Therapy Strategies for Late-life Depression: A Review

Abstract

Background: Depression in the elderly requires different treatment options because therapies that are commonly used for depression in younger patients show different effects later in life. Treatment options for late-life depression (LLD) are summarized in this article. Methods: A literature search in Medline/ PubMed performed in June 2020 identified 83 relevant studies. Results: Pharmacotherapy with selective serotonin reuptake inhibitors can be an effective first-line treatment in LLD, but > 50% of elderly patients do not adequately respond. Switching to other selective serotonin reuptake inhibitors or augmenting with mood stabilizers or antipsychotics is often effective in achieving a therapeutic benefit. Severely depressed patients with a high risk of suicidal behavior can be treated with electroconvulsive therapy. Psychotherapy provides a measurable benefit alone and when combined with medication. Limitations: LLD remains an underrepresented domain in research. Paucity of data concerning the effect of specific therapies for LLD, heterogeneity in the quality of study designs, overinterpretation of results from meta-analyses, and discrepancies between study results and guideline recommendations were often noted. Conclusions: Treating LLD is complex, but there are several treatment options with good efficacy and tolerability. Some novel pharmaceuticals also show promise as potential antidepressants, but evidence for their efficacy and safety is still limited and based on only a few trials conducted to date.

Research status and global trends of late-life depression from 2004 to 2023: bibliometric analysis

“…Most evidence suggests that pharmacological and psychological treatments are more effective in patients with LLD, which may be related to improvements in their overall physical functioning during treatment. However, LLD has a poorer prognosis, and its treatment is more challenging than that in young adults, with a higher incidence of comorbidities and adverse events due to the use of multiple medications ( Piel and Quante, 2023 ); therefore, it is essential to individualize treatment regimens for different individuals. Additionally, the development of effective and low-cost preventive measures for the majority of older adults remains a major challenge in the prevention of LLD ( Vyas and Okereke, 2020 ).…”

Attitudes towards seeking psychological help among community dwelling older adults enrolled in primary care in Chile

“…Hence, addressing a higher demand for mental health care among older adults in Chile, and improving the ability to detect and treat mental health problems in this age group, should be a priority. According to previous research, psychotherapy can be an effective strategy to treat common mental disorders in old age [ 15 – 17 ], even more effective compared to other age groups [ 18 ].…”

“…The existing evidence has shown that psychotherapy can be effective to treat depression among older adults [ 15 – 17 ]. Although Cuijpers et al [ 16 ] findings did not support a greater efficacy of psychotherapy for depression among older adults, compared to younger adults, a recent study in England found that psychotherapy was more effective to reach recovery from depression and anxiety among older adults, compared to working age adults [ 18 ].…”

Grey Matters: The Unique Landscape of Depression Treatment in Older Adults

“…When depressed older adults do receive treatment, antidepressants remain one of the most common first-line measures, and all three kinds of antidepressants (TCAs, SSRIs, MAOIs) are generally effective and tolerated by older patients (Bottino et al, 2012). However, many patients do not respond to antidepressants at all (Gutsmiedl et al, 2020;Mallery et al, 2019) or see only limited benefits and no remission (Piel & Quante, 2023). Several factors specific to older adults may contribute to their treatment resistance, including comorbid medical conditions, functional changes in the brain during aging, poor adherence to treatment due to memory/cognitive decline, changes in drug metabolism, and suboptimal prescription of antidepressants (Lenze et al, 2008;Kok & Reynolds, 2017).…”