Pharmacological and psychological treatments for depressed older patients:A meta-analysis and overview of recent findings

A meta-analysis was carried out to evaluate data published between January 1974 and February 1998 comparing rates of treatment response and tolerabili ty of pharmacological and psychological treatments for depression in person s over age 55. Drugs (tricyclic antidepressants, selective serotonin-reupta ke Inhibitors, and a mixed group of other drugs) were significantly better than placebo, with an average reduction in symptom severity of 48.0% versus 31.3% (analysis weighted by sample size; 50.6% vs. 21.4% unweighted). No s ingle drug or group of drugs was superior in terms of efficacy, and no stat istically significant differences in tolerability emerged between tricyclic antidepressants and selective serotonin-reuptake inhibitors, whether measu red by total dropouts or by dropouts due to side effects. Compared to the d ata on pharmacological treatments, those for outcomes of psychological trea tments are very limited. Existing data indicate that cognitive-behavioral, behavioral, and psychodynamic therapies are significantly better than place bo. In the current meta-analysis, response rates to these nondrug therapies did not differ significantly from those observed with tricyclic antidepres sants or selective serotonin-reuptake inhibitors, but direct comparison dat a are insufficient for firm conclusions to be drawn about comparative effic acy. It is possible, even likely, that not only different subtypes of depre ssion but also different patients vary in their treatment responses. Howeve r, lack of adequate data prevented the current meta-analysis from addressin g these issues. Rigorously designed prospective studies on treatment outcom e, taking into account the above differences, are urgently needed to provid e robust data on which to base clinical recommendations for the treatment o f depression in older patients.