Topics:

Resilience, Stress, and the Neurobiology of Aging: Page 4 of 4

Resilience, Stress, and the Neurobiology of Aging: Page 4 of 4

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).

Conclusion

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.

Pages

References

References

1. Dominguez LJ, Barbagallo M, Morley JE. Anti-aging medicine: pitfalls and hopes. Aging Male. 2009;12:13-20.
2. Vaillant GE. Aging Well. Surprising Guidepost to a Happier Life From the Landmark Harvard Study of Adult Development. New York: Little, Brown and Co; 2002:373.
3. Fredrickson BL. The role of positive emotions in positive psychology. The broaden-and-build theory of positive emotions. Am Psychol. 2001;56:218-226.
4. Fredrickson BL, Joiner T. Positive emotions trigger upward spirals toward emotional well-being. Psychol Sci. 2002;13:172-175.
5. Rowe JW, Kahn RL. Successful Aging. New York: Dell Publishing; 1999:265.
6. Depp CA, Jeste DV. Definitions and predictors of successful aging: a comprehensive review of larger quantitative studies. Am J Geriatr Psychiatry. 2006;14:6-20.
7. Peel NM, McClure RJ, Bartlett HP. Behavioral determinants of healthy aging. Am J Prev Med. 2005;28:298-304.
8. Selye H. The Stress of Life. New York: McGraw-Hill; 1956.
9. McEwen BS. The End of Stress as We Know It. Washington, DC: National Academies Press; 2004:239.
10. Miller MM, McEwen BS. Establishing an agenda for translational research on PTSD. Ann N Y Acad Sci. 2006;1071:294-312.
11. Sterling P, Eyer J. Allostasis: a new paradigm to explain arousal pathology. In: Fisher S, Reason J, eds. Handbook of Life Stress, Cognition, and Health. New York: John Wiley & Sons; 1988:629-649.
12. McEwen BS. Sex, stress, and the hippocampus: allostasis, allostatic load and the aging process. Neurobiol Aging. 2002;23:921-939.
13. Seeman TE, McEwen BS, Rowe JW, Singer BH. Allostatic load as a marker of cumulative biological risk: McArthur studies of successful aging. Proc Natl Acad Sci U S A. 2001;98:4770-4775.
14. Karlamangla AS, Singer BH, McEwen BS, et al. Allostatic load as a predictor of functional decline. MacArthur studies of successful aging. J Clin Epidemiol. 2002;55:696-710.
15. Black S, Humphrey JH, Niven JS. Inhibition of the Mantoux reaction by direct suggestion under hypnosis. Br Med J. 1963;1:1649-1652.
16. Ershler WB. Interleukin-6: a cytokine for gerontologists. J Am Geriatr Soc. 1993;41:176-181.
17. Ferrucci L, Harris TB, Guralnik JM, et al. Serum IL-6 level and the development of disability in older persons. J Am Geriatr Soc. 1999;47:639-646.
18. Kiecolt-Glaser JK, Preacher KJ, MacCallum RC, et al. Chronic stress and age-related increases in the proinflammatory cytokine IL-6. Proc Natl Acad Sci U S A. 2003;100:9090-9095.
19. Krabbe KS, Pedersen M, Bruunsgaard H. Inflammatory mediators in the elderly. Exp Gerontol. 2004;39:687-699.
20. Papanicolaou DA, Wilder RL, Manolagas SC, Chrousos GP. The pathophysiologic roles of interleukin-6 in human disease. Ann Intern Med. 1998;128:127-137.
21. Harris TB, Ferrucci L, Tracy RP, et al. Associations of elevated interleukin-6 and C-reactive protein levels with mortality in the elderly. Am J Med. 1999;106:506-512.
22. Davidson RJ. Affective style, psychopathology, and resilience: brain mechanisms and plasticity. Am Psychol. 2000;55:1196-1214.
23. Davidson RJ. Anxiety and affective style: role of prefrontal cortex and amygdala. Biol Psychiatry. 2002;51:68-80.
24. Lavretsky H, Irwin MR. Resilience and aging. Aging Health. 2007;3:309-323.
