Problem-Solving Therapy and Supportive Therapy in Older Adults With Major Depression and Executive Dysfunction

Abstract

Objective The purpose of this study was to determine whether problem-solving therapy is an effective treatment in older patients with depression and executive dysfunction, a population likely to be resistant to antidepressant drugs. Method Participants were adults age 60 and older with major depression and executive dysfunction. Problem-solving therapy was modified to be accessible to this population. Participants were randomly assigned to 12 weekly sessions of problem-solving therapy or supportive therapy and assessed at weeks 3, 6, 9, and 12. Results Of the 653 individuals referred for this study, 221 met selection criteria and were enrolled in the study. Reduction of depressive symptom severity was comparable for the two treatment groups during the first 6 weeks of treatment, but at weeks 9 and 12 the problem-solving therapy group had a greater reduction in symptom severity, a greater response rate, and a greater remission rate than the supportive therapy group (response rates at week 9: 47.1% and 29.3%; at week 12: 56.7% and 34.0%; remission rates at week 9: 37.9% and 21.7%; at week 12: 45.6% and 27.8%). Problem-solving therapy yielded one additional response or remission over supportive therapy for every 4.4–5.6 patients by the end of the trial. Conclusions These results suggest that problem-solving therapy is effective in reducing depressive symptoms and leading to treatment response and remission in a considerable number of older patients with major depression and executive dysfunction. The clinical value of this finding is that problem-solving therapy may be a treatment alternative in an older patient population likely to be resistant to pharmacotherapy.

Patterns of Reduced Cortical Thickness in Late-Life Depression and Relationship to Psychotherapeutic Response

“…Two PhD-level clinical psychologists and two licensed social workers with at least five years of post-licensure experience served as therapists for this study. “Treatment response” was defined as 50% reduction in depression severity scores from baseline after 12 weeks of treatment (14). Of the 22 participants receiving treatment for depression, 100% completed 12 weeks of psychotherapy.…”

“…Both antidepressant medication treatments and psychotherapeutic interventions are commonly utilized to treat LLD and both have been shown to relatively effective (14, 15), however up to 55% of patients do not respond to either type of treatment (14, 16). Structural brain changes associated with LLD have been posited as a significant factor in these poor treatment outcomes and, to date, the impact of structural brain abnormalities on treatment outcomes has focused exclusively on antidepressant medication treatments.…”

“…Psychotherapeutic interventions are becoming increasingly recognized as an evidence based treatment for LLD (20–24) and these interventions are typically conceptualized as requiring a significant amount of cognitive processing in order to be effective. As such, psychotherapies have been modified to accommodate for cognitive impairments that are common in LLD (14, 22, 23). While these psychotherapies have been shown to be effective in the treatment of LLD, as with medication treatments, a significant portion of individuals receiving treatment do not respond to these interventions (14, 23).…”

“…As such, psychotherapies have been modified to accommodate for cognitive impairments that are common in LLD (14, 22, 23). While these psychotherapies have been shown to be effective in the treatment of LLD, as with medication treatments, a significant portion of individuals receiving treatment do not respond to these interventions (14, 23). Given the cognitive demands of psychotherapy and known associations between cognitive deficits and cortical atrophy in older adults (25, 26), as well as the impact of cortical atrophy on antidepressant treatment response (18, 27), there is compelling evidence to suggest that cortical atrophy may have a deleterious impact on psychotherapy treatment outcomes.…”

This issue: Clinical and Neurobiological Findings, Treatment Developments in Late-Life Depression

“…PST-ED was found more effective than supportive therapy. 11,12 Problem adaptation therapy (PATH) was designed for patients with severe executive dysfunction. It combines problem-solving therapy with environmental adaptations and involves caregivers in treatment.…”