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Lise never thought of herself as someone with depression.
The daughter of Austrian parents who spent nearly two years hopscotching across Europe to escape the Nazis, Lise (who asked that her full name not be used) remembers her mother slumped in a chair, staring at the wall for hours after they finally arrived safely in New York City. "I never wanted to be like that," said Lise, 71.
For decades, despite a diagnosis of clinical depression in 1989, she let her illness go untreated. Instead, she forced herself to get up and work -- when the sadness and confusion descended, when her marriage was falling apart, even after she developed excruciating pain in her joints from arthritis nearly a decade ago.
On her own, mired in blackness, Lise, who lives in an apartment in Capitol Hill, couldn't know that depression was preventing her from easing the aches and stiffness in her hips and fingers.
She didn't realize the two could be linked until participating in a recent study led by a Seattle physician. The two-year study found that elderly adults with clinical depression experienced less pain from osteoarthritis when they received close, follow-up care for their mental illness.
The results appear this week in the Journal of the American Medical Association's special issue on pain management.
More than 50 percent of men and women older than 65 and 80 percent older than 70 have arthritis. Most of them have osteoarthritis, a degenerative joint disease that generally strikes older adults.
Without effective treatment for depression, arthritis patients continue to suffer needlessly, said Dr. Elizabeth Lin, the study's lead researcher with Group Health Cooperative's Center for Health Studies.
Older adults with chronic illness have higher rates of depression than elderly people in good health, said Lin, a primary care physician in Seattle for 20 years. And although arthritis can't be cured, there are therapies and pain relievers that can improve quality of life.
"With patients who are depressed I was struck by how they seemed so hopeless and overwhelmed," Lin said. "Patients who are not depressed can go out and exercise and start feeling better and stronger and do the things they enjoy."
The findings were part of a larger depression treatment study, from 1999 to 2001, which tracked 1,801 men and women 60 or older at 18 primary care clinics around the country. Of those, 1,001 had been diagnosed with arthritis.
Half the group with both arthritis and depression received routine care for depression -- typically antidepressants and referrals to psychiatric care as needed. The others received more comprehensive care, including assignment of depression-care managers (usually nurses or psychologists) who served as go-betweens with the patients' doctors, monitoring their progress and following up on the effectiveness of medications and other treatments. Psychotherapy and coaching on problem-solving skills was also offered.
"We didn't use new medications and new techniques," said Lin, who said she would like to see the team approach implemented in all primary care settings. "We just helped reorganize the care."
Elderly people with depression should request follow-up phone calls or checkups, rather than waiting for cues from their doctor, she said. "Be as much of your own advocate as possible."
The antidepressants Lise began taking during the study help her sleep better and think more clearly, she said. That keeps her focused on placing a pillow at her lower back, buying shoes with extra padding and doing the physical therapy that alleviates her arthritis pain.
At her once-a-week appointments with a nurse during the study, Lise also learned strategies for dealing with her depression beyond medications, including getting out of the house for walks and staying in touch with her family and friends at church.
"I grew up in an atmosphere of depression, so I knew no better. Now I know what depression is, and I know I don't have it. It's like being given a new life."
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