Depressed patients with executive dysfunction (ED), tend not to respond to antidepressant medication. Approaches to overcome this treatment resistance include adding other pharmacological agents or adding behavioral interventions that specifically target the deficits associated with ED. In this study, we elected to evaluate the efficacy of Problem Solving Therapy (PST) because the skills taught in this therapy may be able to medicate the deficits associated with ED.
To evaluate it’s efficacy, we compared PST to Supportive Therapy (ST) in a group of elderly subjects with impairment in executive functions. A total of 25 elderly subjects with major depression and ED were randomly assigned to 12 weeks of PST or ST. Blind raters collected outcome s for this study. According to these results, PST was more effective than ST in remission of depression (chi square=6.74, df=1, p<0.01), resulted in a lower post-treatment depressive symptoms (t=2.66, df=24, p<0.02) and disability (t=4.69, df=24, p<0.001). We were able to demonstrate subject’s improvement in ED related deficits accounted for a large part of the change in depression and disability.
While this study is preliminary, and a larger trial to truly assess the effects of ST on depression in older adults with ED is currently underway, the data presented here suggest that PST is effective in reducing depressive symptoms and disability in elderly patients with major depression and executive dysfunction. The data further suggest that PST may become an important therapeutic alternative for a patient population is minimally responsive to antidepressant medication.
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