Preventing late-life depression: a clinical update

Abstract

Background: Achieving remission in late-life depressive disorder is difficult; it is far better to prevent depression. In the last ten years there have been a number of clinical studies of the feasibility of prevention.

Methods: A limited literature review was undertaken of studies from 2000 specifically concerning the primary prevention of late-life depressive disorder or where primary prevention is a relevant secondary outcome.

Results: Selective primary prevention (targeting individuals at risk but not expressing depression) has been shown to be effective for stroke and macular degeneration but not hip fracture. It may also prove effective for the depression associated with caregiving in dementia. Emerging evidence finds effectiveness for indicated prevention (in those identified with subthreshold depression often with other risk factors such as functional limitation). Despite a number of promising risk factors (for example, diet, exercise, vascular risk factors, homocysteine and insomnia), universal prevention of late-life depression (acting to reduce the impact of risk factors at the population level) has no current evidence base, although a population approach might mitigate suicide.

Conclusion: Interventions which work in preventing late-life depression include antidepressant medication in standard doses and Problem-Solving Treatment. When integrated into a care model, such as collaborative care, prevention is feasible but more economic studies are needed.