The effectiveness of the treatment of depression in the physically ill elderly

The effectiveness of depression treatments in older people with physical illnesses is critically reviewed. Few controlled studies have been published and many of these have methodological limitations.These include small samples, inadequate duration of treatment and lack of diagnostic criteria for depression and standardized measures of physical health. Controlled studies of antidepressants indicate they are effective in the treatment of major depression associated with chronic stable physical illness, though there are high dropout rates. There is insufficient evidence to determine their efficacy in depression associated with acute or serious illness. Psychological interventions have been infrequently investigated in controlled studies. The few available studies support their potential utility in chronic stable illness. Uncontrolled trials suggest that electroconvulsive therapy is safe and effective in the treatment of severe major depression associated with physical illness. A range of psychosocial interventions, including exercise and music therapy, that target quality of life domains should be further investigated in less severe depression. Combination and tailored interventions show promise but require more research. Future studies need to have larger sample sizes and use established diagnostic criteria and standardized measures of physical health. Outcome measures should include quality of life, functional capacity, health service utilization, social function and mortality.