Objectives: Late-life major depressive disorder (MDD) can be conceptualized as a complex dynamic system. However, it is not straightforward how to analyze the covarying depressive symptoms over... Show moreObjectives: Late-life major depressive disorder (MDD) can be conceptualized as a complex dynamic system. However, it is not straightforward how to analyze the covarying depressive symptoms over time in case of sparse panel data. Dynamic time warping (DTW) analysis may yield symptom networks and dimensions both at the patient and group level. Methods: In the Netherlands Study of Depression in Older People (NESDO) depressive symptoms were assessed every 6 months using the 30-item Inventory of Depressive Symptomatology (IDS) with up to 13 assessments per participant. Our sample consisted of 182 persons, aged >= 60 years, with an IDS total score of 26 or higher at baseline. Symptom networks dimensions, and centrality metrics were analyzed using DTW and Distatis analyses. Results: The mean age was 69.8 years (SD 7.1), with 69.0% females, and a mean IDS score of 38.0 (SD = 8.7). DTW enabled visualization of an idiographic symptom network in a single NESDO participant. In the group-level nomothetic approach, four depressive symptom dimensions were identified: "core symptoms", "lethargy/somatic", "sleep", and "appetite/atypical". Items of the "internalizing symptoms" dimension had the highest centrality, whose symptom changes over time were most similar to those changes of other symptoms. Conclusions: DTW revealed symptom networks and dimensions based on the within-person symptom changes in older MDD patients. Its centrality metrics signal the most influential symptoms, which may aid personalized care. Show less
In this thesis the heterogeneity of late-life depression is being examined. The first part of the thesis focuses on data-driven analyses as a way of identifying subtypes of late-life depression.... Show moreIn this thesis the heterogeneity of late-life depression is being examined. The first part of the thesis focuses on data-driven analyses as a way of identifying subtypes of late-life depression. Through latent class analysis, we have identified three subtypes: a severe melancholic subtype, an atypical subtype, and a moderately severe subtype. These subtypes had different sociodemographic and clinical characteristics, but no specific biological disturbances could be addressed to the different subtypes. This is probably because of the tangle of (patho)physiological processes in aging itself, muddling the results. The stability of these subtypes over a two-year follow-up was however high, strengthening the clinical relevance of found subtypes.The second part of this thesis examines psychomotor disturbances in melancholic depression as a possible predicting symptom of response in electroconvulsive therapy. We have found that psychomotor disturbances predict to a certain amount the response to electroconvulsive therapy, but this effect was overruled by the predictive value of psychotic symptoms in depression. Finally, we have examined the speed of response of different depressive symptoms on electroconvulsive therapy in older depressed persons, and have found that all ten symptoms show response in two weeks, underlining the safety and efficacy of electroconvulsive therapy in older persons. Show less
Veltman, E.M.; Boer, A. de; Dols, A.; Exel, E. van; Stek, M.L.; Sienaert, P.; ... ; Rhebergen, D. 2019
Objectives In clinical practice, particularly melancholic depression benefits from electroconvulsive therapy (ECT), albeit research melancholia criteria from the Diagnostic and Statistical Manual... Show moreObjectives In clinical practice, particularly melancholic depression benefits from electroconvulsive therapy (ECT), albeit research melancholia criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM) is not conclusive. We compared clinical characteristics and ECT outcome of melancholic and nonmelancholic depression, here defined by psychomotor symptoms. Methods One hundred ten depressed older in-patients treated with ECT were included in the Mood Disorders in Elderly treated with ECT study. The CORE was used for the assessment of psychomotor symptoms, with a score of 8 or higher defining melancholic depression. Depression severity was measured before, during, and after ECT. Characteristics were compared across melancholic and nonmelancholic patients. Regression analysis was used to assess the relation between psychomotor symptoms and remission/response, and survival analysis was used to examine the difference in time. Results Patients with melancholic depression had higher severity, lower cognitive and overall functioning, and lower prevalence of cardiovascular disease. However, no significant relations were found between CORE scores and remission/response. Because psychotic symptoms are a positive predictor of ECT response and remission, we examined whether CORE score was a predictor of response in the nonpsychotic group (n = 49). In nonpsychotic patients, remission was 62%, and the association between CORE scores and remission almost reached significance (P = 0.057). Discussion Although melancholically and nonmelancholically depressed patients differed significantly on several clinical characteristics, ECT outcome did not differ. Analyses may be hampered by a high prevalence of psychotic features. In nonpsychotic patients, CORE scores neared significance as predictor of remission, suggesting that CORE scores might be a distinguishing characteristic of melancholia in nonpsychotic patients and a clinical useful predictor of ECT response. Show less
Veltman, E.M.; Boer, A. de; Dols, A.; Exel, E. van; Stek, M.L.; Sienaert, P.; ... ; Rhebergen, D. 2019
