Depression among older adults is an often-overlooked health crisis. Studies show that more than half of all people older than 60 diagnosed with depression fail to respond to initial treatment programs. In general, a psychotropic medication such as Lexapro (escitalopram) is one option of many as a first treatment. A variety of factors, however, complicate the successful treatment of elderly depression. Comorbid conditions, such as anxiety or poor physical health, may exacerbate the symptoms of depression. For reasons not fully understood, elderly patients respond more slowly to psychotropic medications in general. The patient’s level of independence likewise contributes to the success or failure of standard treatments. Despite the well-documented difficulty of treating depression in the elderly, relatively little work has been done to find more age-appropriate solutions to the problem.
In the case of elderly adults with depression, behavioral therapy may be at least as important as medication. One form of therapy known as depression care management (DCM) focuses on educating the patient about depression, their treatment, and practical measures for improving mood and daily functioning. Another therapy, known as interpersonal psychotherapy (IPT), is more intense and individually targeted. IPT resembles traditional cognitive-behavioral therapy, whereas DCM is more akin to routine counseling.
In a study of elderly adults, researchers tested whether DCM alone or coupled with IPT is more beneficial for those with a history of poor response to antidepressant medication. Study participants were administered standard prescriptions for Lexapro, which was increased as needed after an initial 6 weeks. People who experienced remission with medication alone were dropped from the study. Poor responders were divided into a DCM group and a DCM plus IPT group. Eighty percent of these individuals saw some improvement, while half experienced full remission of symptoms. Interestingly, there were no significant differences between the groups. Researchers theorized that “quantity” of therapeutic attention was less important than the existence of the attention at all. Therefore, the addition of DCM alone produced benefits; adding IPT did not produce more benefits.
The study was somewhat limited because researchers did not control for external variables, other than medical conditions that might argue against the use of Lexapro. In addition, some patients might have improved simply because of increased dosages and not behavioral interventions. More investigation is necessary to answer such questions.
Reynolds III, C. F., Dew, M. A., Martire, L. M., Miller, M. D., Cyranowski, J. M., Lenze, E., et al. (2010). Treating depression to remission in older adults: a controlled evaluation of combined escitalopram with interpersonal psychotherapy versus escitalopram with depression care management. International Journal of Geriatric Psychiatry, 25(11), 1134-1141.
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