Diagnosis and treatment of depression in late life. Consensus statement update

B. D. Lebowitz, J. L. Pearson, L. S. Schneider, C. F. Reynolds 3rd, G. S. Alexopoulos, M. L. Bruce, Y. Conwell, I. R. Katz, B. S. Meyers, M. F. Morrison, J. Mossey, G. Niederehe and P. Parmelee
National Institute of Mental Health, Bethesda, Md 20857, USA. blebowit@nih.gov

OBJECTIVE: To reexamine the conclusions of the 1991 National Institutes of Health Consensus Panel on Diagnosis and Treatment of Depression in Late Life in light of current scientific evidence. PARTICIPANTS: Participants included National Institutes of Health staff and experts drawn from the Planning Committee and presenters of the 1991 Consensus Development Conference. EVIDENCE: Participants summarized relevant data from the world scientific literature on the original questions posed for the conference. PROCESS: Participants reviewed the original consensus statement and identified areas for update. The list of issues was circulated to all participants and amended to reflect group agreement. Selected participants prepared first drafts of the consensus update for each issue. All drafts were read by all participants and were amended and edited to reflect group consensus. CONCLUSIONS: The review concluded that, although the initial consensus statement still holds, there is important new information in a number of areas. These areas include the onset and course of late-life depression; comorbidity and disability; sex and hormonal issues; newer medications, psychotherapies, and approaches to long-term treatment; impact of depression on health services and health care resource use; late-life depression as a risk factor for suicide; and the importance of the heterogeneous forms of depression. Depression in older people remains a significant public health problem. The burden of unrecognized or inadequately treated depression is substantial. Efficacious treatments are available. Aggressive approaches to recognition, diagnosis, and treatment are warranted to minimize suffering, improve overall functioning and quality of life, and limit inappropriate use of health care resources.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The Impact of Cost Sharing on Antidepressant Use Among Older Adults in British Columbia
Wang et al.
Psychiatr. Serv. 2008;59:377-383.
ABSTRACT | FULL TEXT  

Dyadic Relationship Scale: A Measure of the Impact of the Provision and Receipt of Family Care
Sebern and Whitlatch
Gerontologist 2007;47:741-751.
ABSTRACT | FULL TEXT  

Late-Life Depression
Unutzer
NEJM 2007;357:2269-2276.
FULL TEXT  

Problem-Solving Therapy for Late-Life Depression in Home Care: A Randomized Field Trial
Gellis et al.
AJGP 2007;15:968-978.
ABSTRACT | FULL TEXT  

Comorbid Depression in Adult Oncology
Jackson and Jackson
Journal of Pharmacy Practice 2007;20:360-367.
ABSTRACT  

Characterization of the Lipid Profile in Dementia and Depression in the Elderly
Dimopoulos et al.
J Geriatr Psychiatry Neurol 2007;20:138-144.
ABSTRACT  

Does Depression Precede or Follow Executive Dysfunction? Outcomes in Older Primary Care Patients
Cui et al.
Am. J. Psychiatry 2007;164:1221-1228.
ABSTRACT | FULL TEXT  

Attenuated Anterior Cingulate Activation During a Verbal Fluency Task in Elderly Patients With a History of Multiple-Episode Depression
Takami et al.
AJGP 2007;15:594-603.
ABSTRACT | FULL TEXT  

Depression in Elderly Diabetes Patients
Trief
Diabetes Spectr. 2007;20:71-75.
FULL TEXT  

Effect of comorbid anxiety on treatment response and relapse risk in late-life depression: controlled study
Andreescu et al.
Br. J. Psychiatry 2007;190:344-349.
ABSTRACT | FULL TEXT  

The Clinical Significance of Subsyndromal Depression in Older Primary Care Patients
Lyness et al.
AJGP 2007;15:214-223.
ABSTRACT | FULL TEXT  

End-of-Life Care: Issues Relevant to the Geriatric Psychiatrist
Lyness
Focus 2007;5:459-471.
ABSTRACT | FULL TEXT  

Depression in Assisted Living Is Common and Related to Physical Burden
Watson et al.
AJGP 2006;14:876-883.
ABSTRACT | FULL TEXT  

Treatments for Later-Life Depressive Conditions: A Meta-Analytic Comparison of Pharmacotherapy and Psychotherapy
Pinquart et al.
Am. J. Psychiatry 2006;163:1493-1501.
ABSTRACT | FULL TEXT  

