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Comparing Clinical Practice With Guideline Recommendations for the Treatment of Depression in Geriatric Patients

Findings From the APA Practice Research Network

Received May 16, 2002; revised August 23, 2002; accepted September 16, 2002. From the Office of the Dean, College of Medicine, Texas A&M University System Health Science Center (CCC), Department of Psychiatry, Michigan State University, East Lansing, Michigan (DBW,MM), the University of Pennsylvania School of Social Work, Philadelphia, PA (SCM), the RAND Corporation, Arlington, VA and Pittsburgh, PA (TT,HAP), and the Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA (HAP). Address correspondence to Dr. Colenda, Dean, College of Medicine, Texas A&M University System Health Science Center, College Station, TX 77843-1114. e-mail: colenda{at}medicine.tamu.edu

Objective: The authors describe treatments provided for depressed geriatric patients (age 65+) treated by psychiatrists in the American Psychiatric Association's (APA) Practice Research Network (PRN) and compare treatments with recommended guidelines for treating late-life depression. Methods: Detailed demographics, diagnoses, service utilization, and treatment information were collected on relevant patients treated by psychiatrists participating in the APA's PRN during 1997, sample-weighted to produce nationally representative estimates. Treatment data were qualitatively compared with existing depression treatment guidelines from the APA and the Expert Consensus Guideline Series on pharmacotherapy of depressive disorders in older patients. Results: Of patients treated by psychiatrists in the PRN (N=152), just over 41% had a diagnosable depressive disorder, and, of those with depression, nearly 84% had major depression. Over 90% received a psychotropic medication, and over 75% received an antidepressant. Treatment intensity, as measured by visit frequency and duration of treatment, were more intense than typically found in primary care. Most patients received a combination of medication management and psychotherapy. Selective serotonin reuptake inhibitors were the most frequently prescribed antidepressant, although they were less frequently prescribed than in primary care and other national surveys. Just over 11% received a tertiary amine antidepressant, and nearly 43% received benzodiazepines, this frequency being inconsistent with existing guidelines. Conclusion: Depressed geriatric patients treated by psychiatrists in APA's PRN receive active treatments largely consistent with existing guidelines, which generally resulted in favorable patient outcomes.

Key Words: Depression • APA Practice Research Guidelines

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