TREATMENT OF LATE-LIFE DEPRESSION - A RESPONSE TO THE NIH-CONSENSUS-CONFERENCE

Conclusions of the NIH Consensus Conference on treatment of late life depression, particularly with regard to their recommendations regardin g cognitive behavioral therapies as those compare to a review of empir ical findings, are examined. In contrast to the NIH recommendations, r esearch demonstrates that psychotherapy is at least of equal effective ness as compared to antidepressant medication for older depressed pati ents. Cognitive and behavioral approaches have not been shown to be mo re effective than other brief therapies, particularly interpersonal th erapy and brief psychodynamic therapy. There are more studies, however , demonstrating the effectiveness of cognitive and behavioral therapie s than any other approach. Older adults hold generally positive attitu des towards such treatments and may prefer them to medication treatmen t. Offering cognitive or behavioral therapy as a first line interventi on for mild to moderately depressed older adults could be the most cos t-effective approach in most settings. Promotion of cognitive and beha vioral therapies for older depressed patients would be supported by in volvement in the development of treatment guidelines at the national l evel, expansion of the work of the APA task force on empirically valid ated treatments to include therapies for older adults, and by the effo rts of individuals to present information to older adults in the commu nity on the potential benefits of cognitive and behavioral treatments for depression.