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Papers by Charles Reynolds III
Sleep Medicine Reviews, 2000
The prevalence of Alzheimer's disease (AD) is rapidly increasing as growing numbers of people aro... more The prevalence of Alzheimer's disease (AD) is rapidly increasing as growing numbers of people around the world are living to old age. Sleep disturbances are a common, and often highly disruptive, behavioral symptom associated with AD. Nevertheless, the study of sleep in AD is relatively new. Little is known about the moderating factors that may alter a given patient's risk for developing sleep problems, or that may influence severity of presentation and persistence. Current treatments for improving sleep in AD fall into three broad categories: (i) pharmacological; (ii) cognitive-behavioral or psycho-educational strategies; and (iii) biological/circadian therapies. There are few studies demonstrating the efficacy of these treatments with community-dwelling AD patients, although studies with persons in institutional settings are promising. In this review, it is suggested that sleep problems in AD are multi-factorial, and influenced by a variety of demographic, physical, psychiatric and situational factors. These factors vary in how readily they can be modified and in how relevant they are to any individual case. Thus, when developing a treatment plan for sleep problems in a dementia patient, it is important to evaluate the underlying causes as well as the context in which the problems are occurring, and to target the intervention accordingly.
Biological Psychiatry, 1997
Our aim was to contrast the effects of maintenance nortriptyline and placebo on electroencephalog... more Our aim was to contrast the effects of maintenance nortriptyline and placebo on electroencephalographic sleep measures in elderly recurrent depressives who survived 1-year without recurrence of depression. Patients on nortriptyline took longer to fall asleep and did not maintain sleep better than patients on placebo; however, maintenance nortriptyline was associated with more delta-wave production and higher delta-wave density in the first non-REM (NREM) period relative to the second. Nortriptyline levels were positively but weakly related to all-night delta-wave production during maintenance (accounting for 6.6% of the variance in delta-wave counts). Total phasic REM activity increased 100% under chronic nortriptyline relative to placebo, with a robust increase in the rate of REM activity generation across the night. Effective long-term pharmacotherapy of recurrent major depression is associated with enhancement in the rate of delta-wave production in the first NREM period (i.e., delta sleep ratio) and of REM activity throughout the night.
International Journal of Geriatric Psychiatry, 1999
The authors assessed the severity of nortriptyline's side-eects in older patients with recurrent ... more The authors assessed the severity of nortriptyline's side-eects in older patients with recurrent major depression during placebo-controlled, double-blind maintenance therapy. Data were from 37 patients completing 2±3 years of maintenance therapy; 29 were on nortriptyline and eight were on placebo. The authors detected a time-by-treatment interaction for dry mouth (greater in nortriptyline-treated patients), but no increased association of nortriptyline with constipation, weight change or orthostatic symptoms. Heart rate was consistently higher in nortriptyline-maintained patients as compared with placebo. The total`side-eect' score on the Asberg Rating Scale, as well as complaints of physical tiredness, daytime sleepiness and nocturnal sleep disturbance, were related primarily to residual depression rather than treatment with nortriptyline.
JAMA, 2012
Depressive disorders erode quality of life, productivity in the workplace, and fulfillment of soc... more Depressive disorders erode quality of life, productivity in the workplace, and fulfillment of social and familial roles. In today's knowledge-and service-driven economies, the population's mental capital (ie, cognitive, emotional, and social skills resources required for role functioning) becomes both more valuable and more vulnerable to the effects of depression. Depressive disorders, severe mental illnesses that should not be confused with normal mood variations, are part of a vicious circle of poverty, discrimination, and poor mental health in middle-and low-income countries. 1 These realities also have major economic ramifications: treatment costs of depression are soaring but are only a fragment of the costs of reduced productivity due to depression. 2 More than half of those with depression develop a recurrent or chronic disorder after a first depressive episode and are likely to spend more than 20% of their life-time in a depressed condition. With a 12-month prevalence rate of more than 5% in most high-, middle-, and low-income countries and its occurrence at almost any age, 3 depression generates substantial loss of quality of life and personal morbidity and despair. But it also leads to considerable additional damage through biological sequelae and maladaptive illness behaviors, thus increasing risk of cardiovascular disease, dementing illnesses, and early death while amplifying disability, complications, and health services use in those with coexisting chronic illnesses. Depression ranks third among disorders responsible for global disease burden, with all the concomitant economic costs to society, and will rank first in high-income countries by 2030. 4
BMJ (Clinical research ed.), 2013
To investigate whether an intervention to improve treatment of depression in older adults in prim... more To investigate whether an intervention to improve treatment of depression in older adults in primary care modified the increased risk of death associated with depression. Long term follow-up of multi-site practice randomized controlled trial (PROSPECT-Prevention of Suicide in Primary Care Elderly: Collaborative Trial). 20 primary care practices in New York City, Philadelphia, and Pittsburgh, USA, randomized to intervention or usual care. 1226 participants identified between May 1999 and August 2001 through a two stage, age stratified (60-74; ≥ 75 years) depression screening of randomly sampled patients; enrollment included patients who screened positive and a random sample of patients who screened negative. For two years, a depression care manager worked with primary care physicians in intervention practices to provide algorithm based care for depression, offering psychotherapy, increasing antidepressant dose if indicated, and monitoring symptoms, adverse effects of drugs, and adher...
