Enhancing Processing Speed and Executive Functioning in Depressed Older Adults With Computerized Cognitive Training
Depression in Old Age, Depression
About this trial
This is an interventional treatment trial for Depression in Old Age
Eligibility Criteria
Inclusion Criteria:
- Age greater than or equal to 60 years
- DSM5 Diagnosis of Major Depressive Disorder (MDD), Persistent Depressive Disorder, or Depression Not Otherwise Specified (NOS)
- Hamilton Rating Scale for Depression (HRSD) score ≥ 20
- Decreased processing speed (1 SD below age-adjusted norms on the WAIS-IV Digit Symbol Coding Test)
- Access to a computer with daily internet access
- Willing to and capable of providing informed consent and complying with all study procedures. At the end of the CCT phase (week 4), depression severity will be reassessed. To be eligible for Phase 2 (SSRI trial), participants will be required to have an HRSD score ≥ 14.
Exclusion Criteria:
- Diagnosis of substance abuse or dependence (excluding Tobacco Use Disorder) within the past 12 months
- History of psychosis, psychotic disorder, mania, or bipolar disorder
- Primary neurological disorder, including dementia, stroke, Parkinson's disease, epilepsy, etc.
- Mini Mental Status Examination (MMSE) score less than 24
- HRSD suicide item greater than 2 or Clinical Global Impressions (CGI)-Severity score of 7 at baseline
- History of allergic or adverse reaction to escitalopram, or non-response to adequate trial of escitalopram (at least 4 weeks at dose of 20 mg) during the current episode
- Current or recent (within the past 2 weeks) treatment with psychotherapy, antidepressants, antipsychotics, mood stabilizers
- Contraindication to MRI scanning (such as metal in body) or inability to tolerate the scanning procedures
- History of significant radioactivity exposure (nuclear medicine studies or occupational exposure).
Sites / Locations
- New York State Psychiatric Institute
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Experimental
Active Comparator
Experimental
Placebo Comparator
Computerized Cognitive Training
Solitaire Training
Open-label antidepressant treatment
Placebo-controlled antidepressant treatment
Those assigned to the computerized cognitive training arm prior to antidepressant trial enrollment will receive computerized cognitive training that includes games that scale in difficulty.
Those assigned to the solitaire training arm prior to antidepressant trial enrollment will receive computerized solitaire games.
Those assigned to receive open-label antidepressant treatment will begin with 10 mg of escitalopram. If the participant cannot tolerate or has an adverse reaction to escitalopram, duloxetine will be offered instead.
Those assigned to the placebo-controlled group will be told that they have a 50/50 chance of receiving either escitalopram or placebo.