Depression defense: sick elderly get mood aid from home treatment.

Brief instructional sessions delivered by a nurse or psychologist show promise as a way to prevent depression in elderly people with serious health problems, at least in the short run.

As the U.S. population ages, such treatment--which focuses on finding ways for people to continue daily activities and achieve goals despite physical ailments--will attract increasing interest, say psychiatrist Barry W. Rovner of Jefferson Hospital for Neuroscienee in Philadelphia and his colleagues.

Rovner's group studied 206 patients, all in their 70s or 80s, with preexisting macular degeneration in one eye and newly diagnosed macular degeneration in the other eye, an indicator of impending blindness.

Macular degeneration, characterized by deterioration of part of the retina, affects nearly 10 million people. It's the most common cause of legal blindness in the United States.

In a prior study, Rovner and his co-workers found that almost 30 percent of patients with macular degeneration in one eye became depressed soon after their other eye became affected.

In the new investigation, participants randomly received either sessions known as problem-solving treatment or standard follow-up medical care. In the former plan, a nurse or a psychologist visited volunteers' homes six times over 8 weeks to tailor an approach for patients to cope with blindness.

Two months after the study began, 12 percent of patients receiving problem-solving treatment were depressed, compared with 23 percent of those getting standard care. Markedly fewer patients in the problem-solving group than in the standard-care group had given up activities that they valued, such as visiting friends. The preservation of key daily activities may protect elderly medical patients against depression, the researchers propose.

However, by 6 months after the study had started, the emotional benefits of problem-solving treatment over standard care had narrowed. At that point, depression afflicted 21 percent of the problem-solving group and 27 percent of the standard-care group. Patients who had completed problem-solving treatment still pursued valued activities more often than standard-care recipients did.

Frequent contact with experimenters and an expectation of receiving problem-solving treatment after the clinical trial ended kept the depression rate artificially low in standard-care patients, the scientists suggest in the August Archives of General Psychiatry.

They call for further trials of problem-solving treatment that target medical patients in the early stages of depression and that include more than six sessions. Future trials might include counseling focused on emotional support in order to examine how the relationship of caregiver to patient influences depression.

Prior studies of depression prevention in elderly patients have primarily explored the use of antidepressant medication to protect against mood disorders following strokes and other illnesses.

Rovner's study "breaks new ground" because physically ill people probably prefer to learn coping skills at home than to take antidepressants when they still feel fine, write psychiatrist Charles F. Reynolds III of the University of Pittsburgh School of Medicine and his coworkers in a comment published with the new report.