Aging & Health A to Z

Depression

Care & Treatment

Most people respond well to treatment for depression, but some may relapse and have more bouts of depression after an initial bout has been treated.  Treatment for depression typically has three parts:

1. Immediate treatment for depression
2. Continuing treatment to prevent relapse. This includes antidepressant therapy, usually lasting for about six months
3. Maintenance therapy (longer-term therapy), if considered necessary

The following treatments, which may be used in combination, can help treat depression among older adults:

• Psychotherapy (or “talk therapy”).
• Antidepressant medications.
• Electroconvulsive therapy.
• For people with Seasonal Affective Disorder (SAD), light therapy during the winter months may help restore a normal sleep cycle and reduce depressive symptoms.
• Newer treatments such as vagus nerve stimulation (VNS), deep brain stimulation (DBS), and the most recent – transcranial magnetic stimulation (TMS), are available in some centers, and usually involve some surgery.

A combination of medications and psychotherapy is best if you have severe or suicidal depression. This combination appears to work quickly and keep depression from recurring. If you are so depressed that you cannot carry out daily activities, or if you are suicidal and cannot be safely cared for in the community, you may need to be treated in a psychiatric hospital.

Therapy should continue as long as your healthcare professional recommends. Remember that depression is a disease, not a sign of weakness. Just as you should continue treatment for a physical health problem as long as needed, you should continue treatment for depression as long as needed.

Psychotherapy

Psychotherapy is a safe and effective way to help you cope with depression. It is often combined with antidepressant drugs (described below). There are several useful psychotherapy techniques:

• Problem-solving therapy. In this type of psychotherapy, a therapist helps you identify specific life difficulties that are causing problems, and helps you find solutions to these problems.
• Cognitive behavioral therapy (CBT). Cognitive behavioral therapy helps you understand the role that your thoughts and other contributors play in your depression, and how to better deal with these factors. CBT programs generally run for a specified number of weekly visits and may include helpful activities and  assignments to perform at home.
• Interpersonal psychotherapy. This therapy has shown promise in treating minor depression, especially in people who become depressed after the death of a close friend or relative. It has also been shown to help caregivers of older adults who develop depression. This therapy helps people deal with personal relationships, grief, loss and coping with their role in life.

Antidepressant Medications

If your healthcare professional determines that medication will help treat your depression, he or she will consider several things when choosing a drug. These include: what other medical problems, if any, you have; what side effects the antidepressant may produce; and whether it might interact with other drugs you are taking.

You will likely start with a low dose of the antidepressant, then your healthcare professional may increase the dose slowly and carefully until you get the desired effect. If you have kidney or liver disease, he or she will monitor the levels of the drug in your blood to make sure these levels aren’t getting too high.  

Antidepressant medications take time to work and must be taken as prescribed for several weeks. About half of adults with major depression respond well to drug treatment within 6 weeks. Another 15% to 25% only begin to respond during the first 6 weeks, but continue to improve if treatment is continued for another 4 to 6 weeks.

If a prescribed medication doesn’t seem to be working, your healthcare provider may increase the dose, prescribe a different medication, or arrange additional therapy such as talk therapy. If the antidepressant you are taking causes side effects, let your provider know right away.

Many people need to continue taking an antidepressant for at least six to twelve months to get the full benefit and lower the odds that the depression will recur. If your healthcare professional recommends stopping a medication, he or she will explain how to do so gradually and under supervision so that you avoid possible withdrawal symptoms.

Common side effects of antidepressants include:

There are different kinds of antidepressant medications. The most commonly used ones are the following.

Selective serotonin re-uptake inhibitors (SSRIs). These are the most commonly prescribed antidepressants. They include:

Serotonin norepinephrine reuptake inhibitors (SNRIs).These medications are also often used. Combination products include:

Tricyclic and tetracyclic antidepressants (TCAs).  These include some older drugs that are still very effective for many people. The following are among the TCAs currently available:

Other antidepressants. These include medications that act on different neurotransmitters:

Monoamine oxidase inhibitors (MAOIs).  You need to watch what you eat if you take monoamine oxidase inhibitors (MAOIs). You may develop life-threatening high blood pressure if you eat high tyramine-containing foods such as wine or aged cheeses.  

Lithium. Lithium carbonate is often prescribed to treat the mania of bipolar disorder. Other drugs used to treat bipolar disorder include anti-seizure drugs (such as valproic acid) and antipsychotic medications.

The body “breaks down” lithium slowly in older people, and can cause side effects such as tremors, diarrhea, and muscle spasms.. Many common drugs, like ibuprofen and diuretics (“water pills”), can also slow the elimination of lithium from the body. This allows the lithium to build up in the blood and may increase the severity of side effects. Side effects of anti-seizure drugs and antipsychotic medications may include skin rashes or problems with the blood or certain organs.

Antipsychotic medications. These may be needed if you have psychotic symptoms, such as delusions or hallucinations, as well as typical symptoms of depression.

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy can be useful if other treatments have not helped. It is the first choice of treatment in life-threatening depression, when a patient is suicidal or at risk of starvation due to depression. Although electroconvulsive therapy may bring scary images to mind, it can actually be a very effective and safe treatment for both major depression and mania. Success rates are better than 70% in older adults.

If you are scheduled to receive electroconvulsive therapy, you will be given general anesthesia, which ensures that the procedure is painless. For people with most kinds of heart disease or stroke, ECT is a safe treatment. But, if you’ve recently had a heart attack or stroke, the risk of complications is higher. In older people with unstable heart problems or increased pressure in the brain due to a brain tumor or other medical problem, electroconvulsive therapy is not appropriate.

The most common side effect of electroconvulsive therapy is short-term amnesia (forgetting things that happened very recently). For example, you may not remember things that occurred immediately before the therapy. You may also find it harder to learn new things for a little while, but this problem usually disappears quickly after the treatment stops. ECT doesn’t cause long-term memory loss, and sometimes, your memory will actually get better.

Transcranial magnetic stimulation (TMS) uses high frequency magnetic pulses to target affected areas of the brain. It may be considered if electroshock therapy has already been tried and your depression still has not resolved.

Updated: March 2012
Posted:  March 2012