THE EFFECT OF DEPRESSION TREATMENT ON ELDERLY PATIENTS PREFERENCES FOR LIFE-SUSTAINING MEDICAL THERAPY

Objective: This study was undertaken 1) to test the hypothesis that re mission of depression results in an increase in desire for life-sustai ning 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, w ere interviewed on admission to a psychiatric inpatient unit and at di scharge about their desire for specific medical therapies in their cur rent state of health and in two hypothetical scenarios of medical illn ess. A psychiatrist rated the impact of depressive thinking on the sub ject's response to these questions. Forty-three subjects completed the study, and 24 were in remission from depression at the time of discha rge. Results: In the majority of patients, remission of depression did not result in an increase in desire for life-sustaining medical thera py. However, a clinically evident increase in desire for life-sustaini ng medical therapies followed treatment of depression in subjects (N=1 1 [26%]) who had been initially rated as more severely depressed more hopeless, and more likely to overestimate the risks and to underestima te the benefits of treatment. Conclusions: In major depression of mild to moderate severity, a patient's desire to forgo life-sustaining med ical treatment is unlikely to be altered by depression treatment. On t he other hand severely depressed patients, particularly those who are hopeless, overestimate the risks of treatment, or underestimate the be nefits of treatment, should be encouraged to defer advance treatment d irectives. In these patients decisions about life-sustaining therapy s hould be discouraged until after treatment of the depression.