Common Mental Disorders Depression - New Zealand Doctor

ehaviour therapies (BT), reminiscence and life-review therapies, interpersonal
psychotherapy (IPT) and problem-solving therapy (PST). No statistically significant
difference in efficacy was found between different psychological therapies. There was
insufficient evidence to determine whether psychological treatment combined with
antidepressants was superior to either treatment alone. 531 Many of the included studies
were of dubious quality and most were recruited from community rather than clinical
settings. One subsequent primary care study supported the efficacy of IPT for moderate
to severe depression in older people, 533 but another found psychotherapy ineffective in
preventing recurrence. 532
Psychological therapies: issues for evidence-based practice
This evidence suggests that psychological treatments are effective in older people,
though it is unclear which specific therapies work best and whether they are best
combined with antidepressants.
Pharmacological therapies
A National Institute for Health and Clinical Excellence (NICE) guideline 243 and a recent
Agency for Healthcare Research and Quality (AHRQ) review 351 addressed this topic.
Neither of these found sufficient evidence to determine whether there is any difference
between older people and other adults in the efficacy of antidepressants, either in a
primary care or a secondary care setting. The AHRQ review also noted that there is
insufficient evidence to determine whether older adults experience different side effects
from young adults when taking second-generation antidepressants. However, some
non-primary care studies and observational evidence suggest older patients may be at
increased risk of rare but potentially serious adverse events associated with SSRIs, such
as hyponatraemia and weight loss. 351 Moreover, a large observational study published
recently reports a doubling of fracture risk in people aged 50 years and over taking
SSRIs. 534 The GDT notes that the risk of fractures secondary to postural hypotension
with many of the TCAs should also be considered.
8.6 Depression with dementia
Dementia is a chronically progressive disease that impairs intellect and behaviour to
the point where customary activities of daily living are compromised. 535 Depression
may be comorbid with dementia and may or may not respond to intervention. 523
Among older adults/koroua/kuia with comorbid depression and dementia, there
is some evidence, albeit scanty, to support the use of psychosocial interventions.
Pharmacological interventions can also be used in this population, based on
international expert opinion. 65 Clinicians need to monitor response to treatment
carefully and reconsider the diagnosis if there is no improvement.
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Identification of Common Mental Disorders and Management of Depression in Primary Care