Early antidepressant therapy for elderly patients.
OBJECTIVE
We studied factors affecting the management of depression in older patients, especially the use of early antidepressant therapy.


METHODS
We recruited 128 primary care physicians to view one version of a 5-minute videotape of an elderly patient with somatic symptoms that were suggestive of depression, and to complete an interview that assessed decision making. Using an experimental factorial design, 16 versions of the videotape were produced, holding constant the clinical features of the case, while varying the patient's age, race, sex, and socioeconomic status. Dependent variables were the physicians' probability assessment of depression and the recommendation of antidepressant medication after the first visit.


RESULTS
Depression was considered a possible diagnosis by 121 physicians (95%) and the most likely diagnosis by 69 (54%). Sixteen physicians (13%) recommended antidepressant therapy after the first visit, and they were less likely than other physicians to order initial laboratory tests to assess the possibility of other conditions. Recommendations for antidepressant therapy was not associated with patient age, sex, race, or socioeconomic status, or with physician sex, race, or experience. Family physicians were more likely than internists to recommend an antidepressant (19% [12/64] vs. 6% [4/64], P = 0.04).


CONCLUSIONS
Based on a 5-minute vignette, physicians were likely to recognize depression, independent of patient characteristics. Those recommending early antidepressant therapy were more likely to be in family medicine and less likely to investigate other diagnoses initially.
Freund
Karen M
KM
Section of General Internal Medicine, Evans Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts 02118-2334, USA. karen.freund@bmc.org
Moskowitz
Mark A
MA
Lin
Ting H
TH
McKinlay
John B
JB
D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003863:Depression / Q000175:diagnosis* / Q000188:drug therapy; D003937:Diagnosis, Differential; D005194:Family Practice / Q000379:methods*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007388:Internal Medicine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016544:Patient Simulation; D010818:Practice Patterns, Physicians'; D011361:Professional Competence; D014743:Videotape Recording
D000928:Antidepressive Agents