Efficacy and tolerability of antidepressants in people aged 65 years or older with major depressive disorder – A systematic review and a meta-analysis

Tham, Anne; Jönsson, Ulf; Andersson, Gerhard; Söderlund, Anne; Allard, Per; Bertilsson, Göran

doi:10.1016/j.jad.2016.06.013

Cited by 86 publications

(64 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Therefore, among older adults, depression and suicidal ideation are easily overlooked, sometimes preventing patients from receiving effective care (Hoeft, Hinton, Liu, & Unützer, 2016). Moreover, in treatment contexts, it has been reported that antidepressants are not very effective and that their effectiveness may be short-lived or associated with increased complications (Almeida, 2014;Almeida, Alfonso, Hankey, & Flicker, 2010;Tham et al, 2016). Therefore, when treating depression among older adults, it is recommended that medication with antidepressants be accompanied by a course of psychosocial therapy as well (Blackburn, Wilkins, & Wiese, 2017;Lill, 2015).…”

mentioning

confidence: 99%

Depression‐linked beliefs in older adults with depression

Tanaka

2019

Journal of Clinical Nursing

View full text Add to dashboard Cite

Aims and objectives To clarify beliefs linked with depression among older adults with depression in Japan. Background As a result of global population ageing, caring for older adults with depression has become an important issue worldwide. In this paper, the concept of “beliefs” pertains to phenomena that lead to distress about disease and can be alleviated through talk therapy. While previous studies focused on illness beliefs in people with mental illness and depression, no studies have yet focused on such beliefs among older adults with depression. Design Qualitative, narrative‐research‐based method. Methods Observation and 1–5 narrative interviews lasting 60–90 min were conducted with each of 19 older adults with depression in a Japanese psychiatric ward. The resulting narratives were thematically analysed to derive relevant themes and subthemes. Reporting of this research adheres to COREQ guidelines. Results Four themes and twelve subthemes were revealed. Depression‐linked beliefs among older adults with depression were (1) “guilt and regret,” (2) “pessimism,” (3) “futility of treatment” and (4) “desire to be needed by loved ones and society.” Conclusion Depression‐linked beliefs among older adults with depression constituted spiritual pain reflecting character tendencies, including experiences of loss and developmental challenges related to ageing as well as subjects' natural diligence and consideration for others. Relevance to clinical practice (1) Helping nurses better understand distress experienced by older adults with depression, who are prone to feel guilt and regret when reflecting on the past and to alleviate distress through dialogue and providing positive affirmation for patients. (2) To understand and assuage distress over experiences of loss in old age. (3) To help older adults with depression form a more relaxed attitude towards life, so that even if they have experienced loss as a result of old age, they can maintain their self‐esteem and existential sense of self‐worth.

show abstract

mentioning

confidence: 99%

Depression‐linked beliefs in older adults with depression

Tanaka

2019

Journal of Clinical Nursing

View full text Add to dashboard Cite

show abstract

“…14 Evidence of antidepressant efficacy specifically in patients 65 years and older is more limited and suggests that SSRIs do not significantly impact MDD relapse or remission. 12 Conversely, duloxetine, 12,15 bupropion XR, 16 and vortioxetine 17 improved MDD response with duloxetine and vortioxetine also improving remission in this age group. This literature base is limited by low strength of evidence (SOE) because of issues of imprecision, inconsistency and risk of bias; often high placebo response rates are observed.…”

Section: Effectiveness Of Antidepressantsmentioning

confidence: 88%

“…26,27 While trials up to a year show efficacy of SSRIs versus placebo, benefits have not been sustained beyond 1 year. 12 Similarly, continuing duloxetine for an additional 12-week continuation period did not impact relapse and recurrence rates versus placebo. Taken together, while some antidepressants maintain their efficacy after a 12 week acute period, these benefits are generally lost over time.…”

Section: Comparative Effectiveness Of Antidepressantsmentioning

confidence: 93%

“…Acute treatment in the elderly is generally considered the first 12 weeks of treatment with antidepressants, 4 with a modestly-sized body of evidence. [5][6][7][8][9][10][11][12][13] When compared with placebo, commonly used antidepressants (bupropion, citalopram, duloxetine, escitalopram, fluoxetine, paroxetine, sertraline and venlafaxine) improved response (≥50% improvement from baseline in Hamilton Depression Rating Scale (HAM-D) or Montgomery and Asberg Depression Rating Scale (MADRS)) and remission with a number needed to treat (NNT) of 13 for response and 20 for remission in a systematic review of 10 high quality RCTs (at least 60 years of age). 11 The SSRIs as a class have been found to have significantly greater response rates than placebo with a NNT of 10, although in this analysis remission rates did not differ.…”

