Journal of Affective Disorders 91S (2006) S47 – S48 www.elsevier.com/locate/jad
Oral free communication 4 FC4.1 Name Address Email Authors Affiliations Conflict Abstract ID Type Title Keywords Abstract
Dr. Chew-Graham Carolyn Rusholme Academic Unit, Walmer Street, Rusholme M14 5NP, UK [email protected]
Dr Carolyn Chew-Graham, Dr Heather Burroughs, Dr Chris Roberts, Dr Karina Lovell, Prof Robert Baldwin, Prof Alistair Burns, Dr Mike Morley, Professor David Richards. University of Manchester, UK; University of York, UK No AB13 Both Is a self-help intervention effective for late-life depression? Late-life depression; Self-help intervention; Feasibility study Aims: To investigate the feasibility and effectiveness of a new intervention for the management of patients with late life depression. Background: Depression is the most prevalent mental health problem in later life, worsens the outcome for co-morbid physical conditions and reduces the quality of life of affected individuals. Depression in later-life is poorly recognised and managed in primary care. The PRIDE trial, funded by the Department of Health, was a feasibility study of a complex intervention for the management of late-life depression in primary care. Methods: The trial was sited in one Manchester Primary Care Trust. All GPs (105), practice nurses and district nurses were invited to refer elderly people who they suspected as having a depressive illness to be assessed for the trial. The intervention, delivered by a CPN, comprised education about depression, medication management, liaison between primary and secondary care, and direct patient work based on SHADE (a self-help manual for the management of anxiety and depression). The intervention (delivered by face to face contact and telephone) lasted twelve weeks and patients were followed up four months after randomisation. Recruitment to the trial was from Feb 2004 and June 2005. A qualitative component was built into the trial to explore acceptability of the intervention. Results: Not all practices engaged with the study. 180 patients were referred for assessment and 105 randomised to intervention or control groups. Some primary care professionals used the trial as a means of obtaining a diagnostic assessment on their patients. We will present early results on the effectiveness of the intervention, and results from the qualitative study on acceptability of the different components of the intervention. Conclusion: Some patients were referred to the trial who were not depressed, and the implications for any service development will be discussed. The qualitative work suggests that the intervention was acceptable, although the use of a self-help manual and contact by telephone may be less acceptable than to a younger patient group. Outcome data is currently being analysed and will be presented for the first time at ISAD.
FC4.2 Name Address Email Authors Affiliations Conflict Abstract ID Type Title
Dr. Michael Thase Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA [email protected]
Michael E. Thase, M.D. University of Pittsburgh Medical Center, USA No AB18 Free communication Efficacy of psychotherapy with and without medication for elderly depressed patients
S48 Keywords Abstract
Oral free communication 4 Psychotherapy; Pharmacotherapy; Depression; IPT; CBT; Late life depression As is the case for depression in mid-life, antidepressants and psychotherapy, either alone or in combination, are first line treatments for elders with nonpsychotic depressive disorders. Although therapeutics research in late-life depression has been determined to be a public health priority, the evidence base supporting the use of psychotherapy is substantially “thinner” than for pharmacotherapy. There are several reasons for this, including the more limited sources of funding for psychotherapy research and ageist beliefs about the suitability of elders for psychotherapy. It is now clear that, with appropriate modifications and a few relevant contraindications (i.e., psychosis and severe cognitive impairment), all of the so-called empirically validated psychotherapies are appropriate for older depressed outpatients. Nevertheless, even the best studied approaches — cognitive behavior therapy (CBT), interpersonal therapy (IPT), and problem solving therapy (PST), have an A level of empirical support (as defined by at least 2 positive randomized controlled trials). In addition to reviewing the pertinent studies examining the efficacy of CBT, IPT, and PST for depression in later life, this presentation will include recommendations for prioritizing the next generation of research on the psychotherapy of late life depression.
FC4.3 Name Address Email Authors Affiliations Conflict Abstract ID Type Title Keywords Abstract
Dr. Janet Carter Department of Psychological Medicine, PO Box 4345, 116 St Martins Road, St Martins, Christchurch, New 8001, New Zealand [email protected]
Dr Janet Carter, Professor Peter Joyce, Associate Professor Suzanne Luty, Professor Roger Mulder, Dr Jan McKenzie, Associate Professor Christopher Frampton Department of Psychological Medicine, Christchurch School of Medicine, New Zealand and Health Sciences, University of Otago, New Zealand No AB41 Free communication Predictors of response to Interpersonal Psychotherapy and Cognitive Behaviour Therapy Psychotherapy; Depression; CBT; IPT; Predictors; Outcome Aims: The aim of this study was to identify patient factors associated with response to CBT and IPT in adults with major depression. Background: Very little is known about the patient characteristics associated with response to CBT and IPT. Certain patient characteristics may be general prognostic indicators of response, irrespective of therapy type, however, there may also be other specific patient characteristics which are indicators of response to a specific treatment type (CBT vs. IPT). Methods: After providing informed written consent, 177 adults with major depression (DSM-IV) were randomized to receive 16 weekly sessions of either CBT or IPT. Patient characteristics were assessed prior to randomization. Outcome at the end of the weekly sessions was defined as percentage improvement on the clinician rated Montgomery Asberg Depression Rating Scale (MADRS), which takes account of initial depression severity. Results: Factors associated with greater percentage improvement on the MADRS over the course of therapy included receiving CBT, having a single episode of depression and a perception that the therapy (irrespective of treatment type) was logical. Individuals who had comorbid personality disorder symptomatology had higher percent improvement over the course of treatment if they received CBT (60%) rather than IPT (30%). Conclusion: Despite examination of a number of potential predictors of differential response to CBT and IPT, few were significant. However, this study suggests that CBT is a better treatment option for depressed patients with comorbid personality disorder than IPT.