Sleep Medicine Reviews, 2000
The prevalence of Alzheimer's disease (AD) is rapidly increasing as growing numbers of people aro... more The prevalence of Alzheimer's disease (AD) is rapidly increasing as growing numbers of people around the world are living to old age. Sleep disturbances are a common, and often highly disruptive, behavioral symptom associated with AD. Nevertheless, the study of sleep in AD is relatively new. Little is known about the moderating factors that may alter a given patient's risk for developing sleep problems, or that may influence severity of presentation and persistence. Current treatments for improving sleep in AD fall into three broad categories: (i) pharmacological; (ii) cognitive-behavioral or psycho-educational strategies; and (iii) biological/circadian therapies. There are few studies demonstrating the efficacy of these treatments with community-dwelling AD patients, although studies with persons in institutional settings are promising. In this review, it is suggested that sleep problems in AD are multi-factorial, and influenced by a variety of demographic, physical, psychiatric and situational factors. These factors vary in how readily they can be modified and in how relevant they are to any individual case. Thus, when developing a treatment plan for sleep problems in a dementia patient, it is important to evaluate the underlying causes as well as the context in which the problems are occurring, and to target the intervention accordingly.
Biological Psychiatry, 1997
Our aim was to contrast the effects of maintenance nortriptyline and placebo on electroencephalog... more Our aim was to contrast the effects of maintenance nortriptyline and placebo on electroencephalographic sleep measures in elderly recurrent depressives who survived 1-year without recurrence of depression. Patients on nortriptyline took longer to fall asleep and did not maintain sleep better than patients on placebo; however, maintenance nortriptyline was associated with more delta-wave production and higher delta-wave density in the first non-REM (NREM) period relative to the second. Nortriptyline levels were positively but weakly related to all-night delta-wave production during maintenance (accounting for 6.6% of the variance in delta-wave counts). Total phasic REM activity increased 100% under chronic nortriptyline relative to placebo, with a robust increase in the rate of REM activity generation across the night. Effective long-term pharmacotherapy of recurrent major depression is associated with enhancement in the rate of delta-wave production in the first NREM period (i.e., delta sleep ratio) and of REM activity throughout the night.
International Journal of Geriatric Psychiatry, 1999
The authors assessed the severity of nortriptyline's side-eects in older patients with recurrent ... more The authors assessed the severity of nortriptyline's side-eects in older patients with recurrent major depression during placebo-controlled, double-blind maintenance therapy. Data were from 37 patients completing 2±3 years of maintenance therapy; 29 were on nortriptyline and eight were on placebo. The authors detected a time-by-treatment interaction for dry mouth (greater in nortriptyline-treated patients), but no increased association of nortriptyline with constipation, weight change or orthostatic symptoms. Heart rate was consistently higher in nortriptyline-maintained patients as compared with placebo. The total`side-eect' score on the Asberg Rating Scale, as well as complaints of physical tiredness, daytime sleepiness and nocturnal sleep disturbance, were related primarily to residual depression rather than treatment with nortriptyline.
JAMA, 2012
Depressive disorders erode quality of life, productivity in the workplace, and fulfillment of soc... more Depressive disorders erode quality of life, productivity in the workplace, and fulfillment of social and familial roles. In today's knowledge-and service-driven economies, the population's mental capital (ie, cognitive, emotional, and social skills resources required for role functioning) becomes both more valuable and more vulnerable to the effects of depression. Depressive disorders, severe mental illnesses that should not be confused with normal mood variations, are part of a vicious circle of poverty, discrimination, and poor mental health in middle-and low-income countries. 1 These realities also have major economic ramifications: treatment costs of depression are soaring but are only a fragment of the costs of reduced productivity due to depression. 2 More than half of those with depression develop a recurrent or chronic disorder after a first depressive episode and are likely to spend more than 20% of their life-time in a depressed condition. With a 12-month prevalence rate of more than 5% in most high-, middle-, and low-income countries and its occurrence at almost any age, 3 depression generates substantial loss of quality of life and personal morbidity and despair. But it also leads to considerable additional damage through biological sequelae and maladaptive illness behaviors, thus increasing risk of cardiovascular disease, dementing illnesses, and early death while amplifying disability, complications, and health services use in those with coexisting chronic illnesses. Depression ranks third among disorders responsible for global disease burden, with all the concomitant economic costs to society, and will rank first in high-income countries by 2030. 4
BMJ (Clinical research ed.), 2013
To investigate whether an intervention to improve treatment of depression in older adults in prim... more To investigate whether an intervention to improve treatment of depression in older adults in primary care modified the increased risk of death associated with depression. Long term follow-up of multi-site practice randomized controlled trial (PROSPECT-Prevention of Suicide in Primary Care Elderly: Collaborative Trial). 20 primary care practices in New York City, Philadelphia, and Pittsburgh, USA, randomized to intervention or usual care. 1226 participants identified between May 1999 and August 2001 through a two stage, age stratified (60-74; ≥ 75 years) depression screening of randomly sampled patients; enrollment included patients who screened positive and a random sample of patients who screened negative. For two years, a depression care manager worked with primary care physicians in intervention practices to provide algorithm based care for depression, offering psychotherapy, increasing antidepressant dose if indicated, and monitoring symptoms, adverse effects of drugs, and adher...