Treatment of late life depression: A response to the NIH consensus conference

Abstract

Conclusions of the NIH Consensus Conference on treatment of late life depression, particularly with regard to their recommendations regarding cognitive behavioral therapies as those compare to a review of empirical findings, are examined. In contrast to the NIH recommendations, research demonstrates that psychotherapy is at least of equal effectiveness as compared to antidepressant medication for older depressed patients. Cognitive and behavioral approaches have not been shown to be more effective than other brief therapies, particularly interpersonal therapy and brief psychodynamic therapy. There are more studies, however, demonstrating the effectiveess of cognitive and behavioral therapies than any other approach. Older adults hold generally positive attitudes towards such treatments and may prefer them to medication treatment. Offering cognitive or behavioral therapy as a first line intervention for mild to moderately depressed older adults could be the most cost-effective approach in most settings. Promotion of cognitive and behavioral therapies for older depressed patients would be supported by involvement in the development of treatment guidelines at the national level, expansion of the work of the APA task force on empirically validated treatments to include therapies for older adults, and by the efforts of individuals to present information to older adults in the community on the potential benefits of cognitive and behavioral treatments for depression.