.5, 1.0 and 2.0 μg/min for 6 minutes, produced a dose-related, greater increase in heart rate in the mitral valve prolapse group than in the control group (16.1 ± 2.3 versus 10 ± 2; 31.8 ± 3.5 versus 19.6 ± 3; 48 ± 4.1 versus 27 ± 3; p< 0.01 with 0.5, 1.0 and 2.0 μg, respectively). The greater increase in heart rate resulted in a significantly shorter diastolic time in the patient group than in the control group (26.4 ± 2 s/min versus 30.6 ± 2; 27 ± 1.5 versus 30.6 ± 2; 26.6 ± 2 versus 30.9 ± 2; p < 0.01 with 0.5, 1.0 and 2.0 μg, respectively). The QT interval was 25 ms shorter than electromechanical systole (QS2) in the normal group and 26.5 ms shorter than QS2in the mitral valve prolapse group at rest; during isoproterenol infusion QT-QS2values were different in the mitral valve prolapse and control groups (3.3 ± 3 versus -7.0 ± 3; 31.9 ± 2.8 versus 10 ± 4; 52 ± 9.2 versus 29 ± 8; p < 0.01 with 0.5, 1.0 and 2.0 μg/min, respectively). Isoproterenol infusion also reproduced symptoms on a dose-related basis in 14 patients with mitral valve prolapse but not in control subjects (excluding palpitation).Symptomatic patients with mitral valve prolapse and high rest values of catecholamines were hypersensitive to isoproterenol infusion, suggesting that some of the symptoms are catecholamine-related or mediated

Development of Cold Cloud Seeding Technology for Use in Precipitation Management

This is a report of the world accomplished and results obtained under a 2-year contract. The primary objective of the Wasatch Weather Modification Project is to assess the effectiveness of selected procedures for increasing the water supply in the Wasatch Mountains by cloud seeding. As part of this overall objective, an airborne seeding experiment has been conducted for two winter seasons. Preliminary results of this experiment indicate a positive seeding effect within and on the periphery of the designated target area. A summary of project designs, procedures, and problems encountered is also included. Data processing, editing, analysis and display procedures, and computer programs are described. Hydrologic and climatological support studies are described and results presented

Economic inequalities in the effectiveness of a primary care intervention for depression and suicidal ideation.

BACKGROUND: Economic disadvantage is associated with depression and suicide. We sought to determine whether economic disadvantage reduces the effectiveness of depression treatments received in primary care. METHODS: We conducted differential-effects analyses of the Prevention of Suicide in Primary Care Elderly: Collaborative Trial, a primary-care-based randomized, controlled trial for late-life depression and suicidal ideation conducted between 1999 and 2001, which included 514 patients with major depression or clinically significant minor depression. RESULTS: The intervention effect, defined as change in depressive symptoms from baseline, was stronger among persons reporting financial strain at baseline (differential effect size = -4.5 Hamilton Depression Rating Scale points across the study period [95% confidence interval = -8.6 to -0.3]). We found similar evidence for effect modification by neighborhood poverty, although the intervention effect weakened after the initial 4 months of the trial for participants residing in poor neighborhoods. There was no evidence of substantial differences in the effectiveness of the intervention on suicidal ideation and depression remission by economic disadvantage. CONCLUSIONS: Economic conditions moderated the effectiveness of primary-care-based treatment for late-life depression. Financially strained individuals benefited more from the intervention; we speculate this was because of the enhanced treatment management protocol, which led to a greater improvement in the care received by these persons. People living in poor neighborhoods experienced only temporary benefit from the intervention. Thus, multiple aspects of economic disadvantage affect depression treatment outcomes; additional work is needed to understand the underlying mechanisms

Three-Dimensional Simulations of Magnetized Thin Accretion Disks around Black Holes: Stress in the Plunging Region

We describe three-dimensional general relativistic magnetohydrodynamic simulations of a geometrically thin accretion disk around a non-spinning black hole. The disk has a thickness $h/r\sim0.05-0.1$ over the radial range $(2-20)GM/c^2$. In steady state, the specific angular momentum profile of the inflowing magnetized gas deviates by less than 2% from that of the standard thin disk model of Novikov & Thorne (1973). Also, the magnetic torque at the radius of the innermost stable circular orbit (ISCO) is only $\sim2$ of the inward flux of angular momentum at this radius. Both results indicate that magnetic coupling across the ISCO is relatively unimportant for geometrically thin disks.Comment: 4 pages, 4 figures, ApJL accepte

Effect of a Lay Counselor Intervention on Prevention of Major Depression in Older Adults Living in Low- and Middle-Income Countries:A Randomized Clinical Trial

