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Depression treatments ‘can extend life’

Researchers have shown for the first time in a randomised trial that treatment for major depression can reduce overall mortality rates in older patients.

The study

US researchers identified 1,226 patients over the age of 60 years from 20 primary care practices who were randomised to an intervention or a usual care group. The intervention included educational sessions for GPs and patients’ families and a ‘depression care manager’ in the practice who monitored symptoms and offered psychotherapy or an increase in antidepressant dose if indicated. This study looked at the mortality risk after long term follow (up of 98 months through 2008).

The findings

After long-term follow-up (98 months), patients with major depression in the intervention group had a 24% lower mortality risk, compared with those who received usual care. The HR of minor depression in the intervention group versus minor depression in the usual care was 1.18. Those with major depression in the intervention group had a similar mortality rate to those without depression (HR 1.09), while patients with major depression in the usual care group had almost double the mortality rate, compared with those without depression (HR 1.90).

What it means for GPs

The authors commented that their data ‘provides the first evidence from a randomized clinical trial that treatment of major depression can extend life.’ The authors concluded:‘Primary healthcare occupies a strategic position inthe evaluation, treatment, and prevention of depression in late life. Our findings underscore the value of providing resources to primary care practices to integrate depression care management into chronic care management.’

BMJ 2013; online 5 June


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