Hostname: page-component-7c8c6479df-8mjnm Total loading time: 0 Render date: 2024-03-26T12:30:44.468Z Has data issue: false hasContentIssue false

Preventing late-life depression: a clinical update

Published online by Cambridge University Press:  01 July 2010

Abstract

Background: Achieving remission in late-life depressive disorder is difficult; it is far better to prevent depression. In the last ten years there have been a number of clinical studies of the feasibility of prevention.

Methods: A limited literature review was undertaken of studies from 2000 specifically concerning the primary prevention of late-life depressive disorder or where primary prevention is a relevant secondary outcome.

Results: Selective primary prevention (targeting individuals at risk but not expressing depression) has been shown to be effective for stroke and macular degeneration but not hip fracture. It may also prove effective for the depression associated with caregiving in dementia. Emerging evidence finds effectiveness for indicated prevention (in those identified with subthreshold depression often with other risk factors such as functional limitation). Despite a number of promising risk factors (for example, diet, exercise, vascular risk factors, homocysteine and insomnia), universal prevention of late-life depression (acting to reduce the impact of risk factors at the population level) has no current evidence base, although a population approach might mitigate suicide.

Conclusion: Interventions which work in preventing late-life depression include antidepressant medication in standard doses and Problem-Solving Treatment. When integrated into a care model, such as collaborative care, prevention is feasible but more economic studies are needed.

