For Immediate Release: September 27, 2000
Contact: Hali Wickner (603) 650-1520
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Medication Assists Elders with Mild Depression, Researchers Note
Hanover, NH -- For older people with mild depression, antidepressant medication improves symptoms faster than counseling or placebo, concluded the authors of an article published in the September 27 issue of the Journal of the American Medical Association. However, patients1 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., MD, University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System; James Barrett, MD, and Thomas Oxman, MD, both of Dartmouth Medical School; Ellen Frank, PhD, University of Pittsburgh; and Wayne Katon, MD, and Mark Sullivan, MD, both of University of Washington.
"Dartmouth1s James Barrett was responsible for the overall direction and supervision of the $2.5 million study, which was funded by the John A. Hartford Foundation of New York and the John D. and Catherine T. MacArthur Foundation of Chicago. Researchers studied 415 ethnically diverse patients over 60 with minor depression and dysthymia (mild, but long-term depression) in four cities: Lebanon, NH; San Antonio, TX; Seattle, WA; and Pittsburgh, PA.
"This is the first large study of the condition in any age group to evaluate drug treatment and counseling," says Williams, the first author. "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 people1s 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 (PaxilSK Beecham) with a therapy developed in England known as Problem-Solving Treatment-Primary Care (PST-PC), a form of behavior therapy that has fewer and shorter sessions than commonly used psychological treatments in the U.S. Mark Hegel, PhD, a DMS psychologist responsible for the training and provision of PST-PC on this study, said, "PST has the potential to be widely used because nurses and other primary care clinicians can learn the techniques and principles." The treatment aims to improve symptoms by helping patients develop problem-solving skills.
The authors recommend antidepressant 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," Williams adds. "Patients with minor depression should receive support, advice on mood-lifting activities such as exercise, and careful follow-up."
