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Depressed Seniors in Primary Care Benefit Most From Team Approach

Depressed older adults being treated in primary care settings do better with psychosocial therapies than with antidepressant medicines, suggests a new review of evidence. //

Furthermore, older adults with depression have the best response when these cognitive-behavioral therapies are delivered by interdisciplinary health teams, say reviewers led by psychologist Karyn Skultety.

The review recommends this integrated approach instead of the more conventional focus on antidepressant medications.

The suggestion is based on only eight studies, yet, “We think the findings give us some valuable information on what works,” says Skultety, who works in the Veterans Administration Palo Alto Health Care System in California.

The reviewers also note that older adults prefer to seek help for depression from primary care physicians, and that many prefer psychosocial treatments. “They’re on a lot of medications already, and usually they’re trying to work with their doctors to reduce the number of medications they’re on, not increase,” Skultety said.

The review, part of a new series, appears in the November issue of the journal Health Psychology. Each evidence-based review centers on a specific psychological assessment or treatment conducted in the context of a physical disease process or risk reduction effort.

The review comprised eight randomized controlled trials comparing psychosocial treatments in primary care to “usual care” for patients aged 55 and older. The number of participants ranged from 96 in the smallest study to 1,801 in the largest.

Usual care in all the studies involved allowing primary care physicians to assess depression and offer treatment as they deemed appropriate.

Psychosocial interventions included education and counseling provided by nurses, social workers, psychologists, counselors, or physicians.

The strongest treatment effects appeared in the two
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