In background information cited by the authors, "major depression and dysthymic disorder affect between 5 percent and 10 percent of older adults seen in the primary care setting. Late-life depression is often chronic or recurrent and is associated with substantial suffering, functional impairment, and diminished health-related quality of life. Depressed, older primary care patients are frequent users of general medical services and may have poor adherence to medical treatments. They are also at increased risk of death from suicide and medical illnesses."

In the current study, the Improving Mood-Promoting Access to Collaborative Treatment (MPACT) trial, Jurgen Unutzer, M.D., M.P.H., and his American colleagues randomized 1,801 depressed, older adults to either collaborative care or usual care. Patient characteristics included older age (60 years or older, 65 percent women) and presence of depressive mood disorder (major depression, 17 percent; dysthymic disorder, 30 percent; both, 53 percent). Of the total, 906 patients were randomized to the trial collaborative intervention and 895 patients were randomized to usual care.

"Intervention patients had access for up to 12 months to a depression care manager who was supervised by a psychiatrist and a primary care expert who offered education, care management, and support of antidepressant management by the patient's primary care physician or a brief psychotherapy for depression, Problem Solving Treatment in Primary Care," the authors write. "The usual care patients could use any primary care or specialty mental health care services available to them in usual care."

Assessments were conducted at baseline and at 3, 6, and 12 months for depression, depression treatments, satisfaction with care, functional impairment, and quality of life.

The researchers wrote "at 12 months, 45 percent of intervention patients had a 50 percent or greater reduction in depressive symptoms from baseline compared with 19 percent of usual care participants. Intervention patients also experienced greater rates of depression treatment, more satisfaction with depression care, lower depression severity, less functional impairment, and greater quality of life than participants assigned to the usual care group."

"Recent studies have reported significant increases in rates of antidepressant use during the past 10 years," the authors wrote. "Almost half of our patients reported depression treatment during the 3 months before the study and more than half of our usual care patients reported antidepressant use or psychotherapy during the 12-month study period. Our findings suggest that despite this recent increase in antidepressant use, treatment of late-life depression in primary care remains challenging."

The researchers concluded that collaborative care involving psychiatric and primary-care expertise appeared to be feasible and significantly more effective than usual care. Further research may show what models best balance the familiarity of primary-care physicians with medical comorbidity and personal issues with the specialty expertise of psychiatrists.