Alzheimer's disease: Psychopathology, medical management and dental implications.
Friedlander et al.
Journal of the American Dental Association 2006;137:1240-1251.
ABSTRACT | FULL TEXT  

Presidential address: psychosomatic medicine and biodefense preparedness--a new role for the american psychosomatic society.
Locke
Psychosom. Med. 2006;68:698-705.
ABSTRACT | FULL TEXT  

Revisiting the 'Fat and Jolly' hypothesis: socio-environmental determinants of obesity and depression in Spain
Costa-Font and Gil
Socioecon Rev 2006;4:513-542.
ABSTRACT | FULL TEXT  

Gender differences in the association between religious involvement and depression: the cache county (utah) study.
Norton et al.
J. Gerontol. B Psychol. Sci. Soc. Sci. 2006;61:P129-P136.
ABSTRACT | FULL TEXT  

Outcomes of Minor and Subsyndromal Depression among Elderly Patients in Primary Care Settings
Lyness et al.
ANN INTERN MED 2006;144:496-504.
ABSTRACT | FULL TEXT  

A Double-Blind, Placebo-Controlled Study of Venlafaxine and Fluoxetine in Geriatric Outpatients With Major Depression
Schatzberg and Roose
AJGP 2006;14:361-370.
ABSTRACT | FULL TEXT  

Geropsychiatric Nursing: The State of the Science
Kolanowski and Piven
J Am Psychiatr Nurses Assoc 2006;12:75-99.
ABSTRACT  

Mental Distress Among Younger Veterans Before, During, and After the Invasion of Iraq
West and Weeks
Psychiatr. Serv. 2006;57:244-248.
ABSTRACT | FULL TEXT  

Cerebrovascular Risk Factors, Executive Dysfunction, and Depression in Older Primary Care Patients
Sanders et al.
AJGP 2006;14:145-152.
ABSTRACT | FULL TEXT  

Depression Treatment Preferences in Older Primary Care Patients
Gum et al.
Gerontologist 2006;46:14-22.
ABSTRACT | FULL TEXT  

Perspectives on Depression, Mild Cognitive Impairment, and Cognitive Decline
Steffens et al.
Arch Gen Psychiatry 2006;63:130-138.
ABSTRACT | FULL TEXT  

Psychosocial and Vascular Risk Factors for Depression in the Elderly
Holley et al.
AJGP 2006;14:84-90.
ABSTRACT | FULL TEXT  

Establishing Priorities for Reducing Suicide and Its Antecedents in the United States
Knox and Caine
Am. J. Public Health 2005;95:1898-1903.
ABSTRACT | FULL TEXT  

Comparing the Geriatric Depression Scale, Minimum Data Set, and Primary Care Provider Diagnosis for Depression in Rural Nursing Home Residents
Kerber et al.
J Am Psychiatr Nurses Assoc 2005;11:269-275.
ABSTRACT  

Depression, Perceived Family Criticism, and Functional Status Among Older, Primary-Care Patients
Seaburn et al.
AJGP 2005;13:766-772.
ABSTRACT | FULL TEXT  

Neighborhood Contextual Influences on Depressive Symptoms in the Elderly
Kubzansky et al.
Am J Epidemiol 2005;162:253-260.
ABSTRACT | FULL TEXT  

Hormone Therapy Does Not Affect Depression Severity in Older Women
Goldstein et al.
AJGP 2005;13:616-623.
ABSTRACT | FULL TEXT  

Competing Paradigms of Response to Assisted Suicide Requests in Oregon
Hamilton and Hamilton
Am. J. Psychiatry 2005;162:1060-1065.
FULL TEXT  

Levels of Depressive Symptoms in Spouses of People With Lung Cancer: Effects of Personality, Social Support, and Caregiving Burden
Kim et al.
Psychosomatics 2005;46:123-130.
ABSTRACT | FULL TEXT  

Use of Psychotherapy for Depression in Older Adults
Wei et al.
Am. J. Psychiatry 2005;162:711-717.
ABSTRACT | FULL TEXT  

End-of-Life Care: Issues Relevant to the Geriatric Psychiatrist
Lyness
Focus 2005;3:341-353.
ABSTRACT | FULL TEXT  

How Does Depression Influence Diabetes Medication Adherence in Older Patients?
Kilbourne et al.
AJGP 2005;13:202-210.
ABSTRACT | FULL TEXT  

A Statewide Case-Control Study of Spousal Homicide-Suicide in Older Persons
Malphurs and Cohen
AJGP 2005;13:211-217.
ABSTRACT | FULL TEXT  

