A Randomized Pilot Study

Abstract

Objective: Although there is evidence for the efficacy of antidepressants and for some individual and group psychotherapy interventions for depressed older adults, a sig- nificant number of these do not respond to treatment. Authors assessed the benefits of augmenting medication with group psychotherapy. Methods: They randomly as- signed 34 (largely chronically) depressed individuals age 60 and older to receive 28 weeks of antidepressant medication plus clinical management, either alone (MED) or with the addition of dialectical behavior therapy skills-training and scheduled tele- phone coaching sessions (MEDDBT). Results: Only MEDDBT showed significant decreases on mean self-rated depression scores, and both treatment groups demon- strated significant and roughly equivalent decreases on interviewer-rated depression scores. However, on interviewer-rated depression, 71% of MEDDBT patients were in remission at post-treatment, in contrast to 47% of MED patients. At a 6-month follow- up, 75% of MEDDBT patients were in remission, compared with only 31% of MED patients, a significant difference. Only patients receiving MEDDBT showed signifi- cant improvements from pre- to post-treatment on dependency and adaptive coping that are proposed to create vulnerability to depression. Conclusion: Results from this pilot study suggest that DBT skills training and telephone coaching may offer promise to effectively augment the effects of antidepressant medication in depressed older adults. (Am