Importance: Preventing depression in older adults living in low- and middle-income countries is important because of the scarcity of treatment resources and the risk of disability, suicide, and dementia. Objective: To assess whether an intervention for depression prevention provided by lay counselors is effective in older adults from low- and middle-income countries. Design, Setting, and Participants: This parallel-group randomized clinical trial with masked outcome assessment was performed in 181 older adults (≥60 years) with subsyndromal depressive symptoms at rural and urban primary care clinics in Goa, India. The first participant entered the trial on March 31, 2015, and the last exited on June 2, 2017. Data analysis used the intention-to-treat approach. Interventions: Lay counselors provided problem-solving therapy, brief behavioral treatment for insomnia, education in self-care of common medical disorders such as diabetes, and assistance in accessing medical and social programs. Main Outcomes and Measures: The main outcome was incidence of major depressive episodes. The study also assessed symptom change during 12 months (12-item General Health Questionnaire [GHQ-12]; score range of 0 to 12, with higher scores indicating greater symptoms of depression and anxiety), functional status (World Health Organization Disability Assessment Schedule 2.0; score range of 12 to 60, with higher scores indicating greater disability), cognition (Hindi Mini-Mental State Examination; score range of 0 to 30, with higher scores indicating better cognitive functioning), blood pressure, and body mass index to provide further clinical context. Results: The study enrolled 181 participants (mean [SD] age, 69.6 [7.2] years; 114 [63.0%] female): 91 to the intervention arm (depression in later life [DIL] intervention) and 90 to care as usual (CAU). Incident episodes of major depression were lower in the DIL intervention than in the CAU group (4.40% vs 14.44%; log-rank P =.04; number needed to treat, 9.95; 95% CI, 5.12-182.43). The 12-month Kaplan-Meier estimates of percentage of depression-free participants were 95.1% (95% CI, 90.5%-99.9%) in the DIL group vs 87.4% (95% CI, 80.4%-95.1%) in the CAU group. The incidence of depressive symptoms (GHQ-12) was also less (12-month mean difference, -1.18; 95% CI, -2.03 to -0.31; group × time interaction P <.001). There were no changes in measures of disability or cognition. The DIL intervention was associated with a significantly greater lowering of systolic blood pressure (12-month mean difference, -6.98; 95% CI, -11.96 to -2.01; group × time interaction P <.001) and change in body mass index (12-month mean difference, 0.23; 95% CI, -0.97 to 1.43; P =.04). Conclusions and Relevance: The DIL intervention is effective for preventing episodes of major depression in older persons with subsyndromal symptoms. If replicated, the DIL intervention may be effective in older adults living in low- and middle-income countries

Association of molecular senescence markers in late-life depression with clinical characteristics and treatment outcome

Importance: Many older adults with depression do not experience remission with antidepressant treatment, and markers of cellular senescence in late-life depression (LLD) are associated with greater severity of depression, greater executive dysfunction, and higher medical illness burden. Since these clinical characteristics are associated with remission in LLD, molecular and cellular senescence abnormalities could be a possible biological mechanism underlying poor treatment response in this population. Objective: To examine whether the senescence-associated secretory phenotype (SASP) index was associated with the likelihood of remission from a depressive episode in older adults. Design, Setting, and Participants: A nonrandomized, open-label clinical trial was conducted between August 2009 and August 2014 in Pittsburgh, Pennsylvania; St Louis, Missouri; and Toronto, Ontario, Canada, with older adults in a current major depressive episode according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) diagnostic criteria. Data from biomarker analyses were reported according to the clinical trial archived plasma samples run in March 2021. Data were analyzed from June to November 2021. Exposure: Venlafaxine extended release (dose ranging from 37.5 mg to 300 mg daily) for up to 12 weeks. Main Outcomes and Measures: The association between a composite biomarker-based index (SASP index) and treatment remission in older adults with major depression was measured using clinical data and blood samples. Results: There were 416 participants with a mean (SD) age of 60.02 (7.13) years; 64% (265 participants) were self-reported female, and the mean (SD) Montgomery-Asberg Depression Rating Scale score was 26.6 (5.7). Higher SASP index scores were independently associated with higher rates of nonremission, with an increase of 1 unit in the SASP index score increasing the odds of nonremission by 19% (adjusted odds ratio, 1.19; 95% CI, 1.05-1.35; P = .006). In contrast, no individual SASP factors were associated with remission in LLD. Conclusions and Relevance: Using clinical data and blood samples from a nonrandomized clinical trial, the results of this study suggest that molecular and cellular senescence, as measured with the SASP index, is associated with worse treatment outcomes in LLD. Combining this index score reflecting interrelated biological processes with other molecular, clinical, and neuroimaging markers may be useful in evaluating antidepressant treatment outcomes. These findings inform a path forward for geroscience-guided interventions targeting senescence to improve remission rates in LLD. Trial Registration: ClinicalTrials.gov Identifier: NCT00892047