From Medscape Medical News
Fran Lowry
June 21, 2010 (Boca Raton, Florida) — Adding an abbreviated version of Tai Chi to antidepressant therapy with escitalopram improved resilience, quality of life, and cognitive function in adults with major depression 60 years and older, according to new research presented here at the New Clinical Drug Evaluation Unit (NCDEU) 50th Anniversary Meeting.
"Fewer than half of elderly depressed patients respond to first-line antidepressant pharmacotherapy," Helen Lavretsky, MD, from the David Geffen School of Medicine at the University of California, Los Angeles, said in her poster presentation here. "There is some information in the literature about the benefits of tai chi in older adults, but this relates to their balance and their physical functioning. We wanted to see whether tai chi would be helpful in improving depression."
The study recruited 112 adults with major depression and treated them with 10 mg of escitalopram daily for 6 weeks. The 70 subjects who partially responded to escitalopram continued to receive 10 mg of escitalopram per day. In addition, they were randomly assigned to receive either 10 weeks of tai chi chih for 2 hours a week or to a lecture on health education for 2 hours a week.
"Tai chi chih is a shortened form of tai chi that has only 20 movements and is easier to remember over the course of 10 weeks," Dr. Lavretsky explained.
Most of the patients (62%) were women, and their mean age was 70 years.
The patients were evaluated for depression, anxiety, resilience, health-related quality of life, psychomotor speed, and cognition.
Both tai chi and health education patients showed similar improvement in the severity of depression, with mean Hamilton Rating Scale for Depression scores of 6.0 in both groups, Dr. Lavretsky reported. However, subjects in the tai chi group showed significantly greater improvement in resilience than did subjects in the health education group (70.2% vs 65.0%; P < .05).
The tai chi group also had better health-related quality of life, with mean well-being scale scores of 80 on the 36-Item Short Form Health Survey vs 66 for the health education group (P < .05), and measures of executive cognitive function, as shown by Stroop mean error scores of 0.03 vs 0.4 errors in the health education group (P < .05).
"Patients who were in the Tai Chi arm had a greater resilience to stress, and I thought the improvement in cognitive measures, such as memory and executive function measures, with tai chi was particularly impressive," Dr. Lavretsky said in an interview.
"I'm in Los Angeles, so people tend to like alternative medicine interventions," she added. "The limiting measure was the degree of arthritis that patients had. The patients who were in the education group liked that intervention, too, but it was very interesting to me to see that this gentle form of exercise had these superior results. Even C-reactive protein levels in the tai chi group were improved."
Commenting on this poster for Medscape Medical News, Craig Nelson, MD, division chief of the Department of Geriatric Medicine at University of California, San Francisco, noted, "The interesting thing about this study was that it showed that the effect of tai chi was greater than that of the education program. That is impressive, because older depressed patients tend to have more of a benefit from a group effect, which an educational program would provide."
He suggested that tai chi may be different in its effects than other exercise. "Looking at such a comparison might be the subject of another study," he said.
This study was funded by the National Center for Complementary and Alternative Medicine. Dr. Lavretsky and Dr. Nelson have disclosed no relevant financial relationships.
New Clinical Drug Evaluation Unit (NCDEU) 50th Anniversary Meeting: Abstract 5, Session II. Presented June 16, 2010.
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