This is the last of a series of posts about depression in older adults.  The first post was on symptoms; the next two (here and here) were on causes.  This post is about treatment.

Since depression in the elderly may be difficult to distinguish from a variety of other conditions, it is important to obtain an evaluation from a professional who is experienced in assessing mental health problems in the elderly.  Many physicians who work with older adults have the expertise to make such an assessment, as do many psychiatrists, psychologists, or clinical social workers.  The provider’s specialty is usually not as important as their experience with emotional problems in the elderly.  Once a diagnosis of depression has been made, treatment typically involves medication, psychotherapy, or both.

There are a variety of antidepressant medications that can be used in the elderly; for the most part, the same antidepressants that are effective in younger adults are effective in older adults.  Older adults are often more sensitive to medications, though, so often the dosage must be lower to start.  There also is an increased risk of side effects and, since many older adults are already taking other medications, of drug interactions.  Thus, drug treatment may be more complex and take longer than is typical with younger adults.

Psychotherapy consists of a series of conversations with a trained mental health professional, usually a psychologist, clinical social worker, or licensed professional counselor.  These conversations differ in format and focus depending on the theoretical orientation of the professional, but, in general, they entail an exploration of current and past problems; an explanation for why depressive symptoms have developed; new learning about one’s emotions, thoughts, or psychic makeup; and development of skills to handle one’s difficulties.  It’s important for the client and therapist to relate well to one another and to agree on the approach being used, so a change of therapists may be advisable if these factors seem absent in the first handful of sessions.  There are a multitude of therapeutic orientations, and most of these have research data to support their effectiveness.  A few approaches that seem particularly well-suited for treatment of depressed older adults are:

• Reminiscence-based approaches, in which the therapist leads the client in a guided life review
• Cognitive Therapy (or Cognitive-Behavioral Therapy), which focuses on the person’s habitual self-talk and associated underlying beliefs, and
• Interpersonal Psychotherapy, a time-limited approach that identifies and works on an interpersonal issue that is problematic for the person

Despite the fact that treatment is usually effective, many depressed older adults never seek professional assistance.  It doesn’t need to be that way!  There are competent and caring professionals available to provide medication management or therapy.  Help is just a phone call away.