Major Depressive Disorder Clinical Trial
Official title:
Investigating the Relationship Between Gait, Depression, and Mind-body Therapy in Seniors
Falls are the leading cause of injury--‐related hospitalization and death in the elderly. As such, fear of falling (FOF) is common among senior populations and often leads to activity avoidance, social isolation, and reduced physical and mental health. Risk of falls is particularly concerning for individuals suffering from late life depression (LLD) as both depression and antidepressant treatment have been shown to be linked to gait impairments, a strong predictor of fall risk. Currently, our team is conducting a study to examine the effects of a non--‐pharmacological mind--‐body therapy commonly known as automatic self--‐transcending meditation (ASTM) on autonomic and mood--‐related symptoms of LLD. This study provides a timely opportunity to explore the intricate relationship between gait disturbances and depression severity, as well as the potential benefits of ASTM intervention on gait and FOF in seniors. Using a GAITRite® portable walkway, measures of stride length and gait velocity will be obtained for seniors in the ASTM and control study arms every four weeks for the duration of the ASTM program. The aim of this study is to answer the following research questions: are gait impairments and depression severity correlated, and does ASTM training have any effect on gait and FOF? The results of this study could not only provide insight into the physical manifestations of depression but if ASTM training is found to improve gait and reduce FOF then there is potential to use this mind--‐body meditation technique as an adjunct therapy to reduce fall risk in seniors with LLD. Furthermore, future research could expand upon these findings to examine the benefits of ASTM on gait impairments secondary to other psychiatric illnesses.
Falls are the leading cause of injury--‐related death in senior populations (i.e. 65 years of
age and older)
1. ; approximately 30% of community--‐dwelling seniors suffer a fall at least once per
year, with this proportion increasing with age
2. . In Canada, 40% of falls by seniors result in hip fractures which oftentimes leads to
only partial recovery
3. , therefore it is not uncommon for older adults to report a fear of falling (FOF). FOF
is particularly common in community--‐dwelling older females and those who have
previously experienced a fall [4,5]. In some individuals, FOF actually leads to activity
avoidance
[5]. Moreover, seniors who have suffered a fall report reductions in their quality of life
[6]. A systematic review by Scheffer et al. [4] has identified the major outcomes of FOF to
be reductions in physical and mental health, quality of life and an increased risk of fall.
Older adults suffering symptoms of depression are also more likely to have a severe FOF,
leading to activity restriction in this group [7, 8]. As such, minimizing the risk of falls
in older populations has important implications for the physical and mental wellbeing of
individuals in this cohort. Among the risk factors that increase the likelihood of seniors
suffering a fall are gait impairments [9] and depression [10--‐12]. Indeed, measures of gait
can be used to predict future falls [13] while increases in depressive symptoms are
associated with increases in fall rate [10]. An association has been established between
depression and gait deficits, even when confounding variables such as socio--‐demographic and
overall health status are controlled; specifically, depression is associated with reductions
in various gait parameters including gait velocity, stride length and swing time variability
[14, 15]. At present, antidepressants are the first line of treatment for depression, however
in seniors the response rate to an antidepressant trial of adequate dose and duration is
often inadequate and can be as low as 30--‐ 40% [16]. In addition, antidepressant use is
often associated with a number of adverse events including increased fall risk [11] and
impairments in gait [17, 18]. For example, in healthy seniors, a single dose of amitriptyline
led to gait impairments when subjects were required to walk in the presence of obstructions
[17]. Therefore the relationship between depression, gait, and fall risk is further
complicated by standard pharmacological treatment practices for this population. In recent
years, various non--‐pharmacological interventions have been embraced by patients with late
life depression (LLD). Loosely defined as mind--‐body therapies, these include biofeedback,
energy healing, meditation, guided imagery, and yoga [19, 20]. Amongst these practices,
meditation therapy may be of particular benefit for older adults with gait impairments and
LLD; meditation is non--‐invasive, easy to learn, has negligible side effects, can be
practiced from anywhere and has been shown to have multi--‐organ benefits [see 21 for a
review]. Whilst relatively few studies have examined the effects of meditation on gait, a
study of mindfulness--‐based cognitive therapy (MBCT) found the therapy normalized gait
patterns in adults with a history of depression [22]. Additionally, a particular type of
meditation, referred to as automatic self--‐transcending meditation (ASTM) has been shown to
reduce symptoms of depression [23]. Currently, our research team is commencing the data
collection phase of an REB approved study that has received funding by the Academic Medical
Organization of Southwestern Ontario (AMOSO) Innovation Fund. This study is a single blind
longitudinal naturalistic randomized control trial targeting individuals with late--‐life
depression, and will examine the effects of ASTM on autonomic and mood--‐related symptoms of
depression. In the framework of the ASTM study there is an opportunity to more closely
examine the relationship between gait and depression in elderly populations, as well as the
potential benefits of this mind--‐body therapy on gait and FOF. We are kindly requesting
funding from the Department of Psychiatry to carry out this investigation. Specifically, we
aim to assess gait parameters such as stride length and gait velocity, which have been shown
to be affected by depression [14, 15], in LLD patients receiving ASTM training in addition to
their current treatment schedules (ASTM group) as well as those that continue with their
treatment as usual (TAU group). A thorough literature and clinical trial registry search
reveals that no one has previously, or is currently, examining the effects of ASTM training
on parameters of gait in LLD patients.
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