For Elderly, Antidepressants May Trump Psychotherapy

NY Times ^ | March 16, 2006 | BENEDICT CAREY

[neverdem]

Antidepressants work better than psychotherapy in preventing relapses in elderly men and women who have recovered from depression, a new study suggests.

The government-financed study, published today in The New England Journal of Medicine, found that a combination of drugs and therapy was the best way to restore well-being in seriously depressed patients 70 and older. Once the patients had recovered, however, drug treatment was more effective over the next two years than once-a-month psychotherapy.

Experts said the results underscored the challenges of treating depression in people past retirement age who are buffeted by anxieties — about dying, losing friends, declining physical health — that are different from those of younger adult patients.

The report also suggests that an orchestrated combination of psychotherapy, medication and careful case management followed by continued drug treatment can keep more than 40 percent of elderly people well for at least two years.

Past studies have found that antidepressants alone are no better than placebos in relieving depression in people over 70, who tend to be more vulnerable to the drugs' side effects, including dizziness. But most of the estimated six million elderly Americans who suffer from depression receive little more than a prescription for an antidepressant if they receive treatment at all, psychiatrists say.

"What this study shows is how well we can do when people get the state-of-the-art treatment, from some of the best people in the field, but it's very rarely done this way," said Dr. Gary Kennedy, chief of geriatric psychiatry at the Montefiore Medical Center in the Bronx.

Dr. Charles Reynolds, a psychiatry professor at the University of Pittsburgh, led the study of 195 people 70 and older in a program that included daily doses of the antidepressant Paxil and 12 to 15 weekly, hourlong therapy sessions.

[vimto]

Thanks for a useful post.

I agree that medication can be poorly used.

It is the clinical end I am concerned about.

The effects of agitated depression (for instance) in the elderly is often fatal.

A part of the problem is that 'depression' is not any one thing but like arthritis has many manifestations.

I am a psychiatric nurse who never ever thought I would suffer form depression. After radical surgery for kidney tumor I found myself somewhere worse than the surgery ever took me. The residue is with me today but I fight against it with the help of therapy and drugs. I have still managed to start my own company and continue to pastor a small church. Much of the time I feel like crap due to mild depression - but that I cope with. Heck we've all got something to put up with. But the severity of the original attack was truly astounding and devastating. I do not ask for sympathy just that the condition is acknowledged as real and serious.

Kind regards,

[vimto]

Thanks for clearing that up - I'm in the UK and couldn't get your drift. Now I can.

There are to issues.

The first is - is clinical depression a serious and often fatal condition. Answer - yes.

The second is - should the government pay for it's treatment answer - ? for you clearly no, and that is honorable.

But I would urge you not to rubbish the former in order to justify the latter.

Kind regards as always

[PGalt]

Thanks for the ping. Interesting.

Two people very close to me used antidepressants. One committed suicide and the other is much healthier mentally since she has been off of them. I do not know anyone else who takes them on a daily basis.

I hope they help some people. My direct contact sample size is insignificant.

[thoughtomator]

With regards to depression itself, I have found that sympathy can be a driver and an enabler of depression... because it is pleasurable to be sympathized with, giving sympathy actually encourages the continuation of depressive behavior.

[verity]

Going "cold turkey" is a measure of one's fortitude. ;-)

[vimto]

I think you are right.

please note I said I do not want sympathy just an acknowledgment of the reality of the condition. And yes there are people who claim to be depressed but are not - and that makes it harder for people like me to get a voice heard.

I have a little personal crusade to get the profile of depression raised.

warm regards.

[technochick99]

But I would urge you not to rubbish the former in order to justify the latter.

Said only in the way a Brit could say it! Glad you have had such a success.

[technochick99]

With regards to depression itself, I have found that sympathy can be a driver and an enabler of depression...

Your insights are certainly worth the price.

[vimto]

that made me giggle...


kind regards,

[SupplySider]

Vitamin D!!!!

Right on. Vitamin D, walnuts, and exercise.

[Alouette]

Grandkids are better than prozac. Pets, too. Having something to do and knowing that you are loved is better than any drug.