Problem solving therapy for older adults with depression and executive dysfunction

January 01, 0001

Problem solving therapy for older adults with depression and executive dysfunction

The purpose of this study by US authors was to determine whether problem-solving therapy is an effective treatment in older patients with depression and executive dysfunction, a population likely to be resistant to antidepressant drugs. Participants were adults age 60 and older. Problem- solving therapy was modified to be accessible to this population. Participants were randomly assigned to 12 weekly sessions of problem-solving therapy or supportive therapy and assessed at weeks 3, 6, 9, and 12 weeks.

They found: "Of the 653 individuals referred for this study, 221 met selection criteria and were enrolled in the study. Reduction of depressive symptom severity was comparable for the two treatment groups during the first 6 weeks of treatment, but at weeks 9 and 12 the problem-solving therapy group had a greater reduction in symptom severity, a greater response rate, and a greater remission rate than the supportive therapy group (response rates at week 9: 47.1% and 29.3%; at week 12:56.7% and 34.0%; remission rates at week 9: 37.9% and 21.7%; at week 12: 45.6% and 27.8%). Problem-solving therapy yielded one additional response or remission over supportive therapy for every 4.4-5.6 patients by the end of the trial."

The authors concluded: "These results suggest that problem- solving therapy is effective in reducing depressive symptoms and leading to treatment response and remission in a considerable number of older patients with major depression and executive dysfunction. The clinical value of this finding is that problem-solving therapy may be a treatment alternative in an older patient population likely to be resistant to pharmacotherapy."

The problem-solving approach for older patients with these disorders has much to offer without the risks of drugs.

For the full abstract, click here.

Am J Psychiatry 167:1391-1398, November 2010
© 2010 to the American Psychiatric Association
Problem-Solving Therapy and Supportive Therapy in Older Adults With Major Depression and Executive Dysfunction. Patricia A. Arean, Patrick Raue, R. Scott Mackin, Dora Kanellopoulos, Charles McCulloch, and George S. Alexopoulos. Correspondence to Dr. Arean: [email protected]/edu

Category: P. Psychological. Keywords: depression, executive dysfunction, older adults, problem-solving therapy, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 7 December 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.