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Randomized Controlled Trial
. 2014 Nov;22(11):1316-24.
doi: 10.1016/j.jagp.2013.05.006. Epub 2013 Aug 14.

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

George S Alexopoulos  1 , Dimitris N Kiosses  2 , Jo Anne Sirey  2 , Dora Kanellopoulos  2 , Joanna K Seirup  2 , Richard S Novitch  3 , Samiran Ghosh  2 , Samprit Banerjee  2 , Patrick J Raue  2
Affiliations
Randomized Controlled Trial

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

George S Alexopoulos et al. Am J Geriatr Psychiatry. 2014 Nov.

Abstract

Objective: We 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.

Design: Randomized controlled trial.

Setting: Community.

Participants: 138 patients who received the diagnoses of COPD and major depression after screening 898 consecutive admissions for acute inpatient pulmonary rehabilitation.

Intervention: Nine sessions of PID-C compared with usual care over 28 weeks.

Measurements: Primary 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.

Results: Low 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.

Conclusions: PID-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.

Keywords: COPD; Clinical trial; disability; dyspnea; geriatric depression; personalized intervention.

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Conflict of interest statement

Conflicts of Interest: Dr. Alexopoulos has received grant support from Forest Pharmaceuticals; has consulted to Hoffman-LaRoche, Lilly, Pfizer, and Otsuka; and has served at the speakers’ bureaus of Astra Zeneca, Avanir, Forest, Merck, Novartis, and Sunovion. No other authors report conflicts of interest.

References

    1. CDC. Healthy Aging: Helping People To Live Long and Productive Lives and Enjoy a Good Quality Of Life. Centers for Disease Control and Prevention; 2011.
    1. Lebowitz BD, Pearson JL, Schneider LS, et al. Diagnosis and treatment of depression in late life. Consensus statement update. JAMA. 1997;278:1186–1190. - PubMed
    1. Services USDoHaH. Multiple Chronic Conditions - A Startegic Framework: Optimum Health and Quality of Life for Individuals with Multiple Chronic Conditions. Washington, D.C: 2010.
    1. Alexopoulos GS, Raue PJ, Sirey JA, et al. Developing an intervention for depressed, chronically medically ill elders: a model from COPD. Int J Geriatr Psychiatry. 2008;23:447–453. - PubMed
    1. Pauwels RA, Rabe KF. Burden and clinical features of chronic obstructive pulmonary disease (COPD) Lancet. 2004;364:613–620. - PubMed

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