Recognizing and Treating Depression in the Elderly

Mark D. Miller, MD

Medscape Psychiatry & Mental Health eJournal. 1997;2(2) 

In This Article

Treatment -- Psychotherapy

The NIMH collaborative study (non-geriatric-age adults) reported that psychotherapy was equivalent in efficacy to antidepressant medication for all but the most severe depressions.[54] Many current case reports and prospective studies have clearly illustrated the willingness and ability of the elderly to benefit from psychotherapy.[55,56,57] Short-term psychotherapy approaches have also been developed for the elderly.[58,59] It has been our research experience that some elderly who ultimately benefitted greatly from psychotherapy were not clear about the process or the benefits--they just wanted to feel better. Having no prior experience, many elderly persons are not sure what psychotherapy is all about, and it may be necessary to educate them about the process.

If the depression occurs in the context of psychosocial stressors, psychotherapy may be all that is necessary to achieve a remission of depressive symptoms in an older person willing to engage in self-reflection. For those with more severe depression that includes a considerable number of vegetative symptoms, such as disorganized sleep or significant weight loss, an antidepressant is also often required. Since depression is always experienced in a social context, with frequent disruption of interpersonal relationships, combined treatment with antidepressant medication and psychotherapy often seems the most reasonable choice. A psychotherapeutic component to treatment strategies can also help ensure adherence to a medication regimen, as well as educate the patient about the symptoms and mechanisms of depression in order to place the patient's social dysfunction in a rational perspective.

The 3-year follow-up study by Frank and colleagues[52] showed that although psychotherapy (interpersonal psychotherapy in this study) was not as potent a protector as imipramine against future episodes of depression (in nongeriatric adults), it was clearly superior to placebo. A similar study with geriatric patients is under way,[53] and Niederehe[60] has recently reviewed the efficacy of psychosocial treatments for geriatric depression.

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