Clinical Psychopharmacology of Geriatric Mood Disorders
Dr. Young's research focuses on the clinical pharmacology of affective disorders in late life, including major depression, manic states and bipolar disorders. The studies utilize therapeutic drug exposure as a probe with which to investigate the clinical and neurobiologic heterogeneity of these disorders. Goals include: Description of age-associated distortion of pharmacokinetics of classical and newer therapeutic drugs. Definition of relationships between plasma drug concentrations and acute therapeutic response and cognitive and peripheral toxicity. Examination of pharmacodynamic differences among patient subgroups. The research provides practical guidelines that can maximize therapeutic benefit and minimize risk; findings are being tested in studies of maintenance treatment. It also provides paradigms for investigation of neurobiologic issues.
Ongoing studies are designed to define optimal plasma antidepressant concentrations in the acute treatment of geriatric major depression and mood stabilizer concentrations in acute geriatric mania. Prior findings include age-associated accumulation of active antidepressant metabolites, and relatively low protein binding of these metabolites. Differences in response characteristics between subgroups defined by striato-frontal and mesio-temporal pathology and by genotyping are being explored. Data obtained generate additional hypotheses concerning differential therapeutics. Acute response as a predictor of long-term outcome is also being tested.