Section: Effectiveness Of Antidepressantsmentioning

confidence: 99%

See 1 more Smart Citation

Adverse Effects of Pharmacological Treatments of Major Depression in Older Adults

Sobieraj¹

2019

View full text Add to dashboard Cite

Purpose of Review To assess adverse events of antidepressants in the treatment of major depressive disorder in adults 65 years of age or older. Key Messages In people 65 years of age or older: • Serotonin norepinephrine reuptake inhibitors (SNRIs) (duloxetine and venlafaxine) cause adverse events more often than placebo and most likely lead to discontinuation of therapy during treatment of up to 12 weeks. • Selective serotonin reuptake inhibitors (SSRIs) (escitalopram and fluoxetine) most likely cause adverse events at a similar frequency to placebo therapy but still may lead to discontinuation of therapy during treatment of up to 12 weeks. • Duloxetine most likely increases the risk of falls over longer treatment (<24 weeks) • Adverse events contributing to discontinuation of therapy were rarely reported in a way that allowed clear characterization of what adverse events to expect. • Few studies compared other antidepressants to placebo or to each other, or reported other outcomes. Trial data were sparse, and trials were short in duration, underpowered, and studied low doses of antidepressants. Observational studies had limitations related to their design. Long-term, rigorous comparative studies are needed. iii This report is based on research conducted by the University of Connecticut Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2015-00012-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report. The information in this report is intended to help healthcare decision makers-patients and clinicians, health system leaders, and policymakers, among others-make well-informed decisions and thereby improve the quality of healthcare services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients. This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders. AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be develo...

show abstract

“…However, at the same time, healthcare professionals should assess the chronic illnesses of patients using depression medications and their past depression symptoms and medications in terms of categories, doses, and side effects [16]. Specifically, duloxetine taken for 8 weeks can alleviate recurrent major depression in people aged 65 years or older with major depressive disorder, but it also increases the risk of side effects such as thirst, constipation, diarrhea, and dizziness [17].…”

Section: Interventions For Depression In Elderly Peoplementioning

confidence: 99%

Integrated Literature Review of Depression in Elderly People

Ku¹,

Chung²

2017

J Gerontol Geriatr Res

View full text Add to dashboard Cite

The authors conducted a literature review of the depression findings of systematic reviews and meta-analyses in elderly people. The defining characteristics of depression in elderly people include 2-5 symptoms, namely sleep disorders, changed weight, psychomotor retardation, fatigue, and feelings of worthlessness or guilt within 2 weeks; the critical symptom is either low mood or loss of interest in usual activities. In addition, elderly people with an abnormal status for the items of the Geriatric Depression Scale (GDS) may have experienced recurrent falls twice during the past 2 years. The related factors of depression in elderly people include demographic, physical, psychological, mental, and social factors. Colasanti et al. in 2010 identified four major self-rating depression scales for elderly people: Beck Depression Inventory (BDI), Self-rating Depression Scale (SDS), Center for Epidemiological Studies Depression (CES-D), and GDS. CES-D is a valid scale that can be used to distinguish major depression from emotional disorders among elderly people, and it can also be used in pharmacological trials. The interventions for depression in elderly people include pharmacological and nonpharmacological methods. Regarding pharmacological treatment, the evidence-based literature has demonstrated that duloxetine taken for 8 weeks can alleviate recurrent major depression in elderly people; at the same time, healthcare professionals should pay attention to some side effects. Moreover, herbal medicine has been found to only alleviate post-stroke depression in elderly people. Nonpharmacological interventions are exercise therapies such as yoga; alternative therapies such as touching, intimate massage, music, art, and nature; and cognitive therapy, reminiscence therapy, and psychotherapy.

show abstract

Efficacy and tolerability of antidepressants in people aged 65 years or older with major depressive disorder – A systematic review and a meta-analysis

Cited by 86 publications

References 49 publications

Depression‐linked beliefs in older adults with depression

Depression‐linked beliefs in older adults with depression

Adverse Effects of Pharmacological Treatments of Major Depression in Older Adults

Integrated Literature Review of Depression in Elderly People

Contact Info

Product

Resources

About