Measuring the Effectiveness of Treatments for Depression in Older People
A systematic review of treatments for depression in older people has found that many treatments that work for other adults are equally effective in people aged 60 and over, but the reviewers are calling for broader testing of other treatments in response to the public's growing acceptance of some non-standard depression treatments.
The review, published in the latest issue of the Medical Journal of Australia, was conducted by Cathy Frazer, Helen Christensen and Kathleen Griffiths from the Centre for Mental Health Research at the Australian National University, Canberra.
Depression is a major health problem that affects many older people, causing significant distress and disability, exacerbating existing medical conditions, and resulting in earlier death and higher use of health services. Estimates of the prevalence of depression among elderly people living in the community vary widely, from less than one percent to 35 per cent.
Depression in older people can be distinguished from that in younger adults by a different symptom profile and possible additional causes.
"In depressed older adults, depressed mood may be less commonly reported, while symptoms such as loss of appetite, lack of energy, irritability, sleeplessness, worrying, and aches and pains are more prominent", say the authors.
We have to look at depression in elderly people as a specialised area because of unique factors that impact on people as they get older.
The authors reviewed three categories of treatments for depression: medical treatments, psychological treatments, and lifestyle changes or alternative therapies.
Treatments with the best evidence of effectiveness in the elderly were antidepressants, electroconvulsive therapy, cognitive behaviour therapy, psychodynamic psychotherapy, reminiscence therapy, problem-solving therapy, bibliotherapy (for mild to moderate depression), and exercise.
There was weaker evidence to support the effectiveness of transcranial magnetic stimulation, dialectical behaviour therapy, interpersonal therapy, light therapy (for people in nursing homes or hospitals), St John's wort and folate in reducing depressive systems.
Treatments for depression that have been shown to work in other age groups, but have not been tested in older people, include alcohol avoidance, negative air ionisation for seasonal winter depression, S-adenosylmethionine treatment and yoga breathing exercises.
The Medical Journal of Australia is a publication of the Australian Medical Association.
CONTACT: Dr Cathy FRAZER, 0423 000 963
Judith Tokley, AMA Public Affairs 02 6270 5471 / 0408 824 306