Is Depression Inevitable with Aging?

According to a policy statement by the American Psychological Association, about 20% of community-dwelling older adults in the United States are depressed. This age-group also has the highest suicide rate in the country. This begs the question: Are depression and its attendant suicide a natural consequence of aging?

Results of the Improving Mood?Promoting Access to Collaborative Treatment for Late Life Depression (IMPACT) study suggest that something can be done about these alarming statistics if the treatment older adults receive in the primary care setting is optimized (BMJ. 2006;332:259-263).

During a 1-year intervention, IM?PACT investigators proved that organized, multifaceted, tailored depression therapy could turn things around for older adults. In 18 primary care centers in 8 US health care organizations, 1801 patients aged >=60 years with major depression were assigned to a collaborative care intervention or usual care.

Collaborative care included a team management approach. The team in?cluded a depression care manager (usually a nurse), primary care physician, and psychiatrist. Each patient was offered education, behavioral activation (that included positive activities like exercise), antidepressant medication, a brief behavior-based psychotherapy program (stressing problem-solving techniques), and individually geared relapse prevention. Participants assigned to usual care had the option of using all treatments?antidepressants, counseling by a physician, and referral to specialty mental health care.

The long-term effectiveness of IM?PACT therapies was reevaluated at 18 and 24 months. Interviewers measured depression, overall functional impairment, quality of life, and physical functioning, as well as depression treatment, and satisfaction with care.

At all follow-up points, IMPACT patients fared significantly better in all aspects of care, except overall functional impairment at 24 months (P = .4632). At 24 months, IMPACT patients showed greater confidence in their ability to manage their depression (P <.001). At all follow-ups, IMPACT patients had lower Hopkins Symptom Checklist (SCL-20) depression scores. One year after the intervention ended, a significant difference in SCL-20 scores was still evident (P <.001).

Explanations for IMPACT's success include:

? Active engagement of an often-reluctant population in their own depression care

? Ongoing relationship with a depression manager as the central caregiver

? Integration of mental health care into primary care.