Healthy Living: Guidelines for treatment of depression
Guidelines for Treatment of Depression: Adolescents, Adults, Older Adults
Health Watch – October 29, 2019
David Prescott, Ph.D. – Acadia Hospital
Depression causes Disability:
Depression is the second leading cause of disability both in the United States and worldwide. In any given year, about 7% of adults will experience an episode of major depression, and almost twice that number (13%) of adolescents will experience an episode of major depression.
In August, 2019, the American Psychological Association published Practice Guidelines for the treatment of depression across three age cohorts:
• Children and Adolescents
• Older Adults
While some of the most effective treatments for these age groups are similar, there are also some important differences. Knowing the symptoms of major depression and the recommended treatments for people in different age groups helps increase the likelihood that people with depression will get effective treatment.
Symptoms of Major Depression:
Major depression, or clinical depression, is more than simply feeling down for a day or two. Diagnostic symptoms include:
• Persistent sad or irritable mood for two or more consecutive weeks
• Decrease in energy and motivation
• Feeling hopeless or excessively guilty
• Loss of appetite
• Poor Memory or Concentration
• Preoccupation with Death or Suicide
• Lack of enjoyment in activities
• Poor self-esteem
Effective Treatment for Adolescents:
Both psychotherapy (counseling) and medication have been shown to be effective in treating adolescents with depression. Most research suggests that a combination of both psychotherapy and medication is superior to either alone. Effective counseling approaches include cognitive-behavioral therapy and interpersonal psychotherapy, which focuses on improving relationships and engaging with others to provide emotional support.
Fluoxetine (Prozac) was the antidepressant medication which had the most research support for treating adolescent depression, although a number of medications of this type (SSRI) are also frequently prescribed.
Effective Treatment for Adults:
Like adolescents, adults benefit the most from a combination of psychotherapy and medication for treating depression. A greater number of psychotherapy approaches have been shown to help adults with depression, compared to adolescents. Insight oriented therapies, cognitive behavior therapy, and interpersonal therapy for adults have all demonstrated effectiveness for adults.
A wider array of medications have demonstrated effectiveness for adults in the treatment of depression. These include second generation medications such as SSRI's and SNRI's which act on brain neurochemical systems involved in depression.
Effective Treatment for Older Adults:
For depression, effective psychotherapy for older adults differs from psychotherapy techniques for adolescents or adults. Older adults benefit from Reminiscence/Life Review group approaches to treatment which focus on reviewing major life events in their life and coping with loss of friends, loved ones, and level of functioning. Interpersonal approaches also appear to be effective in terms of psychotherapy.
Effective medications for older adult depression are similar to those for adult depression, such as SSRIs and NSRIs.
Many go Untreated for Depression
In spite of the research about effective treatment for depression, the number of people who go without treatment is sobering.
• Estimates are that 35% of adults with depression get no treatment.
• In adolescents, the number is even higher, with an estimated 60% receiving no treatment.
For More Information:
American Psychological Association: https://www.apa.org/depression-guideline/patients-families
National Institute of Mental Health: https://www.nimh.nih.gov/health/statistics/major-depression.shtml