Improving Interventions for Mid- and Late-Life Depression
A $4 million, 4-year grant from the National Institute of Mental Health (NIMH) enabled Weill Cornell Medicine investigators to found the Advanced Laboratory for Accelerating the Reach and Impact of Treatments for Mid- and Late-Life Depression (ALACRITY) Research Center. The ALACRITY Center is dedicated to developing and studying novel treatments for depressed middle-aged and older adults that can be delivered in the community.
Depression is the leading cause of disability worldwide. In middle-aged and older adults, depression worsens the course of most medical illnesses and increases mortality. Antidepressants address the needs of no more than half of those afflicted by depression. Psychotherapies are as effective as antidepressants in mild to moderately severe depression, but they are complex and rarely used correctly in community-based services.
With the rapidly rising numbers of older adults in the United States, development of broadly available, novel treatments for mid- and late-life depression is an important national priority, says George S. Alexopoulos, MD, Director of the Weill Cornell Institute of Geriatric Psychiatry at Weill Cornell Medicine and a psychiatrist at NewYork-Presbyterian Westchester Division.
Rather than focusing exclusively on improving the use of existing psychotherapies, the Weill Cornell ALACRITY team is working to both simplify the therapies themselves and to improve their delivery. Using the rapidly developing knowledge on brain biology of depression and their own neurobiology findings, the investigators proposed that dysfunction of specific brain networks (the reward, salience, and cognitive control networks) promotes the development of depression. Based on this view, they designed psycho-therapies consisting of simple techniques aiming to help depressed patients pursue behaviors that engage these networks. “Repeated use of networks can strengthen their function in a similar manner that repeated exercise strengthens the body’s muscles,” says Dr. Alexopoulos, Principal Investigator of the ALACRITY Center.
The ALACRITY psychotherapeutic interventions are relatively easy to learn because they are streamlined and include simple techniques aimed to increase the function of networks implicated in depression. In addition to biology, input by consumers and community clinicians also guided the selection of psychotherapeutic techniques of ALACRITY’s interventions and their implementation approach in the community. To maximize their effect, the interventions have been designed for and tested in community settings where middle-aged and older adults receive care and services. These include primary care clinics, agencies treating victims of elder abuse, and senior centers attended by economically disadvantaged older adults. “We want to make effective psychotherapy available to treatment services offering care to depressed middle-aged and older adults across the country,” says Dr. Alexopoulos.
Currently, Dr. Alexopoulos and his team are testing ALACRITY’s novel interventions in three randomized, double-blind clinical trials in community services. In addition to in-person meetings with therapists, all three psychotherapies include smartphone apps that provide motivational messages reminding patients to pursue their treatment assignments and ask patients to rate various aspects of their mood and behavior daily. The apps also passively sense and monitor some of the patients’ activities (e.g., time spent in conversation, time away from home, places visited, sleep, etc.). If successful, the investigators hope that their psychotherapies can become part of the practice of therapists working in community settings. They also hope that their approach to intervention development can be used for patients affected by other mental health conditions. “Validating our approach in mid- and late-life depression would be a critical step that might increase the public health impact of psychotherapy as it never has before,” says Dr. Alexopoulos.