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Subthreshold Depression Needs A Prime Time In Old Age Psychiatry? A Narrative Review Of Current Evidence.

Marina Maria Biella¹, Marcus Kiiti Borges¹, Jason Strauss²

¹Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.

Neuropsychiatric Disease and Treatment

|October 3, 2019

Summary

Subsyndromic depression (SD) is common in older adults, lacking treatment guidelines. Brief psychotherapy is recommended first-line, with medication for severe cases to prevent negative health outcomes.

Keywords:

depressive symptoms older adults prevalence subthreshold depression treatment

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Area of Science:

Geriatric Psychiatry
Mental Health Research
Clinical Psychology

Background:

Subsyndromic depression (SD) is the most prevalent depressive disorder in older adults.
There is a lack of formal guidelines and consensus on the diagnosis and management of SD.
SD significantly impacts older adults' health and well-being.

Purpose of the Study:

To conduct a narrative review and update the literature on subsyndromic depression in older adults.
To explore the current understanding of SD's classification, diagnosis, causes, course, outcomes, and management.
To provide recommendations for clinical practice and future research in geriatric psychiatry.

Main Methods:

Electronic literature search of Pubmed, EMBASE, and Web of Science.
Inclusion of original English articles from inception to March 1, 2019.
Keywords included "subthreshold depression," "prevalence," "treatment," and "older adults."

Main Results:

No clear consensus exists on the nosologic classification, diagnostic tools, causes, course, outcomes, or management of SD.
SD diagnosis should be based on depressive symptom scales and DSM criteria.
Collaborative care and psychotherapy are primary treatment approaches.

Conclusions:

Brief psychotherapy is recommended as the first-line treatment for SD.
Psychotropic agents may be used for more severe cases or significant functional impairment, in conjunction with psychotherapy.
Effective treatment of SD can prevent negative outcomes like worsening comorbidities, functional decline, increased healthcare utilization, and mortality.