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Comparing the streamlined psychotherapy “Engage” with problem-solving therapy in late-life major depression. A randomized clinical trial

Molecular Psychiatry volume 26, pages 5180–5189 (2021)Cite this article

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Abstract

Effective psychotherapies for late-life depression are underutilized, mainly because of their complexity. “Engage” is a novel, streamlined psychotherapy that relies on neurobiology to identify core behavioral pathology of late-life depression and targets it with simple interventions, co-designed with community therapists so that they can be delivered in community settings. Consecutively recruited adults (≥60 years) with major depression (n = 249) were randomly assigned to 9 weekly sessions of “Engage” or to the evidence-based Problem-Solving Therapy (PST) offered by 35 trained community social workers and assessed by blind raters. “Engage” therapists required an average of 30% less training time to achieve fidelity to treatment than PST therapists and had one-third of the PST therapists’ skill drift. Both treatments led to reduction of HAM-D scores over 9 weeks. The mixed effects model-estimated HAM-D ratings were not significantly different between the two treatments at any assessment point of the trial. The one-sided 95% CI for treatment-end difference was (−∞, 0.07) HAM-D points, indicating a non-inferiority margin of 1.3 HAM-D points or greater; this margin is lower than the pre-determined 2.2-point margin. The two treatment arms had similar response (HR = 1.08, 95% CI (0.76, 1.52), p = 0.67) and remission rates (HR = 0.89, 95% CI (0.57, 1.39), p = 0.61). We conclude that “Engage” is non-inferior to PST. If disseminated, “Engage” will increase the number of therapists who can reliably treat late-life depression and make effective psychotherapy available to large numbers of depressed older adults.

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Fig. 1: “Engage” vs. PST randomized clinical trial.
Fig. 2: Decline in severity of major depression in “Engage” and in PST-treated participants.
Fig. 3
Fig. 4

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Funding

This study was supported by R01 MH102252 (GSA), R01 MH102304 (PAA), P50 MH113838 (GSA), T32 MH019132 (GSA), and P50 MH115837 (PAA).

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Authors and Affiliations

  1. Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY, USA

    George S. Alexopoulos, Samprit Banerjee, Patricia Marino, Nili Solomonov, Adenike Adeagbo, Jo Anne Sirey, Dimitris N. Kiosses & Elizabeth Mauer

  2. Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA

    Patrick J. Raue, Brenna N. Renn & Patricia A. Areán

  3. Talkspace, New York, NY, USA

    Thomas D. Hull

  4. Teachers College, Columbia University, New York, NY, USA

    Thomas D. Hull

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Correspondence to George S. Alexopoulos.

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Conflict of interest

GSA served on Advisory Board of Eisai and of Janssen Pharmaceuticals. He also served on the Speakers Bureaus of Allergan, Otsuka, and Takeda-Lundbeck. TDH is an employee of ‘Talkspace’. All other authors report no conflicts.

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Alexopoulos, G.S., Raue, P.J., Banerjee, S. et al. Comparing the streamlined psychotherapy “Engage” with problem-solving therapy in late-life major depression. A randomized clinical trial. Mol Psychiatry 26, 5180–5189 (2021). https://doi.org/10.1038/s41380-020-0832-3

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