25. Werner EE. The children of Kaui: resiliency and recovery in adolescence and adulthood. J Adolesc Health. 1992;13:262-268.
26. Ryff CD, Singer BH, Dienberg Love G. Positive health: connecting well-being with biology. Philos Trans R Soc Lond B Biol Sci. 2004;359:1383-1394.
27. Richardson GE, Waite PJ. Mental health promotion through resilience and resiliency education. Int J Emerg Ment Health. 2002;4:65-75.
28. Fava GA, Rafanelli C, Cazzaro M, et al. Well-being therapy. A novel psychotherapeutic approach for residual symptoms of affective disorders. Psychol Med. 1998;28:475-480.
29. Fava GA, Ruini C, Rafanelli C, et al. Six-year outcome of cognitive behavior therapy for prevention of recurrent depression. Am J Psychiatry. 2004;161:1872-1876.
30. Fava GA, Ruini C, Rafanelli C, et al. Well-being therapy of generalized anxiety disorder. Psychother Psychosom. 2005;74:26-30.
31. Ruini C, Belaise C, Brombin C, et al. Well-being therapy in school settings: a pilot study. Psychother Psychosom. 2006;75:331-336.
32. Ryff CD, Singer BH. Flourishing under fire: resilience as a prototype of challenged thriving. In: Keyes CL, Haidt J, eds. Flourishing: Positive Psychology and the Life Well-Lived. Washington, DC: American Psychological Association; 2003:15-36.
33. Fava GA. Well-being therapy: conceptual and technical issues. Psychother Psychosom. 1999;68:171-179.
34. Miller GE, Cohen S. Psychological interventions and the immune system: a meta-analytic review and critique. Health Psychol. 2001;20:47-63.
35. Irwin M, Pike J, Oxman M. Shingles immunity and health functioning in the elderly: tai chi chih as a behavioral treatment. Evid Based Complement Alternat Med. 2004;1:223-232.
36. Irwin MR, Olmstead R, Oxman MN. Augmenting immune responses to varicella zoster virus in older adults: a randomized, controlled trial of Tai Chi. J Am Geriatr Soc. 2007;55:511-517.
37. Motivala SJ, Sollers J, Thayer J, Irwin MR. Tai chi chih acutely decreases sympathetic nervous system activity in older adults. J Gerontol A Biol Sci Med Sci. 2006;61:1177-1180.
38. Lutgendorf SK, Antoni MH, Kumar M, Schneiderman N. Changes in cognitive coping strategies predict EBV-antibody titre change following a stress-or disclosure induction. J Psychosom Res. 1994;38:63-78.
39. Segerstrom SC, Taylor SE, Kemeny ME, Fahey JL. Optimism is associated with mood, coping, and immune change in response to stress. J Pers Soc Psychol. 1998;74:1646-1655.
40. Phillips AC, Burns VE, Lord JM. Stress and exercise: getting the balance right for aging immunity. Exerc Sport Sci Rev. 2007;35:35-39.
41. Epel E, Daubenmier J, Moskowitz JT, et al. Can meditation slow rate of cellular aging? Cognitive stress, mindfulness, and telomeres. Ann N Y Acad Sci. 2009;1172:34-53.
42. Lavretsky H, Siddarth P, Irwin MR. Improving depression and enhancing resilience in family dementia caregivers: a pilot randomized placebo-controlled trial of escitalopram. Am J Geriatr Psychiatry. 2010;18:154-162.
43. Connor KM, Sutherland SM, Tupler LA, et al. Fluoxetine in post-traumatic stress disorder: randomised, double-blind study. Br J Psychiatry. 1999;175:17-22.
44. Davidson JR, Stein DJ, Rothbaum BO, et al. Resilience as a predictor of remission in PTSD patients treated with venlafaxine XR or placebo. Poster presented at: Annual Meeting of the Anxiety Disorders of America; March 23-26, 2006; Miami.

 
Loading comments...

By clicking Accept, you agree to become a member of the UBM Medica Community.