Tag Teaming Depression
Tag Teaming Depression
Collaborative Care Doubles Effectiveness of Therapy
Dec. 10, 2002 -- An estimated 10% of America's elderly have major clinical depression, yet very few older adults receive effective treatment. But a new program hopes to change all that -- by forming a team of doctors and other healthcare workers to combat depression.
"There's a stigma about depression among older adults; to many it means being insane or having serious mental illness, so they're very hesitant to discuss it with their doctors," says psychiatrist Jurgen Unutzer, MD, MPH, of the UCLA Neuropsychiatric Institute. "They don't use the word 'depression' and will attribute whatever depressive symptoms they have to pain caused by another chronic medical condition. And their doctors focus on their physical pain as well."
Even when the elderly are prescribed antidepressants, they often offer little help. "Elderly patients don't stay on their meds very long," Unutzer tells WebMD. "Or if they do, the dose is often too low and never increased, so their depression never improves."
But an experimental intervention program Unutzer designed can more than double the effectiveness of their treatment, according to a study published in the Dec. 11 issue of TheJournal of the American Medical Association.
The secret to its success: A collaborative team approach with long-term follow-up care that routinely assesses how well patients are following treatment -- and how well it's working.
With his program, called Improving Mood-Promoting Access to Collaborative Treatment (IMPACT), a "case manager" -- usually a nurse or psychologist -- first helps establish a treatment protocol with a primary care doctor and then keeps track of its effectiveness with patients for a year or longer. If the initial treatment isn't working, specialists such as geriatric psychiatrists are brought in for their expertise.
"The key is being able to provide highly individualized treatment and more follow-up care and treatment assessment than can normally be provided by a primary care physician," Unutzer tells WebMD.
The IMPACT program was evaluated at 18 clinics across the country -- ranging from large HMO-style facilities to individual practices with as few as four doctors sharing a single "case manager."
After studying 1,800 patients aged 60 and over with depression, researchers found that almost half of those receiving IMPACT intervention reported a 50% drop in symptoms from the start of the program. But just 19% of patients treated only by their regular doctors had the same magnitude of improvement. The IMPACT patients were also more satisfied with their treatment.
Tag Teaming Depression
Collaborative Care Doubles Effectiveness of Therapy
Dec. 10, 2002 -- An estimated 10% of America's elderly have major clinical depression, yet very few older adults receive effective treatment. But a new program hopes to change all that -- by forming a team of doctors and other healthcare workers to combat depression.
"There's a stigma about depression among older adults; to many it means being insane or having serious mental illness, so they're very hesitant to discuss it with their doctors," says psychiatrist Jurgen Unutzer, MD, MPH, of the UCLA Neuropsychiatric Institute. "They don't use the word 'depression' and will attribute whatever depressive symptoms they have to pain caused by another chronic medical condition. And their doctors focus on their physical pain as well."
Even when the elderly are prescribed antidepressants, they often offer little help. "Elderly patients don't stay on their meds very long," Unutzer tells WebMD. "Or if they do, the dose is often too low and never increased, so their depression never improves."
But an experimental intervention program Unutzer designed can more than double the effectiveness of their treatment, according to a study published in the Dec. 11 issue of TheJournal of the American Medical Association.
The secret to its success: A collaborative team approach with long-term follow-up care that routinely assesses how well patients are following treatment -- and how well it's working.
With his program, called Improving Mood-Promoting Access to Collaborative Treatment (IMPACT), a "case manager" -- usually a nurse or psychologist -- first helps establish a treatment protocol with a primary care doctor and then keeps track of its effectiveness with patients for a year or longer. If the initial treatment isn't working, specialists such as geriatric psychiatrists are brought in for their expertise.
"The key is being able to provide highly individualized treatment and more follow-up care and treatment assessment than can normally be provided by a primary care physician," Unutzer tells WebMD.
The IMPACT program was evaluated at 18 clinics across the country -- ranging from large HMO-style facilities to individual practices with as few as four doctors sharing a single "case manager."
After studying 1,800 patients aged 60 and over with depression, researchers found that almost half of those receiving IMPACT intervention reported a 50% drop in symptoms from the start of the program. But just 19% of patients treated only by their regular doctors had the same magnitude of improvement. The IMPACT patients were also more satisfied with their treatment.
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