Not long ago, depression in older adulthood was considered a fact of life. After all, the reasoning went, wouldn't you feel gloomy if your friends were dying, your memory fading and your knees creaking?
Today that mentality is changing, says Leon Hyer, PhD, professor of psychiatry at the Mercer University School of Medicine and the Georgia Neurosurgical Institute. "Older people are grudgingly but increasingly aware that, given a medical problem, they may also have psychological problems," he says. "We know that if they address both, quality of life improves."
But as depression diagnoses among the 65-plus crowd become more commonplace — rising from 3.2 percent to 6.3 percent from 1992 to 2005, according to a nationally representative survey of Medicare enrollees — so, too, have medication-only treatments. Over that same period, the percentage of Medicare enrollees diagnosed with depression who were treated with antidepressants rose from 53.7 percent to 67.1 percent. The proportion of those who received psychotherapy, on the other hand, dropped from 26.1 percent to 14.8 percent (Journal of the American Geriatrics Society, 2011).
Older adults aren't the only ones experiencing this trend. An analysis of two nationally representative surveys of U.S. households, for example, found that 75 percent of patients with depression were given antidepressants from 1998 to 2007, while the percentage of those who received psychotherapy dropped from about 53 percent to 43 percent over the same period (Archives of General Psychiatry, 2010).
"I think it's too bad … that there's not more attention to psychological interventions at least as an addition to — if not instead of — psychotropic medication," says Bob Knight, PhD, of the University of Southern California's Davis School of Gerontology and Andrus Gerontology Center, and author of the 2004 textbook "Psychotherapy for Older Adults."
The growing gap between these two forms of treatment concerns psychologists, who point to the strong data that show antidepressants are often no more effective than psychotherapy. In fact, APA's review of more than 30 peer-reviewed studies concluded that psychotherapy usually produces longer-lasting effects than medical treatments and — unlike medications — rarely causes harmful side effects.
Due to these results and to encourage greater psychotherapy use, APA released a resolution on psychotherapy effectiveness in August. According to the resolution, a combination approach to treating depression and anxiety is often most effective among the general population. But among older adults — who take more medications and are more prone to side effects — the resolution goes a step further, saying psychotherapy should be a "front-line intervention."
But until more mental health providers are trained to treat an aging population, other clinicians may continue to overlook psychotherapy as a treatment for older patients.
- Last fall, APA launched "Psychotherapy: More Than a Quick Fix," a campaign to educate consumers about psychotherapy's effectiveness and encourage them to ask their physicians about it as a treatment option. Watch the campaign videos.