Depression that does not reach the criteria of major depression as defined by the Diagnostic and Statistical Manual of Medical Disorders (Fourth Edition; DSM-IV) is a significant burden to many older adults. Not only does such subclinical depression interfere with quality of life, it is also associated with an increased risk for cognitive impairment, disability in activities of daily living (ADLs), physical ailments, and transition to major depression. A forthcoming review finds that psychotherapy may be a safe and effective way to treat subclinical depression and to prevent major depressive disorder among older adults.
The authors reviewed research studies on the non-pharmacological treatment of subclinical depression among community-dwelling older adults. Although antidepressant medication is often effective against major depressive disorders, it can increase risk of falls (particularly for individuals taking other medications), and appears to be less effective against depression that does not meet the DSM-IV criteria for major depressive disorder.
The authors found five studies that matched their criteria, which consisted of randomized controlled trials that included participants of at least 50 years of age, and who had reliably diagnosed subclinical forms of depression. The studies that were reviewed varied in their method, design, and number of participants. They included cognitive-behavioral therapy and life review therapy administered in a range of methods. Overall, the interventions that were reviewed had large effects against depressive symptoms, and led to lower incidence of major depression at follow-up assessments.
It is useful to bear in mind that depressive symptoms can vary tremendously across individuals. Because of this, different individuals are likely to respond differently to different forms of treatment. However, this review suggests that therapy for subclinical depression can be effective for improving mood and reducing the likelihood of developing major depression among older adults.
Lee SY, Franchetti ML, Imanbayev A, et al (2012). Non-pharmacological prevention of major depression among community-dwelling older adults: A systematic review of the efficacy of psychotherapy interventions. Arch Gerontol Geriatr (epub ahead of print).