Treatment of Dysthymia and Minor Depression in Primary Care: A Randomized Controlled Trial in Older Adults
Abstract
Context Insufficient evidence exists for recommendation of specific effective treatments for older primary care patients with minor depression or dysthymia. Objective To compare the effectiveness of pharmacotherapy and psychotherapy in primary care settings among older persons with minor depression or dysthymia. Design Randomized, placebo-controlled trial (November 1995-August 1998). Setting Four geographically and clinically diverse primary care practices. Participants A total of 415 primary care patients (mean age, 71 years) with minor depression (n = 204) or dysthymia (n = 211) and a Hamilton Depression Rating Scale (HDRS) score of at least 10 were randomized; 311 (74.9%) completed all study visits. Interventions Patients were randomly assigned to receive paroxetine (n = 137) or placebo (n = 140), starting at 10 mg/d and titrated to a maximum of 40 mg/d, or problem-solving treatment-primary care (PST-PC; n = 138). For the paroxetine and placebo groups, the 6 visits over 11 weeks included general support and symptom and adverse effects monitoring; for the PST-PC group, visits were for psychotherapy. Main outcome measures Depressive symptoms, by the 20-item Hopkins Symptom Checklist Depression Scale (HSCL-D-20) and the HDRS; and functional status, by the Medical Outcomes Study Short-Form 36 (SF-36) physical and mental components. Results Paroxetine patients showed greater (difference in mean [SE] 11-week change in HSCL-D-20 scores, 0.21 [0. 07]; P =.004) symptom resolution t…
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The SCL-20 has been used as an outcome measure in primary care clinical trials, although published evidence on its sensitivity to change as well as other psychometric characteristics is limited.
“The SCL-20 has been used as an outcome measure in primary care clinical trials,18–20 although published evidence on its sensitivity to change as well as other psychometric characteristics”
From The PHQ-9: Validity of a brief depression severity measure (2001) · cites this paper as [20]
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- Authors
- Williams, Jr., Barrett, J., Oxman, T., Frank, E., Katon, W., Sullivan, M., Cornell, J., & Sengupta, A.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2000-09-27
- Volume
- 284
- Issue
- 12
- Pages
- 1519
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2159369918
- Cited by
- 460
- References
- 41
- Citations by year
- 2026: 1 · 2024: 3 · 2023: 5 · 2022: 6 · 2021: 5 · 2020: 4 · 2019: 11 · 2018: 11 · 2017: 8 · 2016: 10 · 2015: 10 · 2014: 16 · 2013: 21 · 2012: 18
- FWCI
- 24.37
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- dysthymia, minor depression, older adults, paroxetine, problem-solving therapy, psychotherapy, pharmacotherapy, primary care, antidepressant efficacy, functional status, depressive symptoms, placebo comparison, adverse effects, adverse drug reactions, relapse prevention
- MeSH terms
- Aged, Aged, 80 and over, Depression, Double-Blind Method, Family Practice, Female, Humans, Male, Psychological Tests, Psychotherapy, Treatment Outcome, Paroxetine, Antidepressive Agents, Second-Generation, Dysthymic Disorder
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