A Systematic Review and Meta-analysis of Psychotherapy for Late-Life Depression

Huang, Alice X.; Delucchi, Kevin; Dunn, Laura B.; Nelson, J. Craig

doi:10.1016/j.jagp.2014.04.003

Cited by 127 publications

(55 citation statements)

References 42 publications

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“…A meta-analysis of 27 RCTs including 2245 participants demonstrated great variability in standardized mean differences of 0.05 to 1.36 depending on the control group. 108 In this meta-analysis, psychotherapies (including bibliotherapy) yielded large effects compared with waitlist and attention controls but small to moderate effects compared with supportive therapy or treatment as usual. The authors suggested that supportive therapy best controlled for the nonspecific elements of psychotherapy and should be used as the control for future studies and that problem-solving therapy (PST) has the strongest evidence base using supportive therapy as a control.…”

Section: What Is the Role Of Nonpharmacological Treatments In Lld?mentioning

confidence: 89%

“…The authors suggested that supportive therapy best controlled for the nonspecific elements of psychotherapy and should be used as the control for future studies and that problem-solving therapy (PST) has the strongest evidence base using supportive therapy as a control. 108 A recent meta-analysis assessed the efficacy of PST in MDD in older adults, demonstrating that PST significantly reduced depression rating scale scores and reduced disability. The authors also noted that PST is one of the few therapies studied in older people with cognitive impairment and executive dysfunction.…”

Section: What Is the Role Of Nonpharmacological Treatments In Lld?mentioning

confidence: 99%

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Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

et al. 2016

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Methods: Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. This section on ''Special Populations'' is the sixth of six guidelines articles.Results: Recent studies inform the treatment of MDD in children and adolescents, pregnant and breastfeeding women, women in perimenopause or menopause, and the elderly. Evidence for efficacy of treatments in these populations is more limited than for the general adult population, however, and risks of treatment in these groups are often poorly studied and reported. Conclusions: Despite the limited evidence base, extant data and clinical experience suggest that each of these special populations can benefit from the systematic application of treatment guidelines for treatment of MDD.

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Section: What Is the Role Of Nonpharmacological Treatments In Lld?mentioning

confidence: 89%

Section: What Is the Role Of Nonpharmacological Treatments In Lld?mentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

et al. 2016

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“…As with younger adults, there is now good meta-analytic evidence that psychosocial interventions are effective in the management of late-life depression [50, 51], with available evidence suggesting that psychosocial treatments appear to be as effective as anti-depressant medications [52]. However, there is some evidence of smaller effect sizes in patients with comorbid physical illness [53].…”

Section: Discussionmentioning

confidence: 99%

Pain severity predicts depressive symptoms over and above individual illnesses and multimorbidity in older adults

et al. 2017

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BackgroundMulti-morbidity in older adults is commonly associated with depressed mood. Similarly, subjective reports of pain are also associated with both physical illness and increased depressive symptoms. However, whether pain independently contributes to the experience of depression in older people with multi-morbidity has not been studied.MethodsIn this study, participants were 1281 consecutive older adults presenting to one of 19 primary care services in Australia (recruitment rate = 75%). Participants were asked to indicate the presence of a number of common chronic illnesses, to rate their current pain severity and to complete the Geriatric Depression Scale.ResultsResults confirmed that the number of medical illnesses reported was strongly associated with depressive symptoms. Twenty-six percent of participants with multi-morbidity scored in the clinical range for depressive symptoms in comparison to 15% of participants with no illnesses or a single illness. In regression analyses, the presence of chronic pain (t = 5.969, p < 0.0005), diabetes (t = 4.309, p < 0.0005), respiratory (t = 3.720, p < 0.0005) or neurological illness (t = 2.701, p = 0.007) were all independent contributors to depressive symptoms. Even when controlling for each individual illness, and the overall number of illnesses (t = 2.207, p = 0.028), pain severity remained an independent predictor of depressed mood (F change = 28.866, p < 0.0005, t = 5.373, p < 0.0005).ConclusionsPhysicians should consider screening for mood problems amongst those with multi-morbidity, particularly those who experience pain.

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“…The frailty characteristics would be treated with the nutritional counseling and/or exercise programs 17,18 that have been shown to be successful in improving the physical abilities of frail or functionally limited older individuals. The depressive illness would be treated with antidepressant medications, 19 psychotherapy (specifically cognitive behavioral therapy, interpersonal therapy, or problem solving therapy, all of which have been shown to be effective for the treatment of depression in late life), 20 or, if very severe, electroconvulsive therapy (ECT).…”

Section: The Relationship Between Frailty and Depressionmentioning

confidence: 99%

The Depressed Frail Phenotype: The Clinical Manifestation of Increased Biological Aging

Brown

Rutherford

Yaffe

et al. 2016

The American Journal of Geriatric Psychiatry

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Depression in later life is a severe public health problem, associated with higher rates of mortality, suicide, and dementia. Effectiveness of treatment is limited by the failure to deconstruct the heterogeneity of the illness and because diagnostic criteria, pathophysiological models, and treatment algorithms for depression are primarily based on studies of younger adults even though symptoms of the illness and physiology of the patient change with age. Thus, understanding how aging interacts with depressive illness may elucidate endophenotypes of late life depression with different clinical manifestations and underlying mechanisms that can then be targeted with more personalized approaches to treatment. This paper proposes a model for the critical confluence between depression and frailty, a high-risk morbidity and mortality syndrome of later life. This model hypothesizes that characteristics of frailty in adults with late life depression represent the clinical manifestation of greater biological aging and their presence in the context of a depressive illness exposes elders to deleterious trajectories. Potential common biological substrates that may result in the manifestation of the depressed frail phenotype including mitochondrial functioning, dopaminergic neurotransmission, and inflammatory processes and implications for the assessment and treatment of adults with late life depression are discussed. As society continues to live longer, the preservation of the quality of these added years becomes paramount, and the combined impact of depression and frailty on the preservation of this quality warrants the attention of clinical researchers and physicians.

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A Systematic Review and Meta-analysis of Psychotherapy for Late-Life Depression

Cited by 127 publications

References 42 publications

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

Pain severity predicts depressive symptoms over and above individual illnesses and multimorbidity in older adults

The Depressed Frail Phenotype: The Clinical Manifestation of Increased Biological Aging

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