Psychotherapy for Depression in Older Patients: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Feng , WU Hongmei , HUANG Changquan , LUN Zhenchan , DONG Birong

Department of Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Psychotherapy; Depression; Elderly; Systematic review

DOI：

10.7507/1672-2531.20080237

Video：

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Objective 　To assess the effectiveness of psychotherapy for depression in older patients.
Methods 　We searched the Cochrane Central Register of Controlled Trials (1990 to August 2007), MEDLINE (1966 to August 2007), EMbase (1980 to August 2007), and CMB-disk (1990 to August 2007) to collect randomized controlled trials (RCTs) in which psychotherapy was used to treat depression in older patients. We screened the retrieved studies according to the predefined inclusion and exclusion criteria, evaluated the quality of included studies, and performed meta-analyses by using The Cochrane Collaboration’s RevMan 4.2 software.
Results 　Ten RCTs were included. Compared with placebo, psychotherapy was more effective in decreasing depression score (SMD 0.63, 95%CI – 0.84 to – 0.42). Subgroup analysis showed that cognitive-behavioral therapy, reminiscence therapy, and general psychological therapy were more effective than placebo (SMD – 0.70, 95%CI – 1.12 to – 0.27; SMD – 0.54, 95%CI – 0.81 to – 0.26; SMD – 0.84, 95%CI – 1.34 to – 0.34, respectively). However, psychotherapy as an adjunct treatment could not significantly improve the effectiveness of antidepressant medication (SMD – 0.35, 95%CI – 0.74 to 0.05). There was no significant difference between cognitive-behavioral therapy and reminiscence therapy in improving depression symptoms (SMD 0.13, 95%CI – 0.30 to 0.56). The dropout rate was similar between patients treated with or without psychotherapy (RR 1.03, 95%CI 0.55 to 1.94).
Conclusion 　 Various kinds of psychotherapy are effective for depression in older patients. But psychotherapy as an adjunct treatment could not significantly improve the effectiveness of antidepressant medication.

Citation： WANG Feng,WU Hongmei,HUANG Changquan,LUN Zhenchan,DONG Birong. Psychotherapy for Depression in Older Patients: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2008, 08(12): 1079-1085. doi: 10.7507/1672-2531.20080237 Copy

