PITTSBURGH, July 17, 1998 — Research from the University of Pittsburgh Medical Center (UPMC) shows that a combination of psychotherapy and medication may be the most effective way to treat depression in old age. But because combination therapy is more expensive than using either medication or talk therapy alone, many managed care companies do not offer patients that choice.
"Our study adds weight to others that suggest combination therapy is the most effective way to treat depression in elderly patients," commented Charles F. Reynolds III, M.D., professor of Western Psychiatric Institute and Clinic and neurology and primary investigator of a study published in the June edition of the American Journal of Psychiatry. "We hope to use this growing body of evidence to convince managed care providers to do the right thing and cover depression and other psychiatric illnesses in the manner that is most effective and best for the patient, just like they would for any other illness."
As people age, many new medical problems and concerns arise. Because people are living longer, depression in the elderly is a growing problem. Since symptoms associated with depression can be passed off as a natural sign of aging or mistaken for another illness, it often remains undiagnosed and untreated in older individuals.
In the study, Dr. Reynolds and his team examined 187 elderly subjects with depression. Of these 187 patients, 129 had an early onset of depression, meaning their first episode of depression struck before they had reached the age of 59, and 58 had their first episode of depression after age 60. The study concluded, in addition to finding the combination of therapy and medication was effective in approximately 80 percent of patients, that patients who experienced early onset depression took five to six weeks longer to recover than those who had their first episode later in life. Such early onset patients require especially careful management because a greater proportion of them have a history of suicide attempts.
Symptoms of depression can include any combination of the following:
Feelings of sadness, helplessness and hopelessness
Loss of interest or pleasure in enjoyable activities
Noticeable changes in appetite, accompanied by either significant weight gain or loss
Changes in sleep patterns, such as fitful sleep, insomnia or sleeping too much
Fatigue or loss of energy
Inability to concentrate
Recurring thoughts of death or suicide
Although no single cause for depression has been identified, the elderly may be at increased risk for the disease due to life experiences such as loss of a loved one, cognitive deterioration, mini-strokes, forms of dementia or decreased self-esteem, according to Dr. Reynolds.
"Depression is not a natural part of aging," said Dr. Reynolds. "It’s important that the elderly and their families know that effective treatments do exist."
For more information about treatment of depression in old age, please call 412-246-6006. For more information about psychiatry or to learn about current research studies, visit the UPMC's Western Psychiatric Institute and Clinic