Feasibility and effectiveness of treatments for depression in elderly medical inpatients: A systematic review

To determine the feasibility and effectiveness of treatments for depressed elderly medical inpatients, MEDLINE was searched for potentially relevant a rticles published from January 1987 to August 1997, using the keywords "dep ression or depressive disorder" (exploded) and "aged." The bibliographies o f relevant articles were searched for additional references. Fifteen report s met the following inclusion criteria: (a) published in English or French; (b) minimum age criterion of 55 and over or mean age 65 and over; (c) subj ects admitted to the medical service of an acute care hospital; (d) used ac cepted criteria for depression; (e) examined treatment(s) for depression; a nd (f) reported outcomes as a depression diagnosis and/or symptom level. In formation was abstracted independently from each article by two reviewers, tabulated, and compared. The limited evidence suggests contraindications to treatment in 38% to 87% of subjects who received a heterocyclic antidepres sant compared to 4% of subjects who received the selective serotonin reupta ke inhibitor (SSRI) fluoxetine; rates of discontinuation and study completi on were similar for heterocyclics, the SSRIs, and psychostimulants. All of the treatments (including social support/psychotherapy) appeared to be at l east modestly effective in the short term.