NEW YORK (June 23, 2009) -- Depression in older adults too often
goes unrecognized and untreated, resulting in untold misery, worsening
of medical illness, and early death. A new study has identified one
important remedy: Adding a trained depression care manager to primary
care practices can increase the number of patients receiving treatment,
lead to a higher remission rate of depression, and reduce suicidal
thoughts.
The two-year outcomes of the multicenter Prevention
of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT)
study are published online in the American Journal of Psychiatry.
Lead
author of the study is Dr. George S. Alexopoulos, director of the
Institute of Geriatric Psychiatry at NewYork-Presbyterian
Hospital/Westchester Division and professor of psychiatry at Weill
Cornell Medical College.
"Almost one in 10 older adults in the
United States has some form of depression, and one-fifth among them
contemplates suicide. Two-thirds of these patients are treated by
primary care physicians. Sadly, their depression is often inadequately
treated due to the primary care physician's time constraints and the
patient's reluctance to discuss their symptoms and adhere to
treatment," says Dr. Alexopoulos. "The critical finding of the PROSPECT
study is that adding a trained care manager to primary care practices
increases the number of depressed older patients who receive treatment
and improves their outcomes, not only in the short term, but over two
years.
"This is important because depression can either
become chronic or relapse after an initial improvement," adds Dr.
Alexopoulos. "Most diseases have worse outcomes when an old person
becomes depressed. Depression almost doubles the risk for death. It
follows that treating depression effectively can reduce sickness,
disability and death."
The study, conduced by NewYork
Presbyterian/Weill Cornell, the University of Pittsburgh, and the
University of Pennsylvania, followed 599 patients aged 60 years and
older with depression at 20 primary care practices of varying sizes in
New York and Pennsylvania. Participants were randomized to receive
either the PROSPECT intervention or usual care. Those in the PROSPECT
group were assigned a care manager -- a trained social worker, nurse or
psychologist -- who helped the physician offer treatment according to
accepted practice guidelines, monitored treatment response and provided
follow-up over two years. Practice guidelines included the
antidepressant citalopram (Celexa), with the option of other drugs or
psychotherapy.
After two years, nearly 90 percent of patients
in the PROSPECT care management group had received treatment for
depression, compared with 62 percent of those receiving usual care by
their physicians. The decline in suicidal ideation (thinking about
and/or planning suicide) was 2.2 times greater in the PROSPECT group.
Remission
of depression happened faster in the PROSPECT intervention group and
remission rates continued to increase between months 18 and 24, while
no appreciable increase occurred in the usual care group during the
same period.
The PROSPECT intervention worked especially well
for a subgroup of patients with major depression, the more severe form
of the disease, with a greater number achieving remission, or the near
absence of symptoms. Patients with minor depression had favorable
outcomes regardless of their study group.
Various forms of
care management are being used successfully for cardiovascular patients
needing anticoagulation medication and for diabetes patients needing
insulin monitoring, says Dr. Alexopoulos. "The PROSPECT study has
demonstrated that care management is highly successful for older adults
with major depression."
"At this time, our nation is focused
on disease prevention as a way to improve the health of Americans and
to reduce health care cost. Reducing depression over long periods of
time can be one of the ways to achieve this objective," continues Dr.
Alexopoulos. "Care management, like that of the PROSPECT study, is
relatively inexpensive. Finding ways to reimburse it can make it
broadly available and have a major impact on the overall heath care."
###
Dr.
Alexopoulos serves as a paid member of the speaker's bureau and a paid
member of the Scientific Advisory Board for Forest Laboratories Inc.,
the maker of the antidepressant drug citalopram (Celexa). Forest
offered free citalopram and a small stipend to support the study.
Co-authors
include Drs. Martha L. Bruce and Patrick J. Raue of
NewYork-Presbyterian/Westchester and Weill Cornell Medical College; Dr.
Charles F. Reynolds III of the University of Pittsburg; Drs. Ira R.
Katz, David W. Oslin and Thomas Ten Have of the University of
Pennsylvania; and Dr. Benoit H. Mulsant of the University of Toronto.
For more information, patients may call (866) NYP-NEWS.
NewYork-Presbyterian Hospital/Westchester Division
NewYork-Presbyterian Hospital/Westchester Division, opened in 1894, is
one of the world's most advanced centers for psychiatric care. The
Westchester Division serves children, adolescents, adults and the
elderly with comprehensive outpatient, day treatment, partial
hospitalization and inpatient services. In addition to clinical
treatment, the Westchester Division is also a center for
interdisciplinary medical research and education through its academic
affiliate, Weill Cornell Medical College. NewYork-Presbyterian Hospital
also comprises NewYork-Presbyterian Hospital/Weill Cornell Medical
Center, NewYork-Presbyterian Hospital/Columbia University Medical
Center, NewYork-Presbyterian Morgan Stanley Children's Hospital and
NewYork-Presbyterian Hospital/The Allen Pavilion. NewYork-Presbyterian
is the #1 hospital in the New York metropolitan area and is
consistently ranked among the best academic medical institutions in the
nation, according to U.S.News & World Report. For more information, visit www.nyp.org.
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