Psychotherapeutic treatments for older depressed people

  • Review
  • Intervention




Despite a number of reviews advocating psychotherapy for the treatment of depression, there is relatively little evidence based on randomised controlled trials that specifically examines its efficacy in older people.


To examine the efficacy of psychotherapeutic treatments for depression in older people.

Search methods

CCDANCTR-Studies and CCDANCTR-References were searched on 11/9/2006. The International Journal of Geriatric Psychiatry and Irish Journal of Psychiatry were handsearched. Reference lists of previous published systematic reviews, included/excluded trial articles and bibliographies were scrutinised.Experts in the field were contacted..

Selection criteria

All randomised controlled trials that included older adults diagnosed as suffering from depression (ICD or DSM criteria) were included. All types of psychotherapeutic treatments were included, categorised into cognitive behavioural therapies (CBT), psychodynamic therapy, interpersonal therapy and supportive therapies.

Data collection and analysis

Meta-analysis was performed, using odds ratios for dichotomous outcomes and weighted mean differences (WMD) for continuous outcomes, with 95% confidence intervals. Primary outcomes were a reduction in severity of depression, usually measured by clinician rated rating scales. Secondary outcomes, including dropout and life satisfaction, were also analysed.

Main results

The search identified nine trials of cognitive behavioural and psychodynamic therapy approaches, together with a small group of 'active control' interventions. No trials relating to other psychotherapeutic approaches and techniques were found. A total of seven trials provided sufficient data for inclusion in the comparison between CBT and controls. No trials compared psychodynamic psychotherapy with controls. Based on five trials (153 participants), cognitive behavioural therapy was more effective than waiting list controls (WMD -9.85, 95% CI -11.97 to -7.73). Only three small trials compared psychodynamic therapy with CBT, with no significant difference in treatment effect indicated between the two types of psychotherapeutic treatment. Based on three trials with usable data, CBT was superior to active control interventions when using the Hamilton Depression Rating Scale (WMD -5.69, 95% CI -11.04 to -0.35), but equivalent when using the Geriatric Depression Scale (WMD -2.00, 95% CI -5.31 to 1.32).

Authors' conclusions

Only a small number of studies and patients were included in the meta-analysis. If taken on their own merit, the findings do not provide strong support for psychotherapeutic treatments in the management of depression in older people. However, the findings do reflect those of a larger meta-analysis that included patients with broader age ranges, suggesting that CBT may be of potential benefit.








搜尋CCDANCTRStudies 和CCDANCTRReferences 到11/9/2006。查詢The International Journal of Geriatric Psychiatry 和Irish Journal of Psychiatry 。查詢先前已發表的回顧文獻後的文獻表,查詢納入/排除文章和書目的文獻表。和這領域的專家接觸。






確認出9篇的研究是有關認知行為治療和精神分析治療,和一組的主動控制組,沒有一個試驗和其他心理治療取向和技巧有關。在7篇試驗中提供足夠的資料來比較CBT和控制組,沒有一篇的試驗是比較精神分析和控制組。根據5篇的試驗中(包括153個受試),認知行為治療的效果比起等候名單的控制組更有效(WMD −9.85, 95% CI −11.97 to −7.73). 只有3篇是比較精神分析和CBT,在效果上並沒有顯著差異。根據3篇實用資料發現,CBT比起主動控制組在Hamilton Depression Rating Scale(WMD −5.69, 95% CI −11.04 to −0.35), 上表現較為優;若使用Geriatric Depression Scale 則相當(WMD −2.00, 95% CI −5.31 to 1.32).





此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。



Plain language summary

Psychotherapeutic treatments for older depressed people

Depression is a common problem facing older people and is often associated with loneliness, physical illness and pain. The condition can last for some years and causes considerable distress and illness. A significant majority of depressed elders do not receive treatment because of difficulty in recognition of the condition. Not only can it present with lowered mood but may also present with physical problems including sleep disturbance, loss of appetite, loss of interest, anxiety and lack of energy. Psychotherapy is recognised as a treatment for mild depression. In this review we included seven small trials, involving a total of 153 participants, that examined psychotherapeutic treatments for depression in older people. Five trials compared a form of cognitive behavioural therapy (CBT) against control conditions, and the findings showed that CBT was more effective than control. Two individual trials compared CBT against psychodynamic therapy, with no significant difference in effectiveness indicated between the two approaches. Our review shows that there is relatively little research in this field and care must be taken in generalising what evidence there is to clinical populations.