Psychological Treatment of Late-Life Depression

doi:10.1016/j.psc.2013.08.005

Psychiatric Clinics of North America

Volume 36, Issue 4, December 2013, Pages 561-575

https://doi.org/10.1016/j.psc.2013.08.005 Get rights and content

Section snippets

Key points

•
Psychological interventions are effective for late-life depression.
•
There is little evidence that one type of intervention is more efficacious than another.
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More research is needed to examine moderators of treatment, including age, depression severity, medical illness, and cognitive impairment.

Cognitive and Behavioral Therapies

Cognitive and behavioral therapies (CBTs) are a group of evidence-based treatments that combine behavioral and cognitive techniques and have demonstrated efficacy for a wide variety of psychiatric problems, including depression.¹⁰ Cognitive therapy developed by Beck¹¹ is based on the theory that how we interpret situations impacts our mood and behaviors. Treatment is designed to teach individuals to identify maladaptive or distorted cognitions and learn to challenge them so as to reduce

Discussion

Consistent with prior reviews and meta-analyses, the results indicate that psychological interventions are effective for the treatment of late-life depression. A total of 17 randomized studies examining CBT, PST, IPT, reminiscence therapy (RT), and BPD were evaluated and all therapies resulted in reduction of depressive symptoms. Given that older adults are generally accepting of psychological treatments,7, 8 it is promising that there are a variety of interventions to choose from. Not only was

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Treatment refractory depression (TRD) in the elderly is a common psychiatric disorder with high comorbidity and mortality. Older adults with TRD often have complicated comorbidities and several predisposing risk factors, which may lead to neuropsychiatric dysfunction and poor response to treatment. Several hypotheses suggest the underlying mechanisms, including vascular, immunological, senescence, or abnormal protein deposition.
Treatment strategies for TRD include optimization of current medication dose, augmentation, switching to an alternative agent or class, and combination of different antidepressant classes, as well as nonpharmacological adjuvant interventions such as biophysical stimulation and psychotherapy. In summary, treatment recommendations for TRD in the elderly favor a multimodal approach, combining pharmacological and nonpharmacological treatments.
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Interpersonal therapy (IPT) is a brief, structured, concrete therapy recommended by the WHO for the management of depression. It focuses on the patient's interpersonal relationships in the here-and-now, mobilizing underlying attachment mechanisms. This therapy is unfortunately little known in France in general, and in the care of the elderly in particular. The purpose of this article will be to present IPTs (principles, structuring and efficacy), and the main adaptations of this psychotherapy for use among the elderly. Finally, the authors discuss the particular interest of this type of psychotherapy in this age group.
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: Disclosures: None.

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Psychological Treatment of Late-Life Depression

Section snippets

Key points

Cognitive and Behavioral Therapies

Discussion

First page preview

Psychiatr Clin North Am

Am J Geriatr Psychiatry

Clin Psychol Rev

Am J Geriatr Psychiatry

Am J Geriatr Psychiatry

Clin Psychol Rev

Clin Psychol Rev

High occurrence of mood and anxiety disorders among older adults: The National Comorbidity Survey Replication

Arch Gen Psychiatry

Depression in late life: review and commentary

J Gerontol A Biol Sci Med Sci

Depression treatment in a sample of 1,801 depressed older adults in primary care

J Am Geriatr Soc

Prevalence of depression and depression recognition in nursing homes

Soc Psychiatry Psychiatr Epidemiol

Older adults' acceptance of psychological and pharmacological treatments for depression

J Gerontol B Psychol Sci Soc Sci

Depression treatment preferences in older primary care patients

Gerontologist

Treatments for later-life depressive conditions: a meta-analytic comparison of pharmacotherapy and psychotherapy

Am J Psychiatry

Cognitive therapy and the emotional disorders

A behavioral approach to depression

Effects of psychotherapy and other behavioral interventions on clinically depressed older adults: a meta-analysis

Aging Ment Health

Cognitive behavioral therapy for depression in older people: a meta-analysis and meta-regression of randomized controlled trials

J Am Geriatr Soc

Psychotherapeutic treatments for older depressed people

Cochrane Database Syst Rev

Comparative efficacy of cognitive and behavioral bibliotherapy for mildly and moderately depressed older adults

J Consult Clin Psychol

The effects of cognitive behavior therapy on depression in older patients with cardiovascular risk

Depress Anxiety

A randomised controlled trial of cognitive behaviour therapy vs treatment as usual in the treatment of mild to moderate late life depression

Int J Geriatr Psychiatry

Clinical effectiveness of individual cognitive behavioral therapy for depressed older people in primary care: a randomized controlled trial

Arch Gen Psychiatry

Comparative effectiveness of psychotherapies for depressed elders

J Consult Clin Psychol

Comparative effects of cognitive-behavioral and brief psychodynamic psychotherapies for depressed family caregivers

J Consult Clin Psychol

Interpersonal psychotherapy: past, present and future

Clin Psychol Psychother

Interpersonal psychotherapy of depression

Interpersonal psychotherapy as a treatment for late-life depression

A systematic review of research findings on the efficacy of interpersonal therapy for depressive disorders

Eur Arch Psychiatry Clin Neurosci