Treatments for late life depression in primary care--a systematic review.
BACKGROUND
Depression is common among older people. It is associated with increased mortality and use of health services. We could identify no prior systematic review of treatment for depression in either primary care attenders or population samples of older people.


OBJECTIVE
The aim of this study was to carry out a systematic review of trials of treatments for depression of patients over 60 years of age in primary care or population samples.


METHODS
We searched Medline, Embase, Cinahl, the Cochrane Library, Psyclit, BIDS--Social Science and BIDS--Science Citation Indices for trials of drug treatment, interpersonal psychotherapy, cognitive behavioural psychotherapy, counselling and social interventions for late life depression in English, French or German published between 1980 and June 1999.


RESULTS
Of the studies identified, only two were of patients over 60 years of age and met all inclusion criteria for content and quality. Three further studies that were not restricted to but included patients over the age of 60 years also fulfilled our criteria. We found no studies of psychological therapies for depression in older people. With few exceptions, studies were limited to older people who reached a diagnostic threshold and excluded those with 'subcase level depression'.


CONCLUSIONS
There is little evidence of effectiveness for a variety of treatment approaches for depression in older people in primary care, particularly in those with less severe depression. As older people take more medication, making contra-indications to the use of antidepressant drugs more likely, there is a pressing need for studies of the efficacy of non-pharmacological interventions in primary care settings.
Freudenstein
U
U
Regional Office, NHS Executive South West, 22 Chesterfield Road, Bristol BS6 5DL, UK.
Jagger
C
C
Arthur
A
A
Donner-Banzhoff
N
N
D000367:Age Factors; D000368:Aged / Q000523:psychology*; D000928:Antidepressive Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003376:Counseling / Q000379:methods / Q000592:standards; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D019317:Evidence-Based Medicine; D005194:Family Practice / Q000379:methods* / Q000592:standards*; D006801:Humans; D008875:Middle Aged; D020380:Needs Assessment; D018579:Patient Selection; D011320:Primary Health Care / Q000379:methods* / Q000592:standards* / Q000706:statistics & numerical data; D011613:Psychotherapy / Q000379:methods / Q000592:standards; D012107:Research Design / Q000592:standards; D016896:Treatment Outcome
D000928:Antidepressive Agents