1.	中华医学会精神科学分会. 中国抑郁障碍防治指南. 2003.
2.	赵瑛, 肖世富, 夏斌, 等. 主编. 老年神经精神病学. 上海: 第二军医大学出版社, 2005, 705-715.
3.	闫芳, 李淑然. 老年抑郁症的发病率及其随访研究. 中国心理卫生杂志, 2000, 14(6): 392-394.
4.	闫芳, 李淑然, 刘津, 等. 老年期痴呆和老年抑郁症的流行病学调查. 中华医学杂志, 2002, 82(15): 20-23.
5.	Baldwin RC, Anderson D, Black S, et al. Guideline for the management of late-life depression in primary care. Int J Geriatr Psychiatry, 2003, 18: 829-838.
6.	Van Schaik DJ, Klijn AF, VanHout HP, et al. Patients’ preferences in the treatment of depressive disorder in primary care. Gen Hosp Psychiatry, 2004, 26: 184-189.
7.	Klaus Grawe. Chief Editor. Psychological therapy. Toronto: Hogrefe ＆ Huber Publishers, 2004.
8.	Bartels SJ, Coakley EH, Zubritsky C, et al. Improving access to geriatric mental health services: a randomized trial comparing treatment engagement with integrated versus enhanced referral care for depression, anxiety, and at-risk alcohol use. Am J Psychiatry, 2004, 161: 1455-1462.
9.	Miller MD, Wolfson L, Frank E, et al. Using interpersonal psychotherapy (IPT) in a combined p sychotherapy/medication research protocol with depressed elders. A descriptive report with case vignettes. J Psychother Pract Res, 1997, 7: 47-55.
10.	Jones C, Griffiths RD, Humphris G, et al. Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Crit Care Med, 2001, 29(3): 573-580.
11.	McCloskey JC, Bulechek GM, Donahue W. Nursing interventions core to specialty practice. Nurs Outlook, 1998, 46(2): 67-76.
12.	Bulechek GM, McCloskey J. All users of NIC encouraged to submit new interventions, suggest revisions. Iowa Intervention Project Research Team. Image J Nurs Sch, 1997, 29(1): 10.
13.	Paul DR, Judith A, Tomhave ZJ. Self-Management Therapy and Educational Group Therapy for Depressed Elders. Cognitive Therapy and Research, 2000, 24(1): 99-119.
14.	Beth A, Mastel S, Judith MF, et al. Improving Depressive Symptoms in Community-Dwelling Older Adults. Journal of Gerontological Nursing, 2007, 33(5): 13-19.
15.	Wang JJ, Hsu YC, Cheng SF. The effects of reminiscence in promoting mental health of Taiwanese elderly. International Journal of Nursing Studies, 2005, 42(1): 31-36.
16.	Serrano JP, Latorre JM, Gatz M, et al. Life review therapy using autobiographical retrieval practice for older adults with depressive symptomatology. Psychology and Aging, 2004, 19(2): 272-277.
17.	Arean PA, Perri MG, Nezu AM, et al. Comparative effectiveness of social problem-solving therapy and reminiscence therapy as treatments for depression in older adults. J Consult Clin Psychol, 1993, 61(6): 1003-1010.
18.	Lynch TR, Morse JQ, Mendelson T, et al. Dialectical behavior therapy for depressed older adults: A randomized pilot study. Am J Geriatr Psychiatry, 2003, 11(1): 33-45.
19.	Thompson LW, Coon DW, Gallagher TD, et al. Comparison of desipramine and cognitive/behavioral therapy in the treatment of elderly outpatients with mild-to-moderate depression. Am J Geriatr Psychiatry, 2001, 9(3): 225-240.
20.	Scogin F, Jamison C, Gochneaur K. Comparative efficacy of cognitive and behavioral bibliotherapy for mildly and moderately depressed older adults. J Consult Clin Psychol, 1989, 57(3): 403-407.
21.	Beutler LE, Scogin F, Kirkish P, et al. Group cognitive therapy and alprazolam in the treatment of depression in older adults. J Consult Clin Psychol, 1987, 55(4): 550-556.
22.	Steuer JL, Mintz J, Hammen CL, et al. Cognitive-behavioral and psychodynamic group psychotherapy in treatment of geriatric depression. J Consult Clin Psychol, 1984, 52(2): 180-189.
23.	Schulberg HC, Post EP, Raue PJ, et al. Treating late-life depression with interpersonal psychotherapy in the primary care sector. Int J Geriatr Psychiatry, 2007, 22(2): 106-114.
24.	van Schaik A, van Marwijk H, Ader H, et al. Interpersonal psychotherapy for elderly patients in primary care. Am J Geriatr Psychiatry, 2006, 14(9): 777-786.
25.	张继志译. 去甲替林和人际心理治疗作为复发重性抑郁的维持治疗: 59岁以上患者的随机对照试验. 美国医学会杂志中文版, 2000, 19(2): 66-68.
26.	Lenze EJ, Mazumdar S, Begley AE, et al. Combined pharmacotherapy and psychotherapy as maintenance treatment for late-life depression: Effects on social adjustment. Am J Psychiatry, 2002, 159(3): 466-468.
27.	Shah A, Odutoye K, De T. Depression in acutely medically ill elderly inpatients: A pilot study of early identification and intervention by formal psychogeriatric consultation. J Affect Disord, 2001, 62(3): 233-240.
28.	Reynolds CF, Miller MD, Pasternak RE, et al. Treatment of bereavement-related major depressive episodes in later life: a controlled study of acute and continuation treatment with nortriptyline and interpersonal psychotherapy. Am J Psychiatry, 1999, 156(2): 202-208.
29.	Jones ED. Reminiscence therapy for older women with depression. Effects of nursing intervention classification in assisted-living longterm care. J Gerontol Nurs, 2003, 29(7): 26-33; quiz 56-57.
30.	Chao SY, Liu HY, Wu CY, et al. The effects of group reminiscence therapy on depression, self esteem, and life satisfaction of elderly nursing home residents. J Nurs Res, 2006, 14(1): 36-45.