Type
Focus on prevention in psychogeriatrics
Copyright
Copyright © International Psychogeriatric Association 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alexopoulos, G. S. et al. (2009). Reducing suicidal ideation and depression in older primary care patients: 24-month outcomes of the PROSPECT Study. American Journal of Psychiatry, 166, 882890.CrossRefGoogle ScholarPubMed
Almeida, O. P., Waterreus, A. and Hankey, G. J. (2006). Preventing depression after stroke: results from a randomized placebo-controlled trial. Journal of Clinical Psychiatry, 67, 11041109.CrossRefGoogle ScholarPubMed
Almeida, O. P., McCaul, K., Hankey, G. J., Norman, P., Jamrozik, K., and Flicker, L. (2008). Homocysteine and depression in later life. Archives of General Psychiatry, 65, 12861294.CrossRefGoogle ScholarPubMed
Baldwin, R. C. (2005). Is vascular depression a distinct subtype of depressive disorder? A review of causal evidence. International Journal of Geriatric Psychiatry, 20, 111.CrossRefGoogle ScholarPubMed
Ballard, C. G., Eastwood, C., Gahir, M. and Wilcock, G. (1996). A follow-up study of depression in the carers of dementia sufferers. BMJ, 312, 947.CrossRefGoogle ScholarPubMed
Boult, C., Boult, L. B., Morishita, L., Dowd, B., Kane, R. L. and Urdangarin, C. F. (2001). A randomized clinical trial of outpatient geriatric evaluation and management. Journal of the American Geriatrics Society, 49, 351359.CrossRefGoogle ScholarPubMed
Bruce, M. L. et al. (2004). Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial. JAMA, 291, 10811091.CrossRefGoogle ScholarPubMed
Burns, A. et al. (2007). Treatment and prevention of depression after surgery for hip fracture in older people: randomized, controlled trials. Journal of the American Geriatrics Society, 55, 7580.CrossRefGoogle ScholarPubMed
Cho, H. J., Lavretsky, H., Olmstead, R., Levin, M. J., Oxman, M. N. and Irwin, M. R. (2008). Sleep disturbance and depression recurrence in community-dwelling older adults: a prospective study American Journal Psychiatry, 165, 15431550.CrossRefGoogle ScholarPubMed
Ciechanowski, P. et al. (2004). Community-integrated home-based depression treatment in older adults: a randomized controlled trial. JAMA, 291, 15691577.CrossRefGoogle ScholarPubMed
Cuijpers, P., Muñoz, R. F., Clarke, G. N. and Lewinsohn, P. M. (2009). Psychoeducational treatment and prevention of depression: the “coping with depression” course thirty years later. Clinical Psychology Review, 29, 449458.CrossRefGoogle ScholarPubMed
Cukrowicz, K. C., Duberstein, P. R., Vannoy, S. D., Lynch, T. R., McQuoid, D. R. and Steffens, D.C. (2009). Course of suicide ideation and predictors of change in depressed older adults. Journal of Affective Disorders, 113, 3036.CrossRefGoogle ScholarPubMed
Dozeman, E., van Schaik, D. J. F., Beekman, A. T. F., Stalman, W. A. B., Bosmans, J. E. and van Marwijk, H. W. J. (2007). Depression and anxiety, an Indicated Prevention (DIP) protocol in homes for the elderly: feasibility and (cost) effectiveness of a stepped care programme. BMC Geriatrics, 7 (6) 19.CrossRefGoogle ScholarPubMed
Duan, W. et al. (2008). Sertraline slows disease progression and increases neurogenesis in N171–82Q mouse model of Huntington's disease. Neurobiology of Disease, 30, 312322.CrossRefGoogle ScholarPubMed
Ensrud, K. E. et al. (2003). Central nervous system active medications and risk for fractures in older women; for the Study of Osteoporotic Fractures Research Group Archives of Internal Medicine, 163, 949957.CrossRefGoogle Scholar
Fava, M. and Mischoulon, D. (2009). Folate in depression: efficacy, safety, differences in formulations, and clinical issues Journal of Clinical Psychiatry, 70 (Suppl. 5), 1217.CrossRefGoogle ScholarPubMed
Fournier, J. C. et al. (2010). Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA, 303, 4753.CrossRefGoogle ScholarPubMed
Gallo, J. J., Bogner, H. R., Morales, K. H., Post, E. P., Lin, J. Y. and Bruce, M. L. (2007). The effect of a primary care practice-based depression intervention on mortality in older adults: a randomized trial. Annals of Internal Medicine, 146, 689698.CrossRefGoogle ScholarPubMed
Jorge, R. E., Robinson, R. G., Arndt, S. and Starkstein, S. (2003). Mortality and poststroke depression: a placebo-controlled trial of antidepressants. American Journal of Psychiatry, 160, 18231829.CrossRefGoogle ScholarPubMed
Lenze, E. J. et al. (2007). Onset of depression in elderly persons after hip fracture: implications for prevention and early intervention of late-life depression. Journal of the American Geriatrics Society, 55, 8186.CrossRefGoogle ScholarPubMed
Llewellyn-Jones, R. H., Baikie, K. A., Smithers, H., Cohen, J., Snowdon, J. and Tennant, C. C. (1999). Multifaceted shared care intervention for late life depression in residential care: randomised controlled trial. BMJ, 319, 676682.CrossRefGoogle ScholarPubMed
LynessJ., M. J., M., Yu, Q., Tang, W., Tu, X. and Conwell, Y. (2009). Risks for depression onset in primary care elderly patients: potential targets for preventive interventions. American Journal of Psychiatry, 166, 13751383.CrossRefGoogle ScholarPubMed
Mann, J. J. et al. (2005). Suicide prevention strategies: a systematic review. JAMA, 294, 20642074.CrossRefGoogle ScholarPubMed
