Recovering from depression may be tougher for certain groups of patients: elderly women, the less educated, those with neurotic traits and the medically ill, according to a new study.
“It is essential to develop and test active treatments for depression that will be more effective in these populations,” says lead study author Wayne Katon, M.D., of the department of psychiatry and behavioral sciences at the University of Washington School of Medicine in Seattle.
“Treatments involving longer-term and more intensive specialty mental health treatment may be necessary,” he added.
Katon and colleagues studied nearly 300 depressed individuals ranging in age from 18 to 90. All had experienced symptoms of depression for at least two years. The researchers treated the study participants in one of three ways: with an antidepressant medication called paroxetine, problem-solving therapy or a placebo.
At the end of the 11-week study period, approximately 48 percent of the study participants were still suffering from depression, while 52 percent had responded positively to treatment. The nonresponders tended to be elderly women or to be individuals with low education levels, more severe medical illnesses or high neuroticism scores, the researchers found.
The study results are published in the current issue of the journal
General Hospital Psychiatry. Another study finding was that females had a significantly higher response to the placebo treatment compared to males. Since this finding is not consistent with previous study findings, it should be interpreted with caution, the authors say.
The researchers called the finding that elderly women were less responsive to treatment intriguing. More than 70 percent of the younger female participants recovered from depression by the end of the study period, compared to just 37 percent of the older females, according to the study.
Other research has found that women on estrogen replacement therapy were more responsive to the antidepressants known as selective serotonin reuptake inhibitors (SSRIs). Estrogen replacement therapy might increase the effectiveness of other treatments as well, but more research is needed on the question, the researchers say. “Future research needs to examine whether estrogen replacement therapy in post-menopausal women with depression would bolster the effects of all active treatments or whether this effect is specific to SSRIs,” says Katon.
Regarding the finding that study participants with lower education levels were less responsive to treatment, the researchers point out that less education is often associated with lower socioeconomic class. Individuals in lower socioeconomic groups may experience more social stressors such as housing and money troubles, live in neighborhoods with more threats and violence, have fewer healthy coping mechanisms and have less social support compared to those in higher socioeconomic groups. Such factors may contribute to poor depression recovery, the researchers say.
The finding that higher levels of neuroticism were associated with poor depression recovery is consistent with previous research findings. “Patients with high neuroticism tend to describe themselves as having low tolerance for stress, feeling alienated, having low self-esteem, being anxious worriers and feeling easily victimized and resentful,” says Katon.
The researchers note that their finding that medically ill individuals were less responsive to treatment is also consistent with other research. Depression treatments for patients who are also suffering from physical illness may also need to incorporate treatments such as physical therapy and pain management to be effective. They also need to be integrated into primary care, they say.
Katon and colleagues point out that the study was limited by the fact that they did not conduct structured interviews with the study participants or measure chronic stress, coping, social support and life events.
This research was supported by grants from the John A. Hartford and MacArthur Foundations.
General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Science. For information about the journal, contact Don R. Lipsitt, M.D., at (617) 499-5008.