November 30, 2009 — 4:32 pm
 Evette J. Ludman, PhD Showing up for a weight loss program matters most in Group Health study
SEATTLE—Women with major depression were no less likely than were women without it to have successful results with a weight loss program, according to an article in the Winter 2009 Behavioral Medicine. Group Health Research Institute Senior Research Associate Evette J. Ludman, PhD, the study leader, concluded that weight loss programs should not exclude depressed people.
Dr. Ludman’s study included 190 female Group Health patients age 40 to 65 with a body mass index (BMI) of 30 or more: 65 with major depressive disorder and 125 without it. The women had not been seeking treatment, but they enrolled in a one-year behavioral weight loss intervention involving 26 group sessions. The intervention, developed at the University of Minnesota over the past 20 years, has proven at least as good as any other currently available non-medical treatment.
Some previous research had hinted that depression might worsen outcomes in behavioral weight loss programs. That’s why trials of weight loss interventions typically exclude people with major depression.
“We expected women with major depression to lose less weight, attend fewer sessions, eat more calories, and get less exercise than those without depression,” Dr. Ludman said. “We were surprised to find no significant differences between the women who had depression and those who did not have it.” Women had lost around the same amount of weight at 6 months (8 or 9 pounds) and 12 months (7 or 8 pounds), with no significant differences between the groups with and without depression. (more…) |
October 5, 2009 — 1:00 pm
Randomized trial at Group Health finds significant benefit with modest cost
SEATTLE—When people get brief, structured, phone-based cognitive behavioral psychotherapy soon after starting on antidepressant medication, significant benefits may persist two years after their first session, with only modest rises in cost. Over two years, this treatment is cost-effective, according to a randomized trial in the October 2009 Archives of General Psychiatry.
“The most important reason to treat depression is to reduce suffering and improve daily functioning,” said Group Health psychiatrist Gregory E. Simon, MD, MPH, also a senior investigator at Group Health Research Institute (formerly called Group Health Center for Health Studies). “But our findings suggest that insurers or health care systems aiming to improve depression treatment in primary care should consider incorporating structured psychotherapy.”
The Journal of the American Medical Association (JAMA) reported earlier results from the same 600-person trial, the largest to date of psychotherapy by phone—and one of the largest studies of psychotherapy ever.
Over two years, phone psychotherapy plus care management led to a gain of 46 depression-free days, with only a $397 increase in outpatient health care costs. The incremental net benefit of phone psychotherapy plus care management was positive, even if a day free of depression was valued as low as $9.
By contrast, phone care management alone, with no phone psychotherapy, led to a gain of only 29 days free of depression, with a $676 rise in outpatient health care costs. The incremental net benefit of phone care management alone was negative, even if a day free of depression was valued up to $20.
The trial enrolled 600 Group Health patients whose primary care doctors diagnosed their depression and (as is usual in primary care) prescribed their antidepressants without psychotherapy. The patients were randomly assigned to receive either: (more…)
