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Recognizing and treating depression in the primary care setting can reduce thoughts of suicide in older patients, according to a report published in this week's issue of the Journal of the American Medical Association (news - web sites). Dr. Charles F. Reynolds, from the University of Pittsburgh, and colleagues evaluated levels of suicidal thinking, also called "suicidal ideation," in 598 older patients with depression who visited primary care practices. The patients were randomly assigned to receive usual care or a special intervention. Suicidal ideation and depression severity were assessed at the start of the trial and at 4, 8 and 12 months. The intervention centered on two key aspects of care. Physician knowledge, the first component, was addressed using a systematic treatment plan for managing geriatric depression in the primary care setting. The second component was treatment management, which was implemented by depression care managers. Suicidal ideation rates fell much faster in the intervention group than in the usual care group, the authors note. At four months, rates of ideation had dropped by about 13 percentage points in the intervention group compared with 3 percentage points in the usual care group. Participation in the intervention also had a beneficial effect on the severity of depressive symptoms and the speed of symptom reduction, the researchers state. However, among patients with minor depression, the intervention's effects on depression were not significant unless suicidal ideation was also present. "Together these findings indicate that efforts to improve the quality of depression treatment for geriatric primary care patients can focus on patients with suicidal ideation or major depression with the expectation that appropriate management will reduce depressive symptoms, suicidal ideation, and the risk of suicide in late life," the investigators conclude. SOURCE: Journal of the American Medical Association, March 3, 2004.