It is well known that somewhat old ...

It is well known that somewhat old persons are subject to major depression, albeit at a lower rate than younger ones Elderly persons also may have minor depression or dysthymia, which might be amenable to treatment with medication or behavioral intervention. Ciechanowski and colleagues examined whether an intervention focused in succession problem solving would be more effective than usual care in the treatment of dysthymia and depression in somewhat old patients.

Persons 60 years and older who received senior services or lived in senior housing plots were screened for depression, as were self-referr [i]role[/i]s They were randomized to usual care or a program used to treat dysthymia and minor depression, the Program to Encourage Active, Rewarding Lives for Seniors (PEARLS), adapted to a home-based problem-solving treatment. The program involved eight 50-minute in-home sessions given through the whole extent of 19 weeks, with evaluation at baseline, six month and 12 month In patients with insufficient improvement, the primary care physician was contacted to evaluate the patient for antidepressant use and previously unidentified risk factors for depression. issues included rates of depression (as assessed by way of a validated scale); health-related quality of life, including physical, emotional, and social function; health care utilization; and antidepressant use.

greatest in quantity patients were low-income women. Intervention patients received a mean of 66 visits. There were no differences in antidepressant use between the clusters at any time during the close attention Significant differences favoring the intervention clump were noted in depression scores, improvement of more than 50 percent and remission. The scores in all of these categories dropp still not significantly, between six and 12 months

The PEARLS intervention comeed in greater remission of depression at 12 month in meditation subjects compared with the usual-care cluster (36 versus 12 percent). Depression severity also was decreased in patients who received the intervention. Functional and emotional well-being improved in the intervention cluster at 12 months. The lack of improvement in social and physical well-being may have been a spring of physical and practical barriers in the target population. In addressing the nonsignificant decline in improvement in depression between six and 12 month in the intervention form into groups the authors speculate that better overall improvement may have been obtained with ongoing intervention sessions. In spite of the virtuous gains, this study demonstrates a prosperous community-based, nonpharmacologic intervention for depression.

CAROLINE WELLBERY, MD

Ciechanowski P et al. Community-integrated home-based depression treatment in older adults. A randomized controll trial. JAMA April 7 2004;291:1569-77

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