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Medication assists elders with mild depression (9-26-00)

For older people with mild depression, anti-depressant medication improves symptoms better and faster than counseling or placebo, concluded the authors of an article published today in the Journal of the American Medical Association. However, patients’ overall improvement was modest after an 11-week course of medication, leading the authors to recommend a cautious approach to treating mild depression in elders.

Primary authors are John W. Williams, Jr., M.D., The University of Texas Health Science Center at San Antonio and the South Texas Veterans Health Care System; James Barrett, M.D., and Tom Oxman, M.D., both of the Dartmouth Medical School; Ellen Frank, Ph.D., The University of Pittsburgh; and Wayne Katon, M.D., and Mark Sullivan, M.D., both of The University of Washington.

“Despite the fact that primary care physicians commonly see many patients with minor depression and dysthymia, this is the first large study of the condition in any age group to evaluate drug treatment and counseling,” Dr. Williams says. Researchers studied 415 ethnically diverse patients with minor depression or dysthymia in four cities: San Antonio, Seattle, Pittsburgh and Lebanon, N.H.

How do these conditions differ from major depression? “When people think of depression, usually it’s major depression,” Dr. Williams notes. “Patients with major depression experience a low mood and lack of pleasure in nearly all activities for at least two weeks, as well as many other symptoms. Minor depression and dysthymia (dis-THIGH-mee-ah) also impair people’s ability to function in everyday life, but symptoms are fewer. With dysthymia, depression continues for at least two years.”

The study was a randomized, placebo-controlled trial comparing paroxetine (Paxil—SK Beecham) with a type of therapy still in development known as Problem-Solving Treatment (PST).

“PST involves fewer and briefer sessions than other commonly used psychotherapies in the United States,” says co-author Ellen Frank, who notes that PST was adapted from a therapy used within the United Kingdom. It is a short-term therapy that aims to improve symptoms by helping patients develop problem-solving skills. “PST has the potential to be widely used because nurses and other primary care clinicians can learn the techniques and principles,” says Mark Hegel, a study therapist.

What are the treatment implications for primary care physicians? “We believe doctors should carefully assess the severity of each patient’s symptoms and the degree of functional impairment before considering a trial of anti-depressant treatment,” Dr. Williams says. The authors recommend anti-depressant medication for older patients with dysthymia and four to six weeks of watchful waiting in older patients with minor depression unless the patient has severe functional impairment. “This is not a recommendation to do nothing,” Dr. Williams adds. “Patients with minor depression should receive support, advice on mood-lifting activities such as exercise, and careful follow-up.”

The John A. Hartford Foundation of New York and the John D. and Catherine T. MacArthur Foundation funded the four-year, $2.5 million study.

Medical reporters who would like more information about treating depression in older patients may visit the following Web site for physicians:

Contact: Karen Stamm, (210) 617-5300 x4266