At age 91 "Earl" was in remarkably good health and excited
about attending his 70th college class reunion. He was particularly looking
forward to seeing his old college friend "Frank" there. During the
reunion, however, Frank died, and Earl became extremely depressed. Eight
months later Earl died as well. Would Earl have lived closer to the century
mark or even beyond if he had not been depressed?
Depression in older individuals has been strongly linked with an increased
risk of dying from various medical illnesses (Psychiatric News,
October 18, 2002). Also, several studies have suggested that treating older
persons' depression can extend their lives.
One was the Enhancing Recovery in Coronary Heart Disease Patients
(ENRICHED) trial. It found that use of a selective serotonin reuptake
inhibitor was associated with a reduction in death over a 40-month period. The
other was the Sertraline Anti-Depressant Heart Attack Randomized Trial
(SAD-HART). It included subjects who had had a heart attack and were
depressed. It found that there was a consistent trend, over a 24-week period,
for subjects taking an antidepressant to have a lower death rate than subjects
taking a placebo. However, the difference did not reach statistical
significance (Psychiatric News, August 2, 2002).
Now a new study headed by Joseph Gallo, M.D., an associate professor of
family medicine and community health at the University of Pennsylvania,
reported in the May 15 Annals of Internal Medicine, further suggests
that depression treatment can extend the lives of seniors.
The study included 396 people aged 60 or older with major depression and
203 with clinically significant minor depression. Half of those with major
depression received care as usual in a primary care practice, and half
received an experimental intervention. It was the same for those with
less-severe depression. The intervention consisted of a depression-care
manager working with a primary care physician to provide algorithm-based
The researchers then followed the subjects for about four years to
determine which ones died and why. Finally they assessed whether there was any
significant difference in the rates of death between the major-depression
subjects who had received usual care and those who had received the
intervention. They also evaluated whether there was any significant difference
in the rates of death between the minor-depression subjects who had received
usual care and those who had received the intervention. In each of these
analyses, they took possibly confounding factors such as age, gender,
education, smoking status, cardiovascular disease, stroke, diabetes, cancer,
cognition, comorbid medical conditions, and suicidal ideation into
No significant differences in death rates were found for the
minor-depression subjects, but significant differences were found for subjects
with major depression. Specifically, major-depression subjects in the
intervention arm of the study were significantly less likely to die over the
follow-up period than were major-depression subjects in the usual-care arm.
The risk of death was cut by 45 percent.
Moreover, the benefit seemed to be limited to a reduction in deaths due to
cancer. The reason for this finding, Gallo told Psychiatric News,
might be because the "cause of death from death certificates isn't as
reliable as vital status (whether someone died or not). So we can't make too
much of this particular observation. However, there could be biological
reasons why depression and cancer are related, or depression could interfere
with a person's cancer being adequately detected and treated."
Gallo also hypothesized as to why his study seemed to produce more positive
results than the two cardiovascular studies cited above. "The persons in
our study were, for the most part, community-dwelling older adults, while the
persons in the other studies were identified after a cardiac event," he
explained. "How depression affects medical illness and whether treatment
affects mortality might differ depending on.. .how far along a person is in
the course of their medical disease."
The take-home message from the two cardiovascular studies and their own,
Gallo said, is that early treatment of depression in older individuals can not
only relieve psychological distress, but may extend lives as well.
The study was financed by the National Institute of Mental Health.
"The Effect of a Primary Care Practice-Based Depression
Intervention on Mortality in Older Adults" is posted at<www.annals.org/cgi/reprint/146/10/689.pdf>.▪