Disparities in the Adequacy of Depression Treatment in the United States
Harman et al.
Psychiatr. Serv. 2004;55:1379-1385.
ABSTRACT | FULL TEXT  

Risk Factors for Geriatric Depression: The Importance of Executive Functioning Within the Vascular Depression Hypothesis
Mast et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2004;59:1290-1294.
ABSTRACT | FULL TEXT  

End-of-Life Care: Issues Relevant to the Geriatric Psychiatrist
Lyness
AJGP 2004;12:457-472.
ABSTRACT | FULL TEXT  

Treatment Effects from UPBEAT: A Randomized Trial of Care Management for Behavioral Health Problems in Hospitalized Elderly Patients
Oslin et al.
J Geriatr Psychiatry Neurol 2004;17:99-106.
ABSTRACT  

Treatment of Depressive Conditions in Later Life: Real-World Light for Dark (or Dim) Tunnels
Lyness
JAMA 2004;291:1626-1628.
FULL TEXT  

Evidence-Based Practices in Geriatric Mental Health Care
Bartels et al.
Focus 2004;2:268-281.
ABSTRACT | FULL TEXT  

The Pharmacological Approach of Behavioral Disturbances in Dementia
Maher
Journal of Pharmacy Practice 2004;17:129-132.
ABSTRACT  

Reducing Suicidal Ideation and Depressive Symptoms in Depressed Older Primary Care Patients: A Randomized Controlled Trial
Bruce et al.
JAMA 2004;291:1081-1091.
ABSTRACT | FULL TEXT  

Decisional Capacity of Depressed Elderly to Consent to Electroconvulsive Therapy
Lapid et al.
J Geriatr Psychiatry Neurol 2004;17:42-46.
ABSTRACT  

Using the Minimum Data Set 2.0 Mood Disturbance Items as a Self-Report Screening Instrument for Depression in Nursing Home Residents
Ruckdeschel et al.
AJGP 2004;12:43-49.
ABSTRACT | FULL TEXT  

Design and Sample Characteristics of the PRISM-E Multisite Randomized Trial to Improve Behavioral Health Care for the Elderly
Levkoff et al.
J Aging Health 2004;16:3-27.
ABSTRACT  

Neighbourhood composition and depressive symptoms among older Mexican Americans
Ostir et al.
J. Epidemiol. Community Health 2003;57:987-992.
ABSTRACT | FULL TEXT  

Depression in Assisted Living: Results From a Four-State Study
Watson et al.
AJGP 2003;11:534-542.
ABSTRACT | FULL TEXT  

One-Month Stability of Depression Among Elderly Home-Care Patients
Raue et al.
AJGP 2003;11:543-550.
ABSTRACT | FULL TEXT  

Comparing Clinical Practice With Guideline Recommendations for the Treatment of Depression in Geriatric Patients: Findings From the APA Practice Research Network
Colenda et al.
AJGP 2003;11:448-457.
ABSTRACT | FULL TEXT  

An 8-Week Multicenter, Parallel-Group, Double-Blind, Placebo-Controlled Study of Sertraline in Elderly Outpatients With Major Depression
Schneider et al.
Am. J. Psychiatry 2003;160:1277-1285.
ABSTRACT | FULL TEXT  

Depression and Bipolar Support Alliance Consensus Statement on the Unmet Needs in Diagnosis and Treatment of Mood Disorders in Late Life
Charney et al.
Arch Gen Psychiatry 2003;60:664-672.
ABSTRACT | FULL TEXT  

Challenges to the Transition to Independent Investigator in Geriatric Mental Health
Bruce
AJGP 2003;11:356-359.
ABSTRACT | FULL TEXT  

Central Nervous System Active Medications and Risk for Fractures in Older Women
Ensrud et al.
Arch Intern Med 2003;163:949-957.
ABSTRACT | FULL TEXT  

Practical Geriatrics: Clinically Significant Nonmajor Geriatric Depression
Lavretsky and Kumar
Psychiatr. Serv. 2003;54:297-299.
FULL TEXT  

Advances in Psychotherapy for Mental Illness in Late Life
Arean
AJGP 2003;11:4-6.
FULL TEXT  

Recognition of Depression Among Elderly Recipients of Home Care Services
Brown et al.
Psychiatr. Serv. 2003;54:208-213.
ABSTRACT | FULL TEXT  

