Depression in Elderly Patients

There is limited data on depression treatment for patients 70 and over. Yet, elderly patients with depression, including those who are first developing the illness in later life, are at high risk for recurrence, disability and mortality.

Studies show that over 2-3 years, depression is 50-90% likely to recur in older patients. The treatment goal for older patients is therefore not only recovery, but also preventing the illness from recurring. To maintain the mental health of older people, it is very important to find practical and affordable depression management strategies that are effective in preventing recurrence.  

In an article recently published in the New England Journal of Medicine, CAMH’s Drs. Benoit Mulsant and Bruce Pollock, and colleagues, demonstrated that patients 70 and older were less likely to have recurrent depression if they received two years of maintenance therapy with an anti-depressant medication.

In this study, scientists tested the effectiveness of an anti-depressant and interpersonal psychotherapy (personal analysis with a nurse, social worker and/or psychologist) in treating patients 70 and older with depression. In this group, 55% of the participants were experiencing depression for the first time. Following response to the two therapies, patients were randomly assigned to one of four maintenance treatment programs. Patients received either the medication or a placebo combined with either monthly psychotherapy or clinical management sessions.

The study showed that major depression recurred over two years in 35% of patients who received the medication and psychotherapy, 37% of the patients who received medication and clinical management, 68% who received placebo and psychotherapy, and 58% who received placebo and clinical management. This shows that patients were less likely to have recurrent depression if they received two years of maintenance therapy with an anti-depressant medication. This study also shows that maintenance monthly psychotherapy did not prevent depression from recurring.

To date, there has been no consensus about the appropriateness of long-term maintenance treatment for depression in elderly patients. This data adds substantially to the body of knowledge regarding long-term treatment strategies in elderly people with depression, especially those with a first episode of this disease. These observations can inform long-term disease management strategies for treating elderly people with depression in general medical settings.

For more information visit http://content.nejm.org/

• Print Bookmark