For older people with mild depression, antidepressant medication improves symptoms better and faster than counseling or placebos, 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.
“This is the first large study of either mild depression or what is known as dysthmia (diss-THIGH-me-uh) in any age group to evaluate drug treatment and counseling,” Katon said. Researchers studied 415 ethnically diverse patients with minor depression in Seattle and three other cities: San Antonio, TX, Lebanon, NH, and Pittsburgh, PA.
“When people think of depression, usually it?s major depression,” Katon said. “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 also impairs people?s ability to function in everyday life, but symptoms are fewer. Dysthymia is a chronic low-grade depression. The patients reported more bad days than good over the previous two years or more.”
The study was a randomized, placebo-controlled trial, comparing anti-depressant medication with a type of therapy still in development known as problem-solving treatment (PST). It is a short-term therapy that aims to improve symptoms by helping patients develop problem-solving skills.
What are the treatment implications for primary-care physicians? Katon and his colleagues said they believe doctors should carefully assess the severity of each patient?s symptoms and the degree of functional impairment before considering a trial of antidepressant treatment. However, the researchers said this is not a recommendation to do nothing. 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. Other researchers on this project included Dr. John Williams, Jr., of the University of Texas Health Science Center in San Antonio; Drs. James Barrett and Tom Oxman, both of Dartmouth Medical School; and Dr. Ellen Frank, University of Pittsburgh.