Psychotherapy for Late-Life Depression
Increase in Late-Life Depression
During the past 30 years, there has been a steady increase in the number of clinical trials initiated that have looked into the effects of psychosocial interventions for late-life depression. Many trials report that psychotherapy is an effective first-line treatment for major depressive disorder (MDD) in persons aged 65 and older.1 According to Professor in the Department of Psychiatry at the UCSF Medical Center, Patricia Arean, Ph.D., cognitive-behavioral therapy (CBT), problem-solving treatment (PST), and interpersonal therapy (IPT) have the strongest evidence-base for treating patients who struggle with late-life depression.
Which Treatment is Better for this Category of Depression?
Unfortunately, there is little information to help clinicians decide which treatment is better for different sets of circumstances.1 CBT was compared with expressive psychotherapy in older family caregivers for dementia patients, and it was found that long-term caregivers responded better to CBT while newer caregivers responded better to expressive psychotherapy. Arean states that newer caregivers were focused more on mourning the loss of their loved one’s cognitive skills, while more long-term caregivers had moved on from that stage and now focus on practical issues related to caregiving.1 Studies that examined the effects of gender and age found that these factors do not influence treatment outcomes.1
There have also been trials regarding psychotherapy for older adults who have specific medical illnesses.1 For example, CBT has been proven effective for older patients managing depression and anxiety as well as chronic obstructive pulmonary disease. However, CBT was not found effective for patients with depression and cardiovascular disease or heart failure. More clinical trials are being completed regarding the effects of CBT in patients with depression and type 2 diabetes mellitus. On the other hand, PST has been studied as an intervention for depression in older medical patients and has been seen to be effective, however, for which specific diseases are currently unknown. The same is true for IPT.
Arean states that traditional therapeutic time frames may not always work for older patients who are also medically ill.1 Weekly appointments of 50-minute sessions can be difficult for those juggling numerous medical appointments, who feel fatigued and ill often, and who need help traveling to their appointments.1 PST and CBT have shown effectiveness with two weeks between sessions, a choice for some patients.1 If so, it is helpful to provide the patient with support materials to use between sessions and enlist the help of family members to assist with therapeutic activities at home.1 According to Arean, fatigue is often an issue and psychotherapies such as PST are geared towards shorter sessions, and CBT offers in-home therapies as well.
Age-Related Changes and Depression
Usually, age-related changes in cognition do not interfere with treatment; however, minor to moderate impairments often do. Only PST has been studied for these patients and has been found to be effective. There have been no large-scale studies for IPT and CBT has not shown positive results.
Although research for psychotherapy for older depressed patients has come a long way, there is still room for growth.1 Arean states that she has four statements, worthy of future research: first, there have been no studies on the effects of psychotherapy on patients with psychosis; second, results from studies comparing antidepressants and psychotherapy have been mixed; third, while psychotherapy reduces depressive symptoms overall, there has been no research regarding specific symptoms; and fourth, there have been no studies of family-based therapies for late-life depression.1
 Arean, P.A. (2012, July 27). Psychotherapy for Late-Life Depression: What Works, What Doesn’t, and Practical Tips. Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/geriatric-psychiatry/content/article/10168/2092941
 Kiosses DN, Leon AC, Areán PA. Psychosocial interventions for late-life major depression: evidence-based treatments, predictors of treatment outcomes, and moderators of treatment effects. Psychiatr Clin North Am. 2011;34:377-401, viii.
 Gallagher-Thompson D, Steffen AM. Comparative effects of cognitive-behavioral and brief psychodynamic psychotherapies for depressed family caregivers. J Consult Clin Psychol. 1994;62:543-549.
 Hynninen MJ, Bjerke N, Pallesen S, et al. A randomized controlled trial of cognitive behavioral therapy for anxiety and depression in COPD. Respir Med. 2010;104:986-994.
 Dekker RL. Cognitive therapy for depression in patients with heart failure: a critical review. Heart Fail Clin. 2011;7:127-141.
 Petrak F, Hautzinger M, Plack K, et al. Cognitive behavioural therapy in elderly type 2 diabetes patients with minor depression or mild major depression: study protocol of a randomized controlled trial (MIND-DIA). BMC Geriatr. 2010;10:21.
 Haverkamp R, Areán P, Hegel MT, Unützer J. Problem-solving treatment for complicated depression in late life: a case study in primary care. Perspect Psychiatr Care. 2004;40:45-52.
 Schulberg HC, Post EP, Raue PJ, et al. Treating late-life depression with interpersonal psychotherapy in the primary care sector. Int J Geriatr Psychiatry. 2007;22:106-114.
 Floyd M, Rohen N, Shackelford JA, et al. Two-year follow-up of bibliotherapy and individual cognitive therapy for depressed older adults. Behav Modif. 2006;30:281-294.
 Wilkins VM, Kiosses D, Ravdin LD. Late-life depression with comorbid cognitive impairment and disability: nonpharmacological interventions. Clin Interv Aging. 2010;5:323-331.
 Alexopoulos GS, Raue PJ, Kiosses DN, et al. Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction: effect on disability. Arch Gen Psychiatry. 2011;68:33-41.
 Miller MD. Using interpersonal therapy (IPT) with older adults today and tomorrow: a review of the literature and new developments. Curr Psychiatry Rep. 2008;10:16-22.
 Ayalon L, Gum AM, Feliciano L, Areán PA. Effectiveness of nonpharmacological interventions for the management of neuropsychiatric symptoms in patients with dementia: a systematic review. Arch Intern Med. 2006;166:2182-2188. Depression.