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Last Updated: Oct 11, 2012 - 10:22:56 PM
Research Article
Depression Channel

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Latest Research : Psychiatry : Depression

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Care Management Reduces Suicidal Ideation in Geriatric Depression

Jun 24, 2009 - 4:00:00 AM , Reviewed by: Dr. Himanshu Tyagi
Almost one in 10 older adults in the United States has some form of depression, and one-fifth among them contemplates suicide.

Care Management Reduces Suicidal Ideation in Geriatric Depression
Level of Evidence
3b - Individual Case-Control Study
Key Points of this article
The decline in suicidal ideation (thinking about and/or planning suicide) was 2.2 times greater in the PROSPECT group.
Main results
After two years, nearly 90 percent of patients in the PROSPECT care management group had received treatment for depression, compared with 62 percent of those receiving usual care by their physicians.

Remission of depression happened faster in the PROSPECT intervention group and remission rates continued to increase between months 18 and 24, while no appreciable increase occurred in the usual care group during the same period.
The two-year outcomes of the multicenter Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) study are published online in the American Journal of Psychiatry. Lead author of the study is Dr. George S. Alexopoulos, director of the Institute of Geriatric Psychiatry at NewYork-Presbyterian Hospital/Westchester Division and professor of psychiatry at Weill Cornell Medical College.
[RxPG] Depression in older adults too often goes unrecognized and untreated, resulting in untold misery, worsening of medical illness, and early death. A new study has identified one important remedy: Adding a trained depression care manager to primary care practices can increase the number of patients receiving treatment, lead to a higher remission rate of depression, and reduce suicidal thoughts.

"Almost one in 10 older adults in the United States has some form of depression, and one-fifth among them contemplates suicide. Two-thirds of these patients are treated by primary care physicians. Sadly, their depression is often inadequately treated due to the primary care physician's time constraints and the patient's reluctance to discuss their symptoms and adhere to treatment," says Dr. Alexopoulos.

The critical finding of the PROSPECT study is that adding a trained care manager to primary care practices increases the number of depressed older patients who receive treatment and improves their outcomes, not only in the short term, but over two years.

"This is important because depression can either become chronic or relapse after an initial improvement," adds Dr. Alexopoulos. "Most diseases have worse outcomes when an old person becomes depressed. Depression almost doubles the risk for death. It follows that treating depression effectively can reduce sickness, disability and death."

The study, conduced by NewYork Presbyterian/Weill Cornell, the University of Pittsburgh, and the University of Pennsylvania, followed 599 patients aged 60 years and older with depression at 20 primary care practices of varying sizes in New York and Pennsylvania. Participants were randomized to receive either the PROSPECT intervention or usual care. Those in the PROSPECT group were assigned a care manager -- a trained social worker, nurse or psychologist -- who helped the physician offer treatment according to accepted practice guidelines, monitored treatment response and provided follow-up over two years. Practice guidelines included the antidepressant citalopram (Celexa), with the option of other drugs or psychotherapy.

The PROSPECT intervention worked especially well for a subgroup of patients with major depression, the more severe form of the disease, with a greater number achieving remission, or the near absence of symptoms. Patients with minor depression had favorable outcomes regardless of their study group.

Various forms of care management are being used successfully for cardiovascular patients needing anticoagulation medication and for diabetes patients needing insulin monitoring, says Dr. Alexopoulos. "The PROSPECT study has demonstrated that care management is highly successful for older adults with major depression."

"At this time, our nation is focused on disease prevention as a way to improve the health of Americans and to reduce health care cost. Reducing depression over long periods of time can be one of the ways to achieve this objective," continues Dr. Alexopoulos. "Care management, like that of the PROSPECT study, is relatively inexpensive. Finding ways to reimburse it can make it broadly available and have a major impact on the overall heath care."

Original research article: http://ajp.psychiatryonline.org/cgi/reprint/appi.ajp.2009.08121779v1 
DOI of the scientific paper: 10.1176/appi.ajp.2009.08121779 
Publication: George S. Alexopoulos, Charles F. Reynolds III, Martha L. Bruce, Ira R. Katz, Patrick J. Raue, Benoit H. Mulsant, David W. Oslin, Thomas Ten Have, and The PROSPECT Group Reducing Suicidal Ideation and Depression in Older Primary Care Patients: 24-Month Outcomes of the PROSPECT Study Am J Psychiatry (published online June 15, 2009) 
On the web: Weill Cornell Medical College 

Funding information and declaration of competing interests: Dr. Alexopoulos serves as a paid member of the speaker's bureau and a paid member of the Scientific Advisory Board for Forest Laboratories Inc., the maker of the antidepressant drug citalopram (Celexa). Forest offered free citalopram and a small stipend to support the study.

Co-authors include Drs. Martha L. Bruce and Patrick J. Raue of NewYork-Presbyterian/Westchester and Weill Cornell Medical College; Dr. Charles F. Reynolds III of the University of Pittsburg; Drs. Ira R. Katz, David W. Oslin and Thomas Ten Have of the University of Pennsylvania; and Dr. Benoit H. Mulsant of the University of Toronto.

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 About Dr. Himanshu Tyagi
This news story has been reviewed by Dr. Himanshu Tyagi before its publication on RxPG News website. Dr. Himanshu Tyagi, MBBS MRCPsych is the founder editor and manager for RxPG News. In this position he is responsible for content development and overall website and editorial management functions. His areas of special interest are psychological therapies and evidence based journalism. He can be reached for corrections and feedback at [email protected]
RxPG News is committed to promotion and implementation of Evidence Based Medical Journalism in all channels of mass media including internet.
 Additional information about the news article
NewYork-Presbyterian Hospital/Westchester Division

NewYork-Presbyterian Hospital/Westchester Division, opened in 1894, is one of the world's most advanced centers for psychiatric care. The Westchester Division serves children, adolescents, adults and the elderly with comprehensive outpatient, day treatment, partial hospitalization and inpatient services. In addition to clinical treatment, the Westchester Division is also a center for interdisciplinary medical research and education through its academic affiliate, Weill Cornell Medical College. NewYork-Presbyterian Hospital also comprises NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork-Presbyterian Hospital/Columbia University Medical Center, NewYork-Presbyterian Morgan Stanley Children's Hospital and NewYork-Presbyterian Hospital/The Allen Pavilion. NewYork-Presbyterian is the #1 hospital in the New York metropolitan area and is consistently ranked among the best academic medical institutions in the nation, according to U.S.News & World Report. For more information, visit www.nyp.org.
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