Interventions like medication or psychotherapy “appear effective for
poor and minority women if they are given support to overcome barriers to care,” says
Jeanne Miranda, Ph.D., of the Health Services Research Center of the University
of California at Los Angeles Neuropsychiatric Institute.
When used properly, medications appeared to give better results than psychotherapy.
But both medication and psychotherapy worked better than educating the women
about depression and referring them to community mental health services.
Miranda’s team recruited 267 poor women living in the Maryland and
Virginia suburbs of Washington, D.C. Average age was 29 years old, and 60
percent lived
at or below the federal poverty line. Forty-four percent of participants
were black and 50 percent were Latina. Two out of three were uninsured.
Researchers randomly assigned the women to three groups. One-third of the
women took the antidepressant drugs paroxetine (sold under the brand name Paxil)
or buproprion (Wellbutrin) for six months. The second group received cognitive
behavioral therapy, a form of psychotherapy based on eight weekly sessions
with a therapist, supplemented by homework and daily monitoring. The final
group received information about depression and was given referrals to existing
community mental health treatment.
The researchers used standard psychiatric tests for depression to evaluate
women in the study. Both medication and psychotherapy reduced the women’s
depressive symptoms and improved their social functioning. Women taking medication
also did better on the instrumental role functioning test.
“Treating these women [using] existing guidelines for medications and
psychotherapy was significantly more effective in decreasing depression than
referrals to community care,” Miranda says. Medication may have proved
more effective for these women because it placed fewer demands on their time
than attending psychotherapy sessions, she adds.
Effective treatment for poor, minority women had been in question because
depression treatment guidelines are based largely on white or college-educated
patients. This left a large gap in the knowledge of treating low-income and
minority women, which this study sought to fill, she says.
“Our results demonstrate that treating depression in this population
has clear advantages,” says Miranda, “both in terms of reducing
personal suffering and improving the ability of these young women to function.”
