Treatment of late-life depression alleviates caregiver burden

There is substantial evidence that late-life depression can be successfully treated with antidepressant medication.1–3 The benefits of treatment extend beyond patients' improved mood to include lower physical disability,4 better social adjustment,5 and lower healthcare costs.6 Another important but unexamined outcome of depression treatment is less burden on the family caregiver. Although older adults with depression rely on family for assistance and support,7 the burden of providing this care is associated with poorer health and greater risk for mortality in caregivers.8,9 Therefore, alleviating caregiver burden is imperative from a public health perspective and, if achieved through treatment of an elderly person's depression, may also provide a more-complete picture regarding the efficacy of depression treatment. This study was designed to address this issue with family caregivers who were recruited from a study of partial treatment response in late-life major depressive disorder (MDD). The treatment study included 6 weeks of low-dose antidepressant medication for all patients with depression followed by 16 weeks of randomized treatment for patients who had only a partial response to medication at the end of the 6 weeks. Partial response to antidepressant medication at 6 weeks is associated with poorer likelihood of eventual symptom remission in older adults.10,11 The randomized phase of treatment examined whether an increased dose of antidepressant medication combined with interpersonal psychotherapy (IPT) was superior to an increased dose of antidepressant medication alone. Patients showed decreases of approximately 30% in depression ratings during open treatment, but remission rates during randomized treatment were similar in the two randomized groups12 (cumulative response rates of 48–61%). In the current study, it was predicted that decreased depressive symptomatology during open treatment with antidepressant medication would be associated with significantly lower caregiver burden, based on findings from dementia studies showing that cholinesterase inhibitors or antidepressant medication for patients resulted in lower caregiver burden.13,14 The second prediction focused on the randomized treatment phase for partial responders, in which the goal was remission of patient symptoms. It was predicted that caregivers of patients who remitted during randomized treatment would show greater alleviation of burden than caregivers of patients who did not remit. Whether caregivers of patients who received IPT and medication during the randomized phase would show even less burden than caregivers of partial responders who received medication alone was also examined. Greater improvement in caregiver burden may occur as the result of targeting patients' interpersonal problems, which have been shown to hinder family members' efforts to provide care and support when it is needed.15 The focus of this study was on change in two related but unique types of caregiver burden: depression-specific burden and general burden. It was expected that the largest decreases would be found in caregiver burden that was specific to the patients' depressive symptoms and behaviors; the depression subscale from the Revised Memory and Behavior Problems Checklist was used to assess how bothered or upset caregivers were about specific depressive behaviors.16 However, the burden of these family members may also stem from the effects of patient illness on social life, other family responsibilities, and finances. Therefore, the effects of patient improvement on this more general type of caregiver burden were also examined using the Burden Interview.17