Citation

Melcher T, Leyhe T. Schweiz Arch. Neurol. Psychiatr. 2015; 166(3): 78-86.

Copyright

(Copyright © 2015, Zeitschriften)

DOI

10.4414/sanp.2015.00329

PMID

unavailable

Abstract

Late-life depression usually has a particular clinical presentation. There is a sharp drop in the rates of diagnosis and treatment among elderly depressed patients compared with younger ones, arguably because concurrent medical health problems obscure the genuine depressive mood symptoms. Typically, patients present instead with less specific symptoms such as insomnia, loss of appetite, fatigue and cognitive impairment. At the same time, depression in old age has a high risk of severe medical sequelae (e.g., dementia, cancer and cardiac conditions) and also of suicide. The efficacy of pharmacotherapeutic interventions appears to be restricted, whereas systematic reviews provide a strong evidence-base for psychotherapy as a first-line treatment in older depressive patients. Basically, psychotherapy in old age could use all the approaches established in younger patients, which, however, should always be reviewed before application for necessary modifications of their therapeutic attitudes and techniques. Based on prevalent gerontological models, required modifications can be described across psychotherapeutic schools and mainly comprise an active and supportive (i.e., not neutral) therapeutic attitude, as well as pronounced goal-orientation and focus combined with an appropriate (i.e., limited) changing intent. Concrete adaptations have been developed for cognitive-behavioural therapy and different psychodynamic therapies, as well as for integrative approaches, particularly interpersonal psychotherapy (IPT), which together provide the basis for a broad clinical application that could close the persisting gap in the care of elderly depressed patients. © 2015, EMH Swiss Medical Publishers Ltd. All rights reserved.

Language: de

Keywords

human; suicide; aged; insomnia; psychotherapy; Psychotherapy; fatigue; elderly care; cognitive defect; cognitive therapy; patient attitude; geriatric patient; senescence; Late-life depression; Interpersonal psychotherapy; Article; Psychodynamic therapy; clinical effectiveness; psychodynamic psychotherapy; systematic review (topic); late life depression; loss of appetite; Cognitive behavioural therapy