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Collaborative, Evidence-Based Approach Encouraged for Depression

CHICAGO – The development of guidelines to treat depression in the elderly using evidence-based research is important, said a panel of experts at a joint conference of the American Society on Aging and the National Council on Aging. However, inadequate research and an unwillingness among providers to rely on evidence-based research make the process challenging.

“The mental health community needs to do a better job of getting on the evidence-based bandwagon,” said Sharon Dumberg-Lee, a licensed certified social worker at the Council for Jewish Elderly in Chicago.

Depression Is Undertreated

Despite the lack of evidence-based treatment, mental health practitioners seem to agree that undertreated depression is a serious problem. “We care about depression because it's a fairly common psychiatric disorder, and because it causes a fair amount of morbidity,” said Dr. John Frederick, a psychiatrist at the University of Washington, Seattle. He noted that depression in older adults complicates chronic medical conditions and, if it is not properly treated, can lead to self-neglect, premature death, and suicide. But the importance of treating depression does not necessarily translate into adequate treatment. “Older adults are often suboptimally treated,” Dr. Frederick said.

Dr. Frederick worked with his colleague, Dr. Mark Snowden, on the Depression Special Interest Project, sponsored by the Centers for Disease Control and Prevention.

Working with other experts, they performed a literature review of research on the treatment of depression in community settings. The investigators looked at 174 studies, each with 25 or more participants, that evaluated community-dwelling adults who were at least 60 years old and in treatment for a wide range of depressive disorders. They determined that the research indicates that two types of treatment improve outcomes in this population: cognitive-behavioral therapy, and depression care management both in the home and in the primary care clinic.

Mixed Report on Interventions

The project also revealed certain interventions that the researchers said do not seem to benefit older adults who seek treatment for depression. These treatment modes included individual psychotherapy, education skills training, and exercise.

The project results not only indicated which treatments of depression in older adults are effective and which are not, but also helped the researchers to understand which areas need improvement. They specifically said that research on the prevention of depression and suicide is lacking. “Suicide is a very tough area to study,” he said.

Dr. Snowden pointed out the large gap between efficacy research and real-world practice. Many practitioners “treat patients all the time, and they get better,” he explained, even though the treatment plans and outcomes may not fit neatly into a publishable research study.

He urged psychiatrists and other community mental health providers to contribute to the knowledge base by participating in research projects.

Lynda A. Anderson, Ph.D., director of Health Aging Program at the CDC, shared her thoughts: “We already know there's a gap between evidence-based research and use in community settings,” she said. She stated that reaching out to social service agencies to promote evidence-based research is important.

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CHICAGO – The development of guidelines to treat depression in the elderly using evidence-based research is important, said a panel of experts at a joint conference of the American Society on Aging and the National Council on Aging. However, inadequate research and an unwillingness among providers to rely on evidence-based research make the process challenging.

“The mental health community needs to do a better job of getting on the evidence-based bandwagon,” said Sharon Dumberg-Lee, a licensed certified social worker at the Council for Jewish Elderly in Chicago.

Depression Is Undertreated

Despite the lack of evidence-based treatment, mental health practitioners seem to agree that undertreated depression is a serious problem. “We care about depression because it's a fairly common psychiatric disorder, and because it causes a fair amount of morbidity,” said Dr. John Frederick, a psychiatrist at the University of Washington, Seattle. He noted that depression in older adults complicates chronic medical conditions and, if it is not properly treated, can lead to self-neglect, premature death, and suicide. But the importance of treating depression does not necessarily translate into adequate treatment. “Older adults are often suboptimally treated,” Dr. Frederick said.

Dr. Frederick worked with his colleague, Dr. Mark Snowden, on the Depression Special Interest Project, sponsored by the Centers for Disease Control and Prevention.

Working with other experts, they performed a literature review of research on the treatment of depression in community settings. The investigators looked at 174 studies, each with 25 or more participants, that evaluated community-dwelling adults who were at least 60 years old and in treatment for a wide range of depressive disorders. They determined that the research indicates that two types of treatment improve outcomes in this population: cognitive-behavioral therapy, and depression care management both in the home and in the primary care clinic.

Mixed Report on Interventions

The project also revealed certain interventions that the researchers said do not seem to benefit older adults who seek treatment for depression. These treatment modes included individual psychotherapy, education skills training, and exercise.

The project results not only indicated which treatments of depression in older adults are effective and which are not, but also helped the researchers to understand which areas need improvement. They specifically said that research on the prevention of depression and suicide is lacking. “Suicide is a very tough area to study,” he said.

Dr. Snowden pointed out the large gap between efficacy research and real-world practice. Many practitioners “treat patients all the time, and they get better,” he explained, even though the treatment plans and outcomes may not fit neatly into a publishable research study.

He urged psychiatrists and other community mental health providers to contribute to the knowledge base by participating in research projects.

Lynda A. Anderson, Ph.D., director of Health Aging Program at the CDC, shared her thoughts: “We already know there's a gap between evidence-based research and use in community settings,” she said. She stated that reaching out to social service agencies to promote evidence-based research is important.

CHICAGO – The development of guidelines to treat depression in the elderly using evidence-based research is important, said a panel of experts at a joint conference of the American Society on Aging and the National Council on Aging. However, inadequate research and an unwillingness among providers to rely on evidence-based research make the process challenging.

“The mental health community needs to do a better job of getting on the evidence-based bandwagon,” said Sharon Dumberg-Lee, a licensed certified social worker at the Council for Jewish Elderly in Chicago.

Depression Is Undertreated

Despite the lack of evidence-based treatment, mental health practitioners seem to agree that undertreated depression is a serious problem. “We care about depression because it's a fairly common psychiatric disorder, and because it causes a fair amount of morbidity,” said Dr. John Frederick, a psychiatrist at the University of Washington, Seattle. He noted that depression in older adults complicates chronic medical conditions and, if it is not properly treated, can lead to self-neglect, premature death, and suicide. But the importance of treating depression does not necessarily translate into adequate treatment. “Older adults are often suboptimally treated,” Dr. Frederick said.

Dr. Frederick worked with his colleague, Dr. Mark Snowden, on the Depression Special Interest Project, sponsored by the Centers for Disease Control and Prevention.

Working with other experts, they performed a literature review of research on the treatment of depression in community settings. The investigators looked at 174 studies, each with 25 or more participants, that evaluated community-dwelling adults who were at least 60 years old and in treatment for a wide range of depressive disorders. They determined that the research indicates that two types of treatment improve outcomes in this population: cognitive-behavioral therapy, and depression care management both in the home and in the primary care clinic.

Mixed Report on Interventions

The project also revealed certain interventions that the researchers said do not seem to benefit older adults who seek treatment for depression. These treatment modes included individual psychotherapy, education skills training, and exercise.

The project results not only indicated which treatments of depression in older adults are effective and which are not, but also helped the researchers to understand which areas need improvement. They specifically said that research on the prevention of depression and suicide is lacking. “Suicide is a very tough area to study,” he said.

Dr. Snowden pointed out the large gap between efficacy research and real-world practice. Many practitioners “treat patients all the time, and they get better,” he explained, even though the treatment plans and outcomes may not fit neatly into a publishable research study.

He urged psychiatrists and other community mental health providers to contribute to the knowledge base by participating in research projects.

Lynda A. Anderson, Ph.D., director of Health Aging Program at the CDC, shared her thoughts: “We already know there's a gap between evidence-based research and use in community settings,” she said. She stated that reaching out to social service agencies to promote evidence-based research is important.

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