Nonpharmacological therapies improve depression in elderly
Several nonpharmacological approaches to depression in old age, such as cognitive behavioural therapy (CBT) and bright-light therapy, seem to be effective but warrant further replication, according to a recent meta-analysis.
After applying selection criteria, 11 primary care studies were included, of which 10 were randomized controlled trials (n=1,529) and one was a cohort study (n=14). These studies focused on CBT (n=5), exercise (n=2), problem-solving therapy (PST; n=1), CBT and bibliotherapy together (n=1), behavioural activation (BA; n=1), and bright-light therapy (n=1).
Pooled data showed that CBT did not produce significant effects on depression immediately after treatment (standardized mean difference [SMD], -0.16; 95 percent CI, -0.34 to 0.02; p=0.09). However, at six months, CBT yielded small but significant effects (SMD, -0.21; -0.40 to -0.03; p=0.03).
Bright-light therapy, which was the focus in a study with a low risk of bias, was effective for reducing depressive symptoms. BA, studied only in a pilot cohort, also showed promise.
On the other hand, PST, CBT-based bibliotherapy and progressive resistance training produced no significant benefit on depressive symptoms.
Another 18 community studies were included, of which 17 were RCTs (n=1,041) and one was a cohort study (n=22). Life review (n=3), in addition to the above interventions, was included.
Similarly, the community studies showed that individual CBT was effective for decreasing depressive symptoms compared with controls who did not receive the treatment. Bibliotherapy, life review and PST were also found to reduce symptoms.