Antidepressants have also been shown to promote resilience in patients with posttraumatic stress disorder (PTSD) and in stressed caregivers.42,43 Connor and colleagues43 undertook a 12-week placebo-controlled trial of fluoxetine in civil-ians with PTSD and reported better efficacy with fluoxetine than with placebo.
Pooled results from 2 large, multicenter, randomized, controlled trials of patients with PTSD using extended-release venlafaxine indicated that total Connor-Davidson Resilience scale scores and treatment were significant predictors of both response and remission.44
In our randomized placebo-controlled pilot study, 10 mg/d of citalopram improved resilience and decreased levels of depression and distress.42 This is the first trial of an antidepressant directed toward increasing resilience in a high-risk group of chronically stressed older caregivers. Preliminary results of our study of the complementary use of tai chi to augment treatment response in elderly depressed patients who had a partial response to 10 mg/d of escitalopram show improvement in psychological resilience and a decline in inflammatory markers (ie, C-reactive protein).
Research on resilience has shifted the focus of investigation from the illness-based approach to the well-being–oriented approach. A pattern of positive characteristics that could target new interventions to promote successful aging include sound intellectual functioning, the ability to handle emotions, self-esteem, optimism, altruism, humor, and an engaged and active coping style. Prospective biological markers of resilience important for future investigations include neuroendocrine, immunological, neural, genetic, temperamental, and environmental influences.
Resilience can be quantified by using standardized assessments in neurobiological and treatment studies. Multimodal assessment of the biological determinants of resilience will help identify targets for intervention to enhance resilience on both individual and cultural levels. Learning to enhance psychological resilience may help overcome health problems and their resulting disabilities.
Successful stress reduction and management, particularly among the most vulnerable seniors, can prevent serious mental and physical illness. Integrated modalities to improve resilience and reduce stress in combination with pharmacotherapy and lifestyle changes are likely to improve the overall functioning and well-being of older adults.
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