Depression affects about one in ten older adults and is a leading cause of years of life lost due to its influence on other health and disability outcomes. A review article in Current Opinion in Psychiatry summarizes the current evidence on approaches to decrease the prevalence of depression among older adults, by prevention as well as the treatment of existing depression.
Preventive strategies against depression in older adults include “indicated prevention,” or interventions that target individuals with depressive symptoms that are not severe enough for a diagnosis of depressive disorder, and “selective prevention,” which targets populations at an elevated risk for depression, such as individuals who have just had a stroke. Unfortunately, findings are mixed on the effectiveness of both indicated and selective prevention. Screening for depression risk in community settings (such as during visits to a physician) has been effective for identifying individuals with depression but has shown little effect on clinical outcomes.
There is some evidence for effective treatment of depression among older adults, both to reduce symptoms and to minimize the risk of recurrence of depression in individuals who have been successfully treated. There is fairly strong evidence for the use of antidepressant medication among older adults, particularly for the reduction of moderate to severe depressive symptoms, though there is some concern about how well these findings would generalize toward older adults with other health conditions and the oldest old, who are generally underrepresented in clinical trials. Antidepressant medication and interpersonal psychotherapy appear effective in preventing a relapse.
Approaches that seek to manage or prevent depression through a broader assessment of relevant life factors, beyond those generally treated through psychiatric medications or psychotherapy, appear promising. A large collaborative care trail involving education, case management, and antidepressant medication showed moderate overall benefits but is likely too costly to be broadly applied. Large, cross-sectional research that looks at multiple demographic, behavioral, and socioeconomic factors suggests that the assessment and management of risk factors (such as health behaviors) is likely to be effective in reducing the onset of depression, but there is currently a lack of longitudinal or experimental research that could provide evidence for a causal relationship.
Almeida OP. Approaches to decrease the prevalence of depression in later life. Current Opinion in Psychiatry (2012); 25(6):451-456.