Treating Older Adults
Studies show that the majority of older adults with depression improve when they receive treatment with an antidepressant, psychotherapy or a combination of both. In addition, research has indicated that treating depression in older adults often improves the outcomes of co-existing medical conditions. Some research has also suggested that the risk for developing depression in people who have had a stroke may be reduced if they receive preventative treatment with an antidepressant or talk therapy.
However, there are some special considerations that doctors must take into account when treating older adults. The commonly prescribed medications for depression may not work well for some older adults because they may interact unfavorably with other medications being taken for other conditions. Some older adults with depression may also have some problems thinking clearly, and these individuals often respond poorly to the drugs.
Combination Treatment is Most Effective
Research shows that, for older adults, a combination of medication and psychotherapy treatment is most effective in treating depression and reducing the risk for relapse. But for those older adults who are unable or unwilling to take medication, psychotherapy alone also can be effective in helping seniors with depression. Studies suggest that cognitive-behavioral therapy (CBT) may be an especially useful type of psychotherapy for treating older adults and improving their quality of life.
Late-Life Depression is Often Undiagnosed
Despite progress in treatment research, late-life depression often goes undiagnosed or is inadequately treated in older adults. In fact, several studies have found that up to 75 percent of older adults who die by suicide had visited their primary care doctors within one month of their deaths. Collaborative or comprehensive care may lead to better treatment results.
The Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) offered antidepressant medication and/or psychotherapy to depressed older adults, along with a "care manager" -- a social worker, nurse or psychologist -- who monitored their symptoms, side effects of medication, and progress.
The study found that those participants who had case-managed care got better more quickly, had longer periods without depression, and in general responded better to treatment than those who did not have case-managed care.
Another study called the Improving Mood: Promoting Access to Collaborative Treatment (IMPACT) trial also found that collaborative care was more effective than usual care, and was less expensive over the long run as well.
Improving Diagnosis of Depression
Researchers also are working to help both doctors and patients better recognize the signs of depression and the potential for suicide in older adults. To improve diagnosis, researchers funded by the National Institute of Mental Health are studying the effectiveness of an education and intervention program that aims to improve recognition and treatment of depression and suicidal symptoms in older patients.
Finally, researchers are looking at the role hormone changes may play in the development of depression in older adults. They want to find out whether hormone replacement therapy with estrogens or androgens may benefit older adults with late-life depression. Other studies are looking to better understand the relationship between other medical illnesses and depression. Still others are looking to help older adults get better access to depression treatment. Findings from these and other studies will provide important information for doctors to treat late-life depression.
In a Crisis? Get Help!
If you are in a crisis...
If you are thinking about harming yourself or attempting suicide, tell someone who can help immediately.
- Call your doctor.
- Call 911 for emergency services.
- Go to the nearest hospital emergency room.
- Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to be connected to a trained counselor at a suicide crisis center nearest you.