• Am J Geriatr Psychiatry · Nov 2014

    Randomized Controlled Trial

    Untangling therapeutic ingredients of a personalized intervention for patients with depression and severe COPD.

    • George S Alexopoulos, Dimitris N Kiosses, Jo Anne Sirey, Dora Kanellopoulos, Joanna K Seirup, Richard S Novitch, Samiran Ghosh, Samprit Banerjee, and Patrick J Raue.
    • Weill Cornell Medical College, Institute for Geriatric Psychiatry, White Plains, NY. Electronic address: gsalexop@med.cornell.edu.
    • Am J Geriatr Psychiatry. 2014 Nov 1;22(11):1316-24.

    ObjectiveWe developed a personalized intervention for depressed patients with COPD (PID-C) aimed to mobilize patients to participate in the care of both conditions. We showed that PID-C reduced depressive symptoms and dyspnea-related disability more than usual care over 28 weeks. This study focused on untangling key therapeutic ingredients of PID-C.DesignRandomized controlled trial.SettingCommunity.Participants138 patients who received the diagnoses of COPD and major depression after screening 898 consecutive admissions for acute inpatient pulmonary rehabilitation.InterventionNine sessions of PID-C compared with usual care over 28 weeks.MeasurementsPrimary outcome measures were the 17-item Hamilton Depression Rating Scale and the Pulmonary Functional Status and Dyspnea Questionnaire-Modified. Other measures were adherence to rehabilitation exercise (≥2 hours per week) and adherence to adequate antidepressant prescriptions.ResultsLow severity of dyspnea-related disability and adherence to antidepressants predicted subsequent improvement of depression. Exercise and low depression severity predicted improvement of dyspnea-related disability.ConclusionsPID-C led to an interacting spiral of improvement in both depression and disability in a gravely medically ill population with a 17% mortality rate over 28 weeks and an expected deterioration in disability. The interrelationship of the course of depression and dyspnea-related disability underscores the need to target adherence to both antidepressants and chronic obstructive pulmonary disease rehabilitation. PID-C may serve as a care management model for depressed persons suffering from medical illnesses with a deteriorating course.Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

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