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The first-ever expert consensus guidelines developed solely for the treatment of geriatric depression have been published.
The first-ever expert consensus guidelines developed solely for the treatment of geriatric depression have been published in Postgraduate Medicine (vol. 110, no. 5). The guidelines, based on a detailed survey of 50 of the country's leading experts in geriatric depression, address the specific psychiatric needs of adults over age 65, a quarter of whom are at serious risk for clinical depression.
The report contains 29 treatment guidelines and indicates that selective serotonin reuptake inhibitors are the most appropriate antidepressants to use in the treatment of all types of geriatric depression. The report also addresses issues such as assessment of depression in older patients, acute treatment strategies, medication selection, dosing and duration of treatment, treatment resistance, strategies for continuation of maintenance treatment, and special treatment issues.
Some highlights of the guidelines:
• Most experts would continue treatment with antidepressant medication for at least one to three years in older patients who had experienced severe major depression.
• For the treatment of many types of depression, the experts recommended combining psychotherapy with use of an antidepressant.
• The preferred psychotherapy techniques for treating depression in older patients were cognitive-behavioral, supportive, problem-solving and interpersonal psychotherapy.
• The experts also recommended that clinicians consider other psychosocial interventions, such as psychoeducation, family counseling and visiting nurse services, in addition to medication and psychotherapy.
Until now, clinicians treating geriatric depression have had to rely on guidelines developed for the treatment of depression in younger populations, who do not present with the same problems as older patients. Depressed elderly patients, as a rule, have many coexisting medical conditions and disabilities that may contribute to depression and complicate its treatment.
Said George S. Alexopoulos, professor of psychiatry at Weill Medical College of Cornell University Ithaca, NY, director of the Cornell Institute of Geriatric Psychiatry and senior investigator of the study that led to the development of the guidelines: "Because these guidelines provide treatment strategies devised specifically for an older population, they address clinical questions that had been unanswered until now." PR