Depression Therapy Less Effective for Some: Study

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Depression Therapy Less Effective for Some: Study

NEW YORK, Feb 12 (Reuters Health) - Elderly women, people with serious

physical illness and less-educated individuals may be less likely than

others to see their depression symptoms get better with treatment, new

research shows.

The study of nearly 300 men and women with depression showed that these

individuals--plus those with highly neurotic personalities--were less likely

to respond to treatment with behavioral therapy or the antidepressant drug

paroxetine (Paxil).

People with " neuroticism " tend to have more anxiety, lower self esteem and

lower tolerance for stress than other individuals, and they may feel

alienated, victimized and resentful.

Researchers led by Dr. Wayne Katon of the University of Washington School of

Medicine in Seattle report the findings in the current issue of the journal

General Hospital Psychiatry.

Patients in the 11-week study all had mild depression and were assigned to

treatment with either medication, problem-solving therapy or an inactive

placebo. At the end of the study, 52% had recovered based on standard tests

of depression, according to the report.

But certain patients--women ages 60 and older, people in poorer physical

health, those who scored high on neuroticism tests and those with no higher

education--had lower rates of recovery.

For example, the researchers report, while 71% of women ages 18 to 59

recovered, only 37% of older women did.

Among participants with 12 years of education or less, the recovery rate was

41%, compared with 61% for those with some higher education. The researchers

point out that education level may serve as a proxy for social and economic

disadvantage, which often comes with chronic " stressors " like housing and

money problems and poorer health habits like smoking and little exercise.

As for their findings on neurotic personalities, the researchers note that

anxiety, low self-esteem, low tolerance for stress and other problems could

hinder recovery from depression.

According to the researchers, these findings call attention to certain

patients who may need specialized care for depression. For example, they

write, those with significant physical illness may need both depression

treatment and care aimed at improving physical functioning and reducing any

pain they have.

And, Katon's team notes, " it is essential to develop and test active

treatments for [depression] that will be more effective in less educated,

medically ill populations since these patients represent a sizable minority

of elderly primary care populations. "

SOURCE: General Hospital Psychiatry 2002;24.