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December 20, 2000

Treatment of Mild Depression in Elderly Patients

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(23):2993-2994. doi:10.1001/jama.284.23.2993

To the Editor: Dr Williams and colleagues1 found that paroxetine was superior to psychotherapy in treating dysthymia and minor depression among older patients in a primary care setting. However, their study was seriously flawed in the choice and administration of the psychotherapy component.

The patients who received psychotherapy were provided a previously unknown and untested protocol called problem-solving treatment–primary care (PST-PC). Although PST-PC is reportedly based on cognitive-behavioral principles, the authors noted that the procedure is unpublished, making it an unknown entity that has not been peer reviewed. Furthermore, although the study used psychotherapists from a variety of disciplines, these practitioners presumably were not allowed to use more common psychotherapeutic interventions. Thus, this was a test of PST-PC, not psychotherapy.

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