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The British Journal of Psychiatry (2000) 177: 281-282
© 2000 The Royal College of Psychiatrists

Correspondence

More disappointing treatment outcomes in late-life depression

S. I. Evans

St Bartholomew's and Homerton Hospitals, London ECIY 7BE

EDITED BY MATTHEW HOTOPF

Tuma (2000) reported disappointing outcomes in the treatment of late-life depression. Suicide rates are highest in the elderly in many countries (Shah & De, 1998), while treatment with drugs and electroconvulsive therapy consistently results in full recovery rates of less than 30% (Murphy, 1983). Some studies show slightly more optimistic findings, such as Baldwin & Jolley (1986) and Brodaty et al (1993) who demonstrated prognosis in later life approaching that in younger adults at one year. Yet others suggest that longer follow-up reveals a worse outcome (Forsell et al, 1994). These studies use standard physical treatments but make no mention of adjunctive psychological treatments of any kind.

There are still too few studies demonstrating the effects of psychological interventions in older people (O'Rourke & Hadjistravropoulos, 1997). More recently published data have shown improved outcome using a combination of drug and psychological treatments, including interpersonal therapy and cognitive-behavioural therapy (Reynolds et al, 1999). In addition, important research by Ong et al (1987) demonstrated relapse prevention for individuals attending a support group.

In a recent postal survey, I enquired of members of the Royal College of Psychiatrists' Faculty for the Psychiatry of Old Age whether elderly patients in their care had specifically requested psychotherapy. The overall response rate was 65%, of which 49% had experience of patients asking for psychotherapy. One can only assume that those already in receipt of such treatments would not ask for it. Patients rarely demand drug treatments as they are often already taking medication. The National Health Service (NHS) Executive (1996) review of psychotherapy services endorses the need for older patients to have access to similar service opportunities as the young.

Since elderly consumers of our service are asking for psychotherapy, and because there is some evidence (Roth & Fonagy, 1996) that it is a useful adjuvant in the war against late-life depression, why are we still producing research which appears to ignore this approach?

REFERENCES

  1. Baldwin, R. C. & Jolley, D. J. (1986) The prognosis of depression in old age. British Journal of Psychiatry, 149, 574-583.[Abstract/Free Full Text]
  2. Brodaty, H., Harris, L., Peters, K., et al (1993) Prognosis of depression in the elderly. A comparison with younger patients. British Journal of Psychiatry, 163, 589-596.[Abstract/Free Full Text]
  3. Forsell, Y., Jorm, A. F. & Winblad, B. (1994) Outcome of depression in demented and non-demented elderly: Observations from a three-year follow-up in a community-based study. International Journal of Geriatric Psychiatry, 9, 5-10.[CrossRef]
  4. Murphy, E. (1983) The prognosis of depression in old age. British Journal of Psychiatry, 142, 111-119.[Abstract/Free Full Text]
  5. NHS Executive (1996) NHS Psychotherapy Services in England: Review of Strategic Policy. London: Department of Health.
  6. Ong, Y. L., Martineau, F., Lloyd, C., et al (1987) A support group for the depressed elderly. International Journal of Geriatric Psychiatry, 2, 119-123.
  7. O'Rourke, N. & Hadjistavropoulos, T. (1997) The relative efficacy of psychotherapy in the treatment of geriatric depression. Aging and Mental Health, 1, 305-310.[CrossRef]
  8. Reynolds, C. F., Frank, E., Perel, J. M., et al (1999) Nortriptyline and IPT as maintenance therapies for recurrent major depression: a randomised controlled trial in patients older than 59 years. Journal of the American Medical Association, 281, 83-84.[Free Full Text]
  9. Roth, A. D. & Fonagy, P. (1996) What Works for Whom? A Critical Review of Psychotherapy Research. New York: Guilford Press.
  10. Shah, A. & De, T. (1998) Suicide and the elderly. International Journal of Psychiatry Clinical Practice, 2, 3-17.
  11. Tuma, T. A. (2000) Outcome of hospital-treated depression at 4.5 years. An elderly and a younger adult cohort compared. British Journal of Psychiatry, 176, 224-228.[Abstract/Free Full Text]




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