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ABSTRACT: Context
Older patients with depression and executive dysfunction represent a population with significant disability and a high likelihood of failing pharmacotherapy.Objectives
To examine whether problem-solving therapy (PST) reduces disability more than does supportive therapy (ST) in older patients with depression and executive dysfunction and whether this effect is mediated by improvement in depressive symptoms.Design
Randomized controlled trial.Setting
Weill Cornell Medical College and University of California at San Francisco.Participants
Adults (aged >59 years) with major depression and executive dysfunction recruited between December 2002 and November 2007 and followed up for 36 weeks. Intervention Twelve sessions of PST modified for older depressed adults with executive impairment or ST. Main Outcome Measure Disability as quantified using the 12-item World Health Organization Disability Assessment Schedule II.Results
Of 653 individuals referred to this study, 221 met the inclusion criteria and were randomized to receive PST or ST. Both PST and ST led to comparable improvement in disability in the first 6 weeks of treatment, but a more prominent reduction was noted in PST participants at weeks 9 and 12. The difference between PST and ST was greater in patients with greater cognitive impairment and more previous episodes. Reduction in disability paralleled reduction in depressive symptoms. The therapeutic advantage of PST over ST in reducing depression was, in part, due to greater reduction in disability by PST. Although disability increased during the 24 weeks after the end of treatment, the advantage of PST over ST was retained.Conclusions
These results suggest that PST is more effective than ST in reducing disability in older patients with major depression and executive dysfunction, and its benefits were retained after the end of treatment. The clinical value of this finding is that PST may be a treatment alternative in an older patient population likely to be resistant to pharmacotherapy.Trial registration
clinicaltrials.gov Identifier: NCT00052091.
SUBMITTER: Alexopoulos GS
PROVIDER: S-EPMC3018861 | biostudies-literature | 2011 Jan
REPOSITORIES: biostudies-literature
Alexopoulos George S GS Raue Patrick J PJ Kiosses Dimitris N DN Mackin R Scott RS Kanellopoulos Dora D McCulloch Charles C Areán Patricia A PA
Archives of general psychiatry 20110101 1
<h4>Context</h4>Older patients with depression and executive dysfunction represent a population with significant disability and a high likelihood of failing pharmacotherapy.<h4>Objectives</h4>To examine whether problem-solving therapy (PST) reduces disability more than does supportive therapy (ST) in older patients with depression and executive dysfunction and whether this effect is mediated by improvement in depressive symptoms.<h4>Design</h4>Randomized controlled trial.<h4>Setting</h4>Weill Co ...[more]