In Reply We agree with Dr Gitlin and Mr Aravena concerning the importance of placing late-life depression within a psychosocial context. We mentioned in our review that “recent life events, coping with functional impairment, or having a lack of social contacts are examples of psychosocial factors that are frequent contributors to depression among older adults and should be addressed as part of treatment planning.”
Treating depression in older adults with antidepressants should be combined with addressing these contributors, as, for example, with the Get Busy, Get Better intervention. Combining antidepressants with psychotherapy may be more effective than either treatment alone and patients find combined treatment more acceptable. We agree that behavioral and psychotherapeutic approaches have a strong evidence base to support their efficacy and utility; unfortunately, the evidence base for combining psychotherapy and pharmacotherapy is not as strong. A recent meta-analysis found only 4 studies in which the combination of psychotherapy and pharmacotherapy was compared with pharmacotherapy alone.1 The difference was not significant (g = 0.41; 95% CI, −0.05 to 0.88) but may be the result of the small number of studies. Only 1 study was found in which combined treatment was compared with psychotherapy only, with combined treatment resulting in greater improvement, although differences were small.2 Even if no obvious psychosocial factors can be found that contribute to depression, antidepressants should be combined with psychoeducation and brief psychosocial interventions.
Kok RM, Reynolds CF. Nonpharmacologic Treatments for Depression in Older Adults—Reply. JAMA. 2017;318(13):1284. doi:10.1001/jama.2017.12024
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