DIMENSIONS Spring 1997


Depression often accompanies Alzheimer's disease, making life even more difficult for patient and caregiver. Treatment can help ease depression and need not involve drugs to be effective. Results of a recent study show that behavioral therapy can significantly reduce clinical depression in both the patient and his or her caregiver.

ADRC researcher Dr. Linda Teri led the project funded by the National Institute of Mental Health to investigate non-drug treatments for depression in AD. Teri, professor of psychiatry and behavioral sciences, and her colleagues Drs. Rebecca Logsdon, Jay Uomoto and Susan McCurry studied 72 AD patient-caregiver pairs, comparing changes in depression over time for pairs who received behavioral therapy with those who did not.

Patients and their caregivers were randomly assigned to one of four groups. Two of the groups received different behavioral therapy interventions. One intervention focused on fostering pleasant events in the patient's lite and general methods for altering behaviors associated with depression. The other intervention centered on problem-solving specific concerns of the caregiver that were related to patient depression. Both interventions involved caregivers' strategies for improving patient depression, taught in one-hour sessions, once a week for nine weeks.

"The two active interventions involved the caregiver as well as the patient," says Teri. "We taught caregivers how to manage and care for their own patient. We taught them what to do when the patient starts to cry and how best to keep the patient active."

The other two groups served as controls. Patient-caregiver pairs in one control group received the type of supportive talking advice that is typical of care available in the community. Participants in the second control group were on a wait list and received no treatment for depression during the nine-week course of the study. They were, however, offered treatment at the end of nine weeks. At the beginning and end of the study the researchers used standard measures to assess depression in the patients. They also evaluated each patient's ability to reason and function independently.

"The before and after measures showed that the two active treatments were very successful in reducing depression in patients," says Teri. And, she points out, they were significantly more effective than both control conditions.

A comparison of the two active treatment conditions indicated that they were equally effective in alleviating symptoms of clinical depression such as thoughts of death or suicide, change in weight or appetite, loss of interest in activities, prolonged feelings of sadness and sleep problems. A follow-up six months later with patients who had received the active treatments showed that the improvement in their depression persisted.

The researchers also assessed caregivers' depression status. Most caregivers participating in the study had at least mild depression and many were diagnosed with major depression. Like their patients, caregivers participating in behavioral treatments, either the problem solving condition or the pleasant-events condition got significantly better.

This result, which was somewhat of a surprise since the behavioral intervention had focused solely on the patient, suggests that giving caregivers the tools to improve the patients depression helps both of them. "Reducing the depression symptoms not only improved the patient's function, but also helped the caregiver cope with the patient better," Teri concluded. "It also probably improved patients' overall quality of life because although they were still demented, they were happier and that meant a lot to them and to the caregivers."

Along with affirming the benefits of behavioral therapies for reducing depression in AD patients, the study's findings also suggest that mood elevating medications may not be an essential part of treating depression in patients with AD. "We don't know how these behavioral treatments would compare with a drug condition because we didn't study that," says Teri. "But we do know that another study looking at drugs found them to be equivalent to placebo for depression in AD. This gives us good reason to believe that non-pharmacological approaches would be at least as good as, if not better than, medication since they were better than control conditions and produced no drug-related side effects."

As part of their analysis, Teri and her colleagues looked at how patient characteristics might influence improvement. "The patients who improved the most had a major depressive disorder, in addition to the dementia," notes Teri. "They had a greater number of symptoms and the types of symptoms they had were more severe. In some ways, the worst got better." The researchers also found a patient's level of dementia was not related to whether his or her depression decreased.

In addition to an ongoing investigation of whether a similar intervention can reduce agitation in AD patients, a major area of emphasis for Teri is making clinicians aware of the effectiveness of behavioral therapies. "We want clinicians who work with AD to know that by training families in caregiving skills they can make a change in the lives of both patient and caregiver."

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