Depression in later life: new clinical review from the BMJ


This week’s British Medical Journal features a review of depression in later life.

The authors bring together recent systematic reviews, meta-analyses, and randomised controlled trials to summarise best current knowledge about the diagnosis and management of patients who develop depression in later life.

The review addresses the following questions:

  • What is late life depression and who gets it?
  • How is depression diagnosed in older patients?
  • Is depression more difficult to diagnose in older adults?
  • Does depression increase the risk of dementia?
  • How is late life depression managed?
  • When should I refer?
  • Which medication should be prescribed?
  • What if first line drug treatment doesn’t work?
  • Can older adults benefit from psychological therapy?
  • What is the outlook for older adults with depression?

The summary from the review states:

Depression in older adults is associated with an increased risk of death and disability

Cognitive and functional impairment and anxiety are more common in older than in younger adults with depression

Older adults with depression are at increased risk of suicide and are more likely than younger adults to complete suicide

Depression is associated with cognitive impairment and an increased risk of dementia

A selective serotonin reuptake inhibitor should be the first line pharmacological treatment for depression for most older adults, including those with chronic physical illness

Psychological and drug treatment is as effective in older as in younger adults

Subthreshold depressive symptoms that substantially affect older patients’ lives are common and management with psychosocial and drug strategies may be effective and prevent further deterioration

Rodda, J. et al. Depression in older adults. BMJ 2011;343. [BMJ abstract]

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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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