Adding cognitive-behavior therapy or supportive psychotherapy to antidepressants in elderly patients with depressive disorder: a randomized controlled study

Abstract

Objective To compare the effect of combining individual medicine with cognitive behavioral therapy (CBT) or supportive psychotherapy on geriatric depression. Methods One hundred geriatric depression patients were randomly divided into study group(n=50) or control group(n=50) based on random number table method and received the combination of usual medicine with CBT or supportive psychotherapy. They were assessed blindly with17-item Hamilton Depression Rating Scale (HAMD17) , HAMA and Social Function Rating Scale (SFRS) after 0, 6, 12 and 20 week of combined treatment. According to age and education years, different subgroups of the two group were divided respectively and compared on the total score of HAMD17. Results There was no statistic difference between the two groups on the total score of HAMD17. After 6 week treatment of combining usual medicine with supportive psychotherapy or CBT, the depressed level of two groups declined significantly, and comparing with control group, the total score of HAMD17 in study group decreased significantly with the time of treatment (t=2.48, 3.89, 4.72; P<0.01 or P<0.05) ; except for weight factor, reducing score rates in study group on other factors or the total score of HAMD17 differed significantly from those in control group at the end of 20th week of treatment (t=-4.58, -3.76, -4.66, -2.53, -7.48, all P<0.01) , and reducing score rates of study group on the total score or each factor score of HAMA and SFRS differed significantly than those in control group(t=-4.26, -3.12, -4.90, all P<0.01; t=-7.13, -3.47, -4.19, all P<0.01). The effective ratio in study group was significantly different with that in control group (83.7%(41/49) vs. 68.1%(32/47); χ2=6.26, P=0.007). The clinical cured rate was significantly higher in study group than control group (32.7%(16/49) vs.12.8%(6/47), χ2=8.53, P=0.004) .Compared with supportive psychotherapy, CBT had no significant effect on patients who were 70 or over 70 years old and the educational level of high school or below. Conclusions With the exception of advanced age and lower educational level, CBT could be more effective in improving elderly depressed patients' clinical symptoms and social function. Key words: Geriatric depression; Cognitive therapy; Drug therapy; Randomized controlled trial