This study proposes to compare the efficacy of Problem Solving Therapy (PST) to that of Supportive Therapy (ST) in non-demented elderly patients with major depression and cognitive impairment. Among them, we will focus on patients with major depression and executive dysfunction because this combination of symptoms (as defined in our preliminary studies) is prevalent, debilitating, and responds poorly to treatment with antidepressant agents. Therefore, we find it compelling to identify an effective treatment for these patients, who would otherwise remain depressed, debilitated, and demoralized during the last years of their lives. We selected PST because it can address depression as well as deficits in problem solving skills that impact on the patients' ability to negotiate their environment and contribute to their depression and disability. Moreover we now have empirical evidence suggesting that PST can reduce depressive symptoms and disability in cognitively unimpaired depressed elderly patients as well as elderly patients with major depression and executive dysfunction. ? ? The subjects will be 240 (120 from each Center) elderly (>64 years) patients with non-psychotic, unipolar major depression and executive dysfunction and will be randomly assigned to receive 12 sessions of PST or ST. The study is designed to test the hypotheses that the PST is more effective than ST in reducing depressive symptoms and disability. Furthermore, we hypothesize that these effects are mediated by improvement in generation of alternative solutions, decision making, and solution implementation. ? ? While we are aware of the methodological problems and confounds posed by studying a """"""""sick and old population"""""""", we bring to this project two groups with complementary expertise in treatment studies and psychotherapy research, and experience in directing multicenter studies. Moreover, the project will be supported by the structures of the Cornell Intervention Research Center (IRC), whose principal objective is to develop treatment interventions targeting specific clinical and biological characteristics of geriatric depression. Accordingly, we are well positioned to meet the challenges inherent in this difficult but important area of research.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH063982-03
Application #
6750064
Study Section
Special Emphasis Panel (ZMH1-ITV-D (01))
Program Officer
Niederehe, George T
Project Start
2002-09-20
Project End
2007-05-31
Budget Start
2004-06-01
Budget End
2005-05-31
Support Year
3
Fiscal Year
2004
Total Cost
$378,750
Indirect Cost
Name
University of California San Francisco
Department
Psychiatry
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Gustavson, Kristen A; Alexopoulos, George S; Niu, Grace C et al. (2016) Problem-Solving Therapy Reduces Suicidal Ideation In Depressed Older Adults with Executive Dysfunction. Am J Geriatr Psychiatry 24:11-17
Areán, Patricia A; Raue, Patrick J; McCulloch, Charles et al. (2015) Effects of Problem-Solving Therapy and Clinical Case Management on Disability in Low-Income Older Adults. Am J Geriatr Psychiatry 23:1307-1314
Gansler, David A; Suvak, Michael; Arean, Patricia et al. (2015) Role of Executive Dysfunction and Dysexecutive Behavior in Late-Life Depression and Disability. Am J Geriatr Psychiatry 23:1038-45
Mackin, R Scott; Nelson, J Craig; Delucchi, Kevin et al. (2014) Cognitive outcomes after psychotherapeutic interventions for major depression in older adults with executive dysfunction. Am J Geriatr Psychiatry 22:1496-503
Mackin, R Scott; Nelson, J Craig; Delucchi, Kevin L et al. (2014) Association of age at depression onset with cognitive functioning in individuals with late-life depression and executive dysfunction. Am J Geriatr Psychiatry 22:1633-41
Yon, Adriana; Scogin, Forrest; DiNapoli, Elizabeth A et al. (2014) Do manualized treatments for depression reduce insomnia symptoms? J Clin Psychol 70:616-30
Dakin, Emily K; Areán, Patricia (2013) Patient perspectives on the benefits of psychotherapy for late-life depression. Am J Geriatr Psychiatry 21:155-63
Mackin, R Scott; Areán, Patricia A; Delucchi, Kevin L et al. (2011) Cognitive functioning in individuals with severe compulsive hoarding behaviors and late life depression. Int J Geriatr Psychiatry 26:314-21
Mackin, R Scott; Delucchi, Kevin L; Bennett, Robert W et al. (2011) The effect of cognitive impairment on mental healthcare costs for individuals with severe psychiatric illness. Am J Geriatr Psychiatry 19:176-84
Alexopoulos, George S; Raue, Patrick J; Kiosses, Dimitris N et al. (2011) Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction: effect on disability. Arch Gen Psychiatry 68:33-41

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