MYSTERIES OF THE MIND

Brain training, healthy eating can help elderly patients at risk for depression



Audrey Woods was cuddling the newest of her 23 great-grandchildren one day last month in her ground floor apartment at the Arbors Arch Court Apartments on the North Side.

"Oh, you're lookin' like you're getting ready to fuss. Here, daddy, you better take her," she said, handing the baby to her grandson.

Ms. Woods, who just turned 80, is the lively, articulate resource coordinator for her seniors apartment complex and one five blocks away, where she sets up programs on everything from diabetes education to flu shots to blood pressure screenings.

She also is the face of one of the most successful programs for preventing depression tested to date.

The program was devised by Charles Reynolds, a psychiatry professor at the University of Pittsburgh, and his colleagues. By enlisting nearly 250 older people who were at risk of depression in each of two simple preventive strategies, his group was able to reduce their incidence of depression from an average of 20 to 25 percent, to just 8 or 9 percent, he said in a recent interview.

The program put one group of participants into a kind of brain training course, and put the others in a healthy eating group.

Each approach was equally effective, he said.

The brain training used a technique called problem-solving therapy. People in that group were asked what their main goals in life were, and what was getting in the way of achieving them. With the help of trained staff, they then brainstormed solutions.

"The process of breaking down problems into smaller pieces and specifying coping strategies gave people a sense of 'I can do this.' Their confidence was restored, and it was through that process we think we saw evidence of protection against the onset of depression."

The other group, which Ms. Woods ended up in, got straightforward advice on how to find and eat healthier foods, consume smaller portions and make other dietary changes.

"It helped me," she said. "I hadn't been under 200 pounds in years. It helped me with better eating habits. And that brought my cholesterol down. I was borderline diabetic and now I don't have to worry about that."

The Pitt project had one other important goal: It wanted to make sure a substantial number of African Americans were enrolled, and Ms. Woods played a key role in that.

Not only did she qualify for the study, but by spreading the word at her apartment complexes and her church, Petra Ministries in the East Hills, she was able to recruit nearly 50 other black residents to take part.

That was particularly important for getting older black men to participate, she said, "because usually the guys don't want to do anything; they're just sitting around and whining."

As someone who organizes health sessions for residents, Ms. Woods knows how important social contact is for overall health. "Some people don't go any farther than from upstairs to downstairs, and if I didn't do these programs, they would just stay up in their little rooms.

"Talk about depression. Some residents have died as a result of not mingling. The walls start caving in on you and you start getting sick and you end up in the hospital and you don't make it back."

Dr. Reynolds said it was important to get African-American participants because "many black people are reluctant for reasons of stigma to pursue mental health services."

"And while our treatments are good," he added, "once someone becomes depressed, our ability to restrict the disabilities that attend depression are more limited than we would like."

In the end, 38 percent of those in the study, whose results will be published in May, were black, and their ability to avoid depression equaled that of white residents.

What's particularly exciting about this preventive approach, he said, is that each person got an average of only six hours of intervention over two years, making it extremely economical.

Older people are particularly vulnerable to depression because they are often afflicted by the "co-travelers" of other physical ailments, he said.

"Depression doesn't exist in pure culture in old age," he said. "It is accompanied by things like hypertension, diabetes, painful arthritis and chronic obstructive pulmonary disease.

"So if people are not adherent with prescribed medications or behavioral regimens to help them be healthier, then they get into a vicious cycle of increasing disability. Depression feed disability, and disability feeds depression."

Depression also affects people's lifespans directly.

A November study published by Dutch researchers showed that people who had experienced depression had signs of premature aging in the form of shorter telomeres, the "end caps" found on chromosomes. As people get older and their cells divide, the telomeres naturally get shorter, but in depressed people, that process was accelerated.

In one of his own studies, Dr. Reynolds found that eight years after one depression trial, those who had been treated for the disease had a 24 percent lower death rate than those who hadn't.

Most of the difference was in cancer deaths. People who get good treatment for depression not only experience less stress, but often adopt healthier lifestyles and take all of their medications more faithfully, all of which could lower cancer rates, he said.

"As I like to say to my patients, getting well is not enough; staying well is just as important."


Mark Roth: mroth@post-gazette.com, 412-263-1130 and on Twitter: @markomar.

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