A 12-week intervention in elderly patients with major depressive disorder (MDD), consisting of a combination of domains that target physical activity, healthy diet, social activity, and brief cognitive restructuring, may reduce depressive symptoms more effectively than supportive therapy, according to study results published in the Journal of Affective Disorders.

The study comprised patients aged >60 years who were diagnosed with MDD (N=78). In this community-based study conducted at a mental health center in Korea, patients were randomly assigned to receive either a multidomain intervention (n=38) or a supportive care intervention (n=40) targeting depression. In the multidomain intervention, patients were encouraged to perform ≥30 minutes of physical activity 3 times per week, consume a healthy diet, engage in social activity at least once a week, and conduct brief cognitive restructuring for 20 minutes per session with a mental healthcare worker.

A total of 4 home visits and 12 telephone calls were provided over the 12-week study period. Patients randomly assigned to supportive care also received general encouragement to engage in physical and pleasurable activities, but they were not given any particular goal-driven direction. Change in depressive symptoms from baseline was assessed at 12 weeks using the Montgomery-Asberg Depression Rating Scale (MADRS). All patients completed a resting state functional magnetic resonance imaging (rs-fMRI) scan, and the researchers assessed functional connectivity with statistical parametric mapping software.

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Patients in the multidomain intervention arm demonstrated a significantly greater reduction in the MADRS total score over the 12-week study period compared with patients in the supportive therapy arm (P =.007). At week 12, patients in the multidomain intervention group also had a significantly lower MADRS total score after correction for multiple comparisons (score difference, 5.117; P =.029). In analyses of the 3-factor MADRS model, improvements in reported sadness, inability to feel, poor sleep, and reduced appetite were determined to play a critical role in the recovery made by the multidomain intervention group.


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In addition, patients in the multidomain intervention group showed less functional connectivity between the posterior cingulate cortex and left inferior parietal lobule within the default mode network compared with patients randomly assigned to the supportive therapy group (FDR-corrected P <.1). This finding may point to decreased functional connectivity in the default mode network in patients who underwent the multidomain intervention.

Study limitations included the small sample size and the inclusion of a high percentage of women (approximately 74.6%). Based on their findings, the researchers concluded that multidomain interventions targeting physical activity, healthy diet, social activity, and cognitive restructuring “could improve the late-life depression care model in community mental health services.”

Reference

Roh HW, Hong CH, Lim HK, et al. A 12-week multidomain intervention for late-life depression: a community-based randomized controlled trial. J Affect Disord. 2020;263:437-444.