Depression therapy less effective for some patients

NEW YORK (Reuters Health) – Elderly women, people with serious physical illness and less-educated individuals may be less likely than others to have an improvement in symptoms during treatment for depression, new research shows.

The results of a 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 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 medication, placebo or problem-solving therapy. At the end of the study, 52% had recovered based on standard tests of depression, according to the report.

But certain patients-women 60 years of age or older, people in poor 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 between the age of 18 and 59 years 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," such as housing and money problems, and poorer health habits, such as smoking and not being physically active.

The researchers also found that among neurotic patients, 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 pain.

Dr. 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."

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