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Chronic depression in the elderly: approaches for prevention.
C F Reynolds1, G S Alexopoulos, I R Katz
1Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania 15213, USA. Reynoldscf@msx.upmc.edu
Drugs & Aging
|August 3, 2001
Summary
Late-life depression often relapses, making maintenance therapy crucial for elderly individuals. Antidepressants and psychotherapy effectively prevent chronic illness and disability in older adults.
Area of Science:
- Geriatric Psychiatry
- Clinical Psychology
- Pharmacology
Background:
- Late-life depression frequently follows a chronic or relapsing course.
- Medical comorbidity, cognitive impairment, and psychosocial resource depletion exacerbate depression in older adults.
- The US National Institutes of Health (NIH) Consensus Development Conference emphasizes preventing relapse, recurrence, and chronicity in late-life depression.
Purpose of the Study:
- To highlight the importance of maintenance therapy for elderly patients with major depressive episodes.
- To discuss the favorable benefit-to-risk ratio of available treatments for preventing relapse and recurrence.
- To underscore the role of pharmacotherapy and psychosocial approaches in managing chronic depressive illness and associated disability.
Main Methods:
- Review of established long-term efficacy of tricyclic antidepressant nortriptyline.
- Discussion of ongoing studies evaluating maintenance efficacy of paroxetine and citalopram.
- Focus on high-risk populations: patients aged 70 and above and those in primary care settings.
Main Results:
- Antidepressant pharmacotherapy is the primary treatment for maintenance.
- Psychosocial interventions, particularly interpersonal psychotherapy, significantly aid in preventing chronic depression and disability.
- Established efficacy of nortriptyline; ongoing research for paroxetine and citalopram in elderly depression.
Conclusions:
- Most elderly patients with major depressive episodes are candidates for maintenance therapy.
- Effective treatment, including pharmacotherapy and psychosocial support, is vital for managing depression in old age.
- Addressing under-recognition and under-treatment of elderly depression in primary care is a public health priority.