Psychiatric Briefs

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Objective: To assess the incidence and clinical predictors of symptom deterioration in depressed elderly patients who have responded to treatment in primary care.

Method: This was a cohort study enrolling 901 older adults who met DSM-IV criteria for major depressive disorder and/or dysthymia at baseline. Participants were drawn from 18 primary care clinics in 5 states. They had participated in a trial of collaborative care for depression compared with usual care and had improved sufficiently to no longer meet criteria for major depressive disorder at 12 months. Participants were evaluated for 1 year (18 and 24 months) after enrolling in the original study.

Results: Over the 12- to 24-month observational period, 40% of patients met criteria for significant depressive symptom deterioration. Greater initial severity of depression and a greater number of residual DSM-IV depressive symptoms at 12 months constituted significant predictors of symptom deterioration among usual-care patients. Symptom deterioration in intervention patients was not predicted by any variables.

Conclusions: Elderly patients in primary care who are treated for depression evince a high rate of symptom deterioration. Attempts to improve long-term outcomes of older patients with major depressive disorder and/or dysthymia ought to concentrate on supplying more intensive treatment and follow up for patients with residual symptoms of depression.

Prim Care Companion J Clin Psychiatry 2007;9(1):74-79