Current Challenges Faced by Clinicians in Managing Late‐Life Depression: What Can Be Learned from Recent Evidence?

Review Article

Current Challenges Faced by Clinicians in Managing Late‐Life Depression: What Can Be Learned from Recent Evidence?

Cornelius Katona¹ and Cara Katona²

Affiliations: ¹MD FRCPsych, Dept Mental Health Sciences, University College London, Charles Bell House, 2nd Floor, 67-73 Riding House Street, London W1W 7EJ and ²BA, Medical Student, St George’s Hospital Medical School,
Cranmer terrace, London SW17 0RE


ABSTRACT

Recent evidence concerning the efficacy of pharmacological and psychological treatments for depression in older individuals will be reviewed. The evidence base addressing the effectiveness of antidepressants in older individuals has significantly increased over the past few years. In particular, some recent acute trials have failed to show superiority of an active drug over placebo, although there is more consistent evidence for the efficacy of continuation and maintenance antidepressant treatment. As for psychological treatments, problem‐solving therapy (PST) appears to be effective in mild depression and in patients with mild executive dysfunction; however, interpersonal psychotherapy (IPT) may be less effective. The evidence base for interventions in refractory depression is surprisingly limited. Several recent studies have adopted a pragmatic approach and have evaluated complex ‘case management’ approaches, most of which have been positive. Future studies are likely to target primary prevention. Preliminary evidence supporting this approach is summarized.

Keywords: depression, elderly, antidepressant, psychological treatment, review
Correspondence: Cornelius Katona, Fax: +44 1304 814299; e-mail: c.katona@ucl.ac.uk