What is major depression?
Major depression is defined by a persistently down mood and/or loss of interest in normal activities for two weeks or more, accompanied by poor functioning in important life areas such as work, relationships and/or health. Other symptoms include a significant change in weight, changes in sleep patterns, agitation, fatigue, feelings of worthlessness or guilt, diminished concentration, indecisiveness and thoughts of death or suicide. While most people with major depression won’t experience all of these symptoms, many will experience one or more.
What causes depression?
The exact cause of depression is unknown. However, it is thought that certain stressful life events such as illness, death and life transitions (like retirement) may trigger a change in brain chemistry. There is evidence that there may be a genetic component to depression, as people with a family history are more likely to become depressed themselves; however, many people with no family history also have depression.
How does depression in late life differ from depression in other age groups?
Seniors are much more likely to go through life changes that cause feelings of sadness, such as the death of a spouse or a chronic illness. Sadness is normal, but if the sadness persists and is accompanied by other symptoms of depression, especially impairment in everyday functions and thoughts of suicide, the person should seek treatment. Seniors with untreated depression are more likely to die, either from suicide or the worsening of other medical conditions. They also are less likely to recover when injured and are more likely to be disabled.
What is the standard treatment for late-life depression?
Although there is not a “gold-standard” treatment for late-life depression, it was commonly thought that six to 12 months of antidepressant therapy and psychotherapy was a sufficient course of treatment for depression in people age 60 and older. A study by Dr. Reynolds and colleagues published in the January 6, 1999 issue of the Journal of the American Medical Association (JAMA) found that this combination was indeed the best therapy for that age group.
What did the current study find?
The study results published in the March 16, 2006 issue of The New England Journal of Medicine (NEJM) by Dr. Reynolds and colleagues found that in people age 70 and older who had recovered from a first episode of major depression, the best way to prevent recurrence was to take an antidepressant for two years. Interpersonal psychotherapy was not effective in this age group.
Aren’t the findings of the current study contradictory to those of the 1999 study published in JAMA?
No. The participants in the current study were older than those in the previous study. A combination of medication and therapy is still the best treatment for depression in people between the ages of 60 and 70. The current study suggests that interpersonal psychotherapy is not effective in people 70 and older.
Does this prove that there isn’t a place for interpersonal psychotherapy when treating people over the age of 70?
No. It just proves that traditional interpersonal psychotherapy is not effective in this age group.
Dr. Reynolds and colleagues hypothesize that this therapy doesn’t work in this age group because cognitive impairment, which is common in old age, can make people slower to process and respond to new information. Future studies by the research group will attempt to adapt traditional therapy to address this concern.
Will Medicare and other insurance companies cover the costs of this therapy?
What individual insurance products will and will not cover differs. However, since it was thought by most third-party payors that six to 12 months of treatment was sufficient for treating major depression in the elderly, that course of treatment is what many companies cover. This study proves that 6 to 12 months is not sufficient, and it is the researchers’ hope that insurance companies will use the new data and increase the length of coverage.
What antidepressant medication was used in this study?
Participants who did not receive placebo received paroxetine, a serotonin-reuptake inhibitor (SSRI). While this study did not test the effectiveness of other drugs, researchers believe that most other SSRIs should work equally as well as paroxetine.
Should patients be concerned about possible side effects from SSRIs, or interactions between the antidepressant and other common medications?
Most antidepressant medications are safe when taken with common medications for heart, kidney, liver and brain diseases, among others. Left untreated, depression could actually make certain conditions like heart disease worse. However, before starting a new medication, people should always discuss possible interactions with current medications with their physician and/or pharmacist.
Where should someone go if they think that they or a loved one might have late-life depression?
It is best for people with late-life depression to consult with a geriatric psychiatrist. Geriatric psychiatrists are medical doctors who have special interest and training in treating the mental health problems of patients over the age of 60. They are particularly knowledgeable about the factors that complicate the treatment of depression in older people such as medical illnesses and the medications that many seniors take to treat those illnesses. In Pittsburgh, call the Late-Life Depression Evaluation and Treatment Clinic at 412-246-6006, or visit the Web site at www.latelifedepression.org. For a referral to a geriatric psychiatrist in other areas of the United States and Canada, contact the American Association for Geriatric Psychiatry at 301-654-7850 x100.