Marriott, A., Donaldson, C., Tarrier, N. and Burns, A. (2000). Effectiveness of cognitive-behavioural family intervention in reducing the burden of care in carers of patients with Alzheimer's disease. British Journal of Psychiatry, 176, 557562.CrossRefGoogle ScholarPubMed
McCusker, J., Cole, M., Keller, E., Bellavance, F. and Berard, A. (1998). Effectiveness of treatments of depression in older ambulatory patients. Archives of Internal Medicine, 158, 705712.CrossRefGoogle ScholarPubMed
Milaneschi, Y., Corsi, A. M., Penninx, B. W., Bandinelli, S., Guralnik, J. M. and Ferrucci, L. (2009). Interleukin-1 receptor antagonist and incident depressive symptoms over 6 years in older persons: the InCHIANTI Study. Biological Psychiatry, 65, 973978.CrossRefGoogle ScholarPubMed
Miller, M. A. et al. (2009). Gender differences in the cross-sectional relationships between sleep duration and markers of inflammation: Whitehall II Study. Sleep, 32, 857864.Google Scholar
Mrazek, P. and Haggerty, R. (1994) Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research. Washington, DC: National Academy Press.Google Scholar
Nelson, J. C., Delucchi, K. and Schneider, L. S. (2008). Efficacy of second generation antidepressants in late-life depression: a meta-analysis of the evidence. American Journal of Geriatric Psychiatry, 16, 558567.CrossRefGoogle ScholarPubMed
Oyama, H., Fujita, M., Goto, M., Shibuya, H. and Sakashita, T. (2006). Outcomes of community-based screening for depression and suicide prevention among Japanese elders. The Gerontologist, 46, 821826.CrossRefGoogle ScholarPubMed
Rabins, P. V. et al. (2000). Effectiveness of a nurse-based outreach program for identifying and treating psychiatric illness in the elderly. JAMA, 283, 28022809.CrossRefGoogle ScholarPubMed
Rasmussen, A. et al. (2003). A double-blind, placebo-controlled study of sertraline in the prevention of depression in stroke patients. Psychosomatics, 44:216221.CrossRefGoogle ScholarPubMed
Robinson, R. G. and Jorge, R. E. (2009). Prevention of first-episode depression: progress and potential. British Journal of Psychiatry, 194, 296297.CrossRefGoogle ScholarPubMed
Robinson, R. G. et al. (2008). Escitalopram and problem-solving therapy for prevention of poststroke depression: a randomized controlled trial. JAMA, 299, 23912400.CrossRefGoogle ScholarPubMed
Rosen, C. J. (2009). Serotonin rising: the bone, brain, bowel connection. New England Journal of Medicine, 360, 957959.CrossRefGoogle ScholarPubMed
Rovner, B. W., Casten, R. J., Hegel, M. T., Leiby, B. E. and Tasman, W. S. (2007). Preventing depression in age-related macular degeneration. Archives of General Psychiatry, 64, 886892.CrossRefGoogle ScholarPubMed
Rush, A. J. (2007). STAR*D: what have we learned? American Journal of Psychiatry, 164, 201204.CrossRefGoogle Scholar
Schoevers, R. et al. (2006). Prevention of late-life depression in primary care: do we know where to begin? American Journal of Psychiatry, 163, 16111616.CrossRefGoogle ScholarPubMed
Sjösten, N. and Kivelä, S-L. (2006). The effects of physical exercise on depressive symptoms among the aged: a systematic review. International Journal of Geriatric Psychiatry, 21, 410418.CrossRefGoogle ScholarPubMed
Smit, F., Ederveen, A., Cuijpers, P., Deeg, D. and Beekman, A. (2006). Opportunities for cost-effective prevention of late-life depression an epidemiological approach. Archives of General Psychiatry, 63, 290296.CrossRefGoogle ScholarPubMed
Sriwattanakomen, R. et al. (2008). Preventing depression in later life: translation from concept to experimental design and implementation. American Journal of Geriatric Psychiatry, 16, 460468.CrossRefGoogle ScholarPubMed
Stewart, J. C., Janicki, D. L., Muldoon, M. F., Sutton-Tyrrell, K. and Kamarck, T. W. (2007). Negative emotions and 3-year progression of subclinical atherosclerosis. Archives of General Psychiatry, 64, 225233.CrossRefGoogle ScholarPubMed
Unützer, J. et al. (2002). Collaborative care management of late-life depression in the primary care setting. JAMA, 288, 28362845.CrossRefGoogle ScholarPubMed
U.S. Institute of Medicine (2009). Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Consensus Report. National Research Council and Institute of Medicine of the National Academies. Washington, DC: The National Academies Press.Google Scholar
van de Rest, O. et al. (2008). Effect of fish-oil supplementation on mental well-being in older subjects: a randomized, double-blind, placebo-controlled trial. American Journal of Clinical Nutrition, 88, 706713.CrossRefGoogle ScholarPubMed
van't Veer-Tazelaar, P. et al. (2009). Stepped-care prevention of anxiety and depression in late life a randomized controlled trial. Archives of General Psychiatry, 66, 297304.CrossRefGoogle ScholarPubMed
van't Veer-Tazelaar, P. et al. (2010) Cost-effectiveness of a stepped care intervention to prevent depression and anxiety in late life: randomised trial. British Journal of Psychiatry, 196, 319325.CrossRefGoogle ScholarPubMed
Williams, J. W. et al. (2000). Treatment of dysthymia and minor depression in primary care: a randomized controlled trial in older adults. JAMA, 284, 15191526.CrossRefGoogle ScholarPubMed
Yan, C., Patel, N., Guo, J. and Siyan, Z. (2007). Antidepressant prophylaxis for poststroke depression: a meta-analysis. International Clinical Psychopharmacology, 22, 159166.Google Scholar