Does psychotherapy help older people with depression?

The jury is still out on whether psychotherapy can help older people with depression, according to a new review of recent research.

Among the small number of patients studied, there were some signs that a treatment called cognitive behavioral therapy could help older patients manage their depression, at least compared to those waiting to start therapy.

Overall, however, “the findings do not provide strong support for psychotherapeutic treatments in the management of depression in older people,” said lead review author Kenneth Wilson, of the University of Liverpool, in England.

The review of studies appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Depression is a common – but often undiagnosed – problem among older people. “A significant proportion of older people with the condition will describe themselves as experiencing a loss of enjoyment and a feeling of ill health rather than sadness or a feeling of depression,” Wilson said.

Wilson and colleagues reviewed nine studies focused on the use of psychotherapy for mild depression in some 700 older patients. Most of the studies involved cognitive behavioral therapy, which encourages patients to replace daily “unhealthy thoughts” with a more positive and realistic viewpoint. A few of the studies used psychodynamic therapy, which attempts to reveal unconscious thoughts and feelings that might be contributing to depression.

In five studies, patients who received cognitive behavioral therapy had significantly fewer symptoms of depression than those waiting to enter a therapy program.

However, most of the studies were small, with relatively few men and many patients who dropped out before the end of their treatment. The patients ranged from mildly to severely depressed, and the treatments themselves were not standard between studies.

Despite stronger evidence of psychotherapy helping younger people, “all of these complications make it hard to say whether psychotherapy could be beneficial among older people,” Wilson said.

Also at issue is the question of whether psychotherapies should be the subject of stricter regulation, according to Michael Sharpe, a professor of psychological medicine at the University of Edinburgh, in Scotland. He said that many see psychotherapies as less harmful than drug therapy.

“We need a much more sophisticated view than ‘psychotherapy good; drug treatment bad' if we are to effectively and safely improve the mental health of the population,” Sharpe said.

Wilson KCM, Mottram PG, Vassilas CA. Psychotherapeutic treatments for older depressed people. The Cochrane Database of Systematic Reviews 2008, Issue 1.

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.