1. 中华医学会精神科学分会. 中国抑郁障碍防治指南. 2003.
2. 赵瑛, 肖世富, 夏斌, 等. 主编. 老年神经精神病学. 上海: 第二军医大学出版社, 2005, 705-715.
3. 闫芳, 李淑然. 老年抑郁症的发病率及其随访研究. 中国心理卫生杂志, 2000, 14(6): 392-394.
4. 闫芳, 李淑然, 刘津, 等. 老年期痴呆和老年抑郁症的流行病学调查. 中华医学杂志, 2002, 82(15): 20-23.
5. Baldwin RC, Anderson D, Black S, et al. Guideline for the management of late-life depression in primary care. Int J Geriatr Psychiatry, 2003, 18: 829-838.
6. Van Schaik DJ, Klijn AF, VanHout HP, et al. Patients’ preferences in the treatment of depressive disorder in primary care. Gen Hosp Psychiatry, 2004, 26: 184-189.
7. Klaus Grawe. Chief Editor. Psychological therapy. Toronto: Hogrefe ＆ Huber Publishers, 2004.
8. Bartels SJ, Coakley EH, Zubritsky C, et al. Improving access to geriatric mental health services: a randomized trial comparing treatment engagement with integrated versus enhanced referral care for depression, anxiety, and at-risk alcohol use. Am J Psychiatry, 2004, 161: 1455-1462.
9. Miller MD, Wolfson L, Frank E, et al. Using interpersonal psychotherapy (IPT) in a combined p sychotherapy/medication research protocol with depressed elders. A descriptive report with case vignettes. J Psychother Pract Res, 1997, 7: 47-55.
10. Jones C, Griffiths RD, Humphris G, et al. Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Crit Care Med, 2001, 29(3): 573-580.
11. McCloskey JC, Bulechek GM, Donahue W. Nursing interventions core to specialty practice. Nurs Outlook, 1998, 46(2): 67-76.
12. Bulechek GM, McCloskey J. All users of NIC encouraged to submit new interventions, suggest revisions. Iowa Intervention Project Research Team. Image J Nurs Sch, 1997, 29(1): 10.
13. Paul DR, Judith A, Tomhave ZJ. Self-Management Therapy and Educational Group Therapy for Depressed Elders. Cognitive Therapy and Research, 2000, 24(1): 99-119.
14. Beth A, Mastel S, Judith MF, et al. Improving Depressive Symptoms in Community-Dwelling Older Adults. Journal of Gerontological Nursing, 2007, 33(5): 13-19.
15. Wang JJ, Hsu YC, Cheng SF. The effects of reminiscence in promoting mental health of Taiwanese elderly. International Journal of Nursing Studies, 2005, 42(1): 31-36.
16. Serrano JP, Latorre JM, Gatz M, et al. Life review therapy using autobiographical retrieval practice for older adults with depressive symptomatology. Psychology and Aging, 2004, 19(2): 272-277.
17. Arean PA, Perri MG, Nezu AM, et al. Comparative effectiveness of social problem-solving therapy and reminiscence therapy as treatments for depression in older adults. J Consult Clin Psychol, 1993, 61(6): 1003-1010.
18. Lynch TR, Morse JQ, Mendelson T, et al. Dialectical behavior therapy for depressed older adults: A randomized pilot study. Am J Geriatr Psychiatry, 2003, 11(1): 33-45.
19. Thompson LW, Coon DW, Gallagher TD, et al. Comparison of desipramine and cognitive/behavioral therapy in the treatment of elderly outpatients with mild-to-moderate depression. Am J Geriatr Psychiatry, 2001, 9(3): 225-240.
20. Scogin F, Jamison C, Gochneaur K. Comparative efficacy of cognitive and behavioral bibliotherapy for mildly and moderately depressed older adults. J Consult Clin Psychol, 1989, 57(3): 403-407.
21. Beutler LE, Scogin F, Kirkish P, et al. Group cognitive therapy and alprazolam in the treatment of depression in older adults. J Consult Clin Psychol, 1987, 55(4): 550-556.
22. Steuer JL, Mintz J, Hammen CL, et al. Cognitive-behavioral and psychodynamic group psychotherapy in treatment of geriatric depression. J Consult Clin Psychol, 1984, 52(2): 180-189.
23. Schulberg HC, Post EP, Raue PJ, et al. Treating late-life depression with interpersonal psychotherapy in the primary care sector. Int J Geriatr Psychiatry, 2007, 22(2): 106-114.
24. van Schaik A, van Marwijk H, Ader H, et al. Interpersonal psychotherapy for elderly patients in primary care. Am J Geriatr Psychiatry, 2006, 14(9): 777-786.
25. 张继志译. 去甲替林和人际心理治疗作为复发重性抑郁的维持治疗: 59岁以上患者的随机对照试验. 美国医学会杂志中文版, 2000, 19(2): 66-68.
26. Lenze EJ, Mazumdar S, Begley AE, et al. Combined pharmacotherapy and psychotherapy as maintenance treatment for late-life depression: Effects on social adjustment. Am J Psychiatry, 2002, 159(3): 466-468.
27. Shah A, Odutoye K, De T. Depression in acutely medically ill elderly inpatients: A pilot study of early identification and intervention by formal psychogeriatric consultation. J Affect Disord, 2001, 62(3): 233-240.
28. Reynolds CF, Miller MD, Pasternak RE, et al. Treatment of bereavement-related major depressive episodes in later life: a controlled study of acute and continuation treatment with nortriptyline and interpersonal psychotherapy. Am J Psychiatry, 1999, 156(2): 202-208.
29. Jones ED. Reminiscence therapy for older women with depression. Effects of nursing intervention classification in assisted-living longterm care. J Gerontol Nurs, 2003, 29(7): 26-33; quiz 56-57.
30. Chao SY, Liu HY, Wu CY, et al. The effects of group reminiscence therapy on depression, self esteem, and life satisfaction of elderly nursing home residents. J Nurs Res, 2006, 14(1): 36-45.

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