Depression in the Elderly
Depression research has shown that certain types of short-term psychotherapy, particularly cognitive behavioral therapy (CBT) and interpersonal therapy (IPT), are effective treatments for depression in the elderly. In addition, psychotherapy alone has been shown to prolong periods of good health free from depression.
By teaching new ways of thinking and behaving, CBT helps people change negative habits that may contribute to their depression. IPT helps people understand and work through troubled personal relationships or events that may cause their depression or make it worse.
For mild to moderate depression, psychotherapy may be the best treatment option. However, sometimes psychotherapy alone is not enough. A study examining depression treatment among older adults found that people who got better with medication and IPT were less likely to have the depression return if they continued their combination treatment for at least two years.
More studies are in progress on the long-term effectiveness of SSRIs and specific psychotherapies for depression in older persons. Findings from these studies will provide important data regarding the clinical course and treatment of depression. Further research will be needed to determine the role of hormonal factors in the development of depression in older adults, and to find out whether hormone replacement therapy with estrogens or androgens is of benefit in the treatment of late-life depression.
When medication and/or psychotherapy does not help improve a person's depression, ECT is sometimes used. ECT, once known as "shock therapy," used to have a bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe depression who have not gotten better or improved with other treatments.
Before electroconvulsive therapy is given, a person takes a muscle relaxant and is put under brief anesthesia. He or she does not consciously feel the electrical impulse from ECT. A person will typically have ECT several times a week, and will often need to take an antidepressant or mood-stabilizing medication to keep the depression from returning. Although some people will need only a few courses of ECT, others may need follow-up treatments, usually once a week at first, then gradually decreasing to once a month for up to one year.
ECT may cause some short-term side effects, including confusion, disorientation, and memory loss. However, these side effects typically clear up within an hour of treatment. Research has shown that after one year of ECT treatments, people show no harmful mental effects.