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Study explores nicotine patch to treat late-life depression

Oct. 15, 2020, 9:13 AM

 

by Kelsey Herbers

Backed by nearly $5 million in funding, researchers from Vanderbilt University Medical Center are testing to see whether transdermal nicotine patches can improve mood, forgetfulness and attentiveness in adults over 60 with a diagnosis of depression.

Previous studies led by VUMC investigators have shown that aging adults with mild cognitive impairment who were prescribed a nicotine patch for six months had improved attention and memory. Unlike with smoking, there were no serious side effects or signs of nicotine withdrawal in the study’s participants.

Warren Taylor, MD, MHSc, and colleagues are exploring why older adults who have successfully been treated for depression experience a recurrence within four to five years.
Warren Taylor, MD, MHSc

“We often see that people who are older and have depression complain about memory problems, find it harder to concentrate and have more difficulty with complex tasks. While these things tend to improve when we treat the depression, they often don’t return to normal, and these residual difficulties with memory and attention continue to impair quality of life,” said Warren Taylor, MD, MHSc, James G. Blakemore Professor of Psychiatry and Behavioral Sciences and principal investigator for the study.

While transdermal nicotine has primarily been studied in older adults to improve symptoms of memory and attention loss, evidence suggests it may also have a beneficial effect on mood by activating parts of the brain that may be impaired when a person becomes depressed.

A small pilot study conducted by Taylor in 15 older adults with depression showed a strong signal in improving depressive symptoms and encouraging results for enhancing memory and attention. The current study will build on this pilot and also on extensive experience that the VUMC Psychiatry team has had with nicotinic stimulation in older individuals, including an ongoing NIH-funded study examining the long-term effects of two years of transdermal nicotine in adults with mild cognitive impairment that includes 40 sites nationwide.

In the current study, which will be conducted in two phases, Taylor and his team, which includes Paul Newhouse, MD, Jim Turner Professor of Cognitive Disorders and director of the Vanderbilt Center for Cognitive Medicine, hope to replicate these findings in 36 adults with major depressive disorder by applying a nicotine patch for 12 weeks.

Participants will undergo memory testing before and after treatment and will be evaluated for depression severity at different intervals to look for signs of improvement. Participants will also undergo brain imaging that includes tasks that require concentration to see how they perform and to examine activity levels in different parts of the brain.

If the patches are deemed safe and effective in the study’s first phase, the second phase will more rigorously test the drug’s effectiveness through a placebo-controlled trial in 72 adults.

Both phases will also include blood draws to examine nicotine levels in the blood, providing hints into the correct dosage for providing maximum benefit.

According to Taylor, who also serves as director of the Division of Geriatric Psychiatry at VUMC, the nicotine patches are meant to accompany antidepressants in older adults who may not be fully responsive to medications or who are experiencing simultaneous problems with memory and concentration.

“Depression for many people can be difficult to treat. There are a lot of good antidepressants, but we know they don’t always work for everyone,” said Taylor. “I like having new options and treatments to help get people better, and I’m hopeful that we’ll see some benefit through our study.”

If the patches are deemed safe and effective, they could quickly be implemented into clinical practice since they are already available and easily accessible. But, they shouldn’t be rolled out before going through the rigorous standards set within a controlled trial, Taylor cautions.

“These patches work very differently than any antidepressant on the market,” said Taylor. “There’s still a lot we don’t know about how this drug may or may not work for depression and brain health in this population.”

This research is supported by the National Institute of Mental Health (grant MH122464).

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