Guideline for the management of late-life depression in primary care.
OBJECTIVE
To develop a guideline for the primary care management of depression in later life based on best practice.


METHODS
Source material included relevant guidelines, literature reviews and consensus documents coupled with an updated literature review covering 1998-October, 2001. This material was summarised as a series of evidence-based statements and recommendations agreed by consensus.


RESULTS
Good quality evidence exists for the pharmacological and psychological treatment of depressive episode (major depression), although not specifically in primary care. There is some evidence of efficacy of antidepressants in late-life dysthymia and minor depression associated with poor functional status. In depressive episode, current evidence suggests acute treatment for at least six weeks and a continuation period of at least 12 months. Both tricyclic antidepressants and Selective Serotonin Re-uptake Inhibitors are effective in longterm prevention. There is less data on how to manage patients who do not respond in the acute treatment phase. More data is needed on sub-groups of patients with specific co-morbid medical conditions and those who are frail. Collaborative care is effective in older depressed primary care patients.


CONCLUSIONS
There are effective treatments for depression in primary care. More research is needed to address the optimum treatment of depression with medical co-morbidity and to elucidate the role of newer psychological interventions. Collaborative care between primary care and specialist services is a promising new avenue for management.
Baldwin
Robert C
RC
Manchester Mental Health and Social Care Trust, Manchester Royal Infirmary, Manchester, UK. Robert.Baldwin@man.ac.uk
Anderson
David
D
Black
Sarah
S
Evans
Sandra
S
Jones
Rob
R
Wilson
Ken
K
Iliffe
Steve
S
D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine; D006801:Humans; D019636:Neurodegenerative Diseases / Q000523:psychology; D011320:Primary Health Care / Q000379:methods*; D011613:Psychotherapy; D006113:United Kingdom
D000928:Antidepressive Agents