TY - JOUR
T1 - The effect of depression treatment on elderly patients' preferences for life-sustaining medical therapy
AU - Ganzini, Linda
AU - Lee, Melinda A.
AU - Heintz, Ronald T.
AU - Bloom, Joseph D.
AU - Fenn, Darien S.
PY - 1994/11
Y1 - 1994/11
N2 - Objective: This study was undertaken 1) to test the hypothesis that remission of depression results in an increase in desire for life-sustaining medical therapy and 2) to characterize patients whose desire for life- sustaining treatment increases substantially following depression therapy. Method: Elderly patients, suffering from major depression, were interviewed on admission to a psychiatric inpatient unit and at discharge about their desire for specific medical therapies in their current state of health and in two hypothetical scenarios of medical illness. A psychiatrist rated the impact of depressive thinking on the subject's response to these questions. Forty-three subjects completed the study, and 24 were in remission from depression at the time of discharge. Results: In the majority of patients, remission of depression did not result in an increase in desire for life- sustaining medical therapy. However, a clinically evident increase in desire for life-sustaining medical therapies followed treatment of depression in subjects (N=11 [26%]) who had been initially rated as more severely depressed, more hopeless, and more likely to overestimate the risks and to underestimate the benefits of treatment. Conclusions: In major depression of mild to moderate severity, a patient's desire to forgo life-sustaining medical treatment is unlikely to be altered by depression treatment. On the other hand, severely depressed patients, particularly those who are hopeless, overestimate the risks of treatment, or underestimate the benefits of treatment, should be encouraged to defer advance treatment directives. In these patients decisions about life-sustaining therapy should be discouraged until after treatment of the depression.
AB - Objective: This study was undertaken 1) to test the hypothesis that remission of depression results in an increase in desire for life-sustaining medical therapy and 2) to characterize patients whose desire for life- sustaining treatment increases substantially following depression therapy. Method: Elderly patients, suffering from major depression, were interviewed on admission to a psychiatric inpatient unit and at discharge about their desire for specific medical therapies in their current state of health and in two hypothetical scenarios of medical illness. A psychiatrist rated the impact of depressive thinking on the subject's response to these questions. Forty-three subjects completed the study, and 24 were in remission from depression at the time of discharge. Results: In the majority of patients, remission of depression did not result in an increase in desire for life- sustaining medical therapy. However, a clinically evident increase in desire for life-sustaining medical therapies followed treatment of depression in subjects (N=11 [26%]) who had been initially rated as more severely depressed, more hopeless, and more likely to overestimate the risks and to underestimate the benefits of treatment. Conclusions: In major depression of mild to moderate severity, a patient's desire to forgo life-sustaining medical treatment is unlikely to be altered by depression treatment. On the other hand, severely depressed patients, particularly those who are hopeless, overestimate the risks of treatment, or underestimate the benefits of treatment, should be encouraged to defer advance treatment directives. In these patients decisions about life-sustaining therapy should be discouraged until after treatment of the depression.
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U2 - 10.1176/ajp.151.11.1631
DO - 10.1176/ajp.151.11.1631
M3 - Article
C2 - 7943452
AN - SCOPUS:0028152710
SN - 0002-953X
VL - 151
SP - 1631
EP - 1636
JO - American Journal of Psychiatry
JF - American Journal of Psychiatry
IS - 11
ER -