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 attend ers or population samples of older people. Objectives. The aim of this study was to carry out a systematic review of t rials of treatments for depression of patients over 60 years of age in prim ary 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 furth er studies that were not restricted to but included patients over the age o f 60 years also fulfilled our criteria, We found no studies of psychologica l therapies for depression in older people. With few exceptions, studies we re limited to older people who reached a diagnostic threshold and excluded those with 'subcase level depression'. Conclusion. There is little evidence of effectiveness for a variety of trea tment approaches for depression in older people in primary care, particular ly in those with less severe depression. As older people take more medicati on, making contra-indications to the use of antidepressant drugs more likel y, there is a pressing need for studies of the efficacy of non-pharmacologi cal interventions in primary care settings.