Improved primary care treatment of depression for the elderly not only reduces depressive symptoms but reduces arthritis pain and improves quality of life, according to the results of a randomized controlled trial.

"From a clinical perspective, current medical treatments cannot cure osteoarthritis nor eliminate arthritis-related pain and disability entirely," write Elizabeth H. B. Lin, MD, MPH, from the Center for Health Studies, Group Health Cooperative, in Seattle , Washington , and colleagues. "Therefore, arthritis management needs to be aimed at decreasing pain, improving function, and enhancing quality of life."

In the elderly, both depression and arthritis are common causes of disability and medical and economic costs. The prevalence of depression is about 16%, whereas osteoarthritis is the most common type of arthritis in older adults, affecting about one third of individuals older than 65 years and almost 80% of those older than 70 years.

From July 1999 to August 2001, investigators in the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) study enrolled 1,801 depressed adults, aged 60 years or older, at 18 primary care clinics from eight U.S. healthcare organizations in five states. At baseline, 1,001 subjects (56%) reported coexisting arthritis. Subjects were randomized to usual care or to an enhanced intervention combining antidepressant medications and/or six to eight psychotherapy sessions (Problem Solving Treatment in Primary Care).

Compared with the usual care group at 12 months, the intervention group had reduction in depressive symptoms, improved overall health and quality of life, and lower average scores for pain intensity ( P = .009), interference with daily activities due to arthritis ( P = .004), and interference with daily activities due to pain ( P = .002).

Study limitations include failure to address mechanisms of action, lack of detailed arthritis treatment data, and possible effect of cognitive impairment on long-term recall.

"Across diverse general health care settings, we found high comorbidity of arthritis and late-life depression," the authors write. "Benefits from increased recognition and improved treatment of depression in patients with comorbid arthritis and depression extended beyond reduced depressive symptoms to include improved pain and functional outcomes. We conclude that recognition and treatment of depression has the potential to lessen the public health burden of comorbid arthritis and late-life depression."