The Relationship Between Homework Compliance and Treatment Outcomes Among Older Adult Outpatients With Mild-to-Moderate Depression
Coon and Thompson
AJGP 2003;11:53-61.
ABSTRACT | FULL TEXT  

Evidence-Based Practices in Geriatric Mental Health Care
Bartels et al.
Psychiatr. Serv. 2002;53:1419-1431.
ABSTRACT | FULL TEXT  

Influence of Cognitive Impairment, Illness, Gender, and African-American Status on Psychiatric Ratings and Staff Recognition of Depression
Teresi et al.
AJGP 2002;10:506-514.
ABSTRACT | FULL TEXT  

Predictors of Two-Year Mortality in a Prospective "UPBEAT" Study of Elderly Veterans With Comorbid Medical and Psychiatric Symptoms
Lavretsky et al.
AJGP 2002;10:458-468.
ABSTRACT | FULL TEXT  

Major Depression in Elderly Home Health Care Patients
Bruce et al.
Am. J. Psychiatry 2002;159:1367-1374.
ABSTRACT | FULL TEXT  

Psychological Disorders and Distress in Older Primary Care Patients: A Comparison of Older and Younger Samples
Klapow et al.
Psychosom. Med. 2002;64:635-643.
ABSTRACT | FULL TEXT  

Clinically Significant Non-Major Depression: Old Concepts, New Insights
Lavretsky and Kumar
AJGP 2002;10:239-255.
ABSTRACT | FULL TEXT  

Depressive Disorders and Symptoms in Older Primary Care Patients: One-Year Outcomes
Lyness et al.
AJGP 2002;10:275-282.
ABSTRACT | FULL TEXT  

Stressful Life Events Interacting With Cognitive/Personality Styles to Predict Late-Onset Major Depression
Mazure et al.
AJGP 2002;10:297-304.
ABSTRACT | FULL TEXT  

A 75-Year-Old Man With Depression
Kroenke
JAMA 2002;287:1568-1576.
FULL TEXT  

Compliance among Pharmacies in California with a Prescription-Drug Discount Program for Medicare Beneficiaries
Lewis et al.
NEJM 2002;346:830-835.
ABSTRACT | FULL TEXT  

The Spectrum of Quality-of-Life Impairments in Recurrent Geriatric Depression
Doraiswamy et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2002;57:M134-137.
ABSTRACT | FULL TEXT  

The Influence of Age on the Response of Major Depression to Electroconvulsive Therapy: A C.O.R.E. Report
O'Connor et al.
AJGP 2001;9:382-390.
ABSTRACT | FULL TEXT  

Quality of Life in Geriatric Depression: A Comparison of Remitters, Partial Responders, and Nonresponders
Doraiswamy et al.
AJGP 2001;9:423-428.
ABSTRACT | FULL TEXT  

Changes in Driving Patterns and Worsening Depressive Symptoms Among Older Adults
Fonda et al.
J. Gerontol. B Psychol. Sci. Soc. Sci. 2001;56:S343-351.
ABSTRACT | FULL TEXT  

Older Adults' Acceptance of Psychological and Pharmacological Treatments for Depression
Landreville et al.
J. Gerontol. B Psychol. Sci. Soc. Sci. 2001;56:P285-291.
ABSTRACT | FULL TEXT  

Major depressive disorder: Psychopathology, medical management and dental implications
FRIEDLANDER and MAHLER
Journal of the American Dental Association 2001;132:629-638.
ABSTRACT | FULL TEXT  

Care of older people: Mental health problems
Burns et al.
BMJ 2001;322:789-791.
FULL TEXT  

Nortriptyline in Geriatric Depression Resistant to Serotonin Reuptake Inhibitors: Case Series
Weintraub
J Geriatr Psychiatry Neurol 2001;14:28-32.
ABSTRACT  

The Challenge of Depression in Late Life: Bridging Science and Service in Primary Care
Gallo and Coyne
JAMA 2000;284:1570-1572.
FULL TEXT  

Chronic Disease Management: Treating the Patient With Disease(s) vs Treating Disease(s) in the Patient
DeBusk et al.
Arch Intern Med 1999;159:2739-2742.
ABSTRACT | FULL TEXT  

Antidepressants for old people
Baldwin et al.
BMJ 1999;319:849b-849.
FULL TEXT  

Multifaceted shared care intervention for late life depression in residential care: randomised controlled trial • Commentary: Beyond the boundary for a randomised controlled trial?
Llewellyn-Jones et al.
BMJ 1999;319:676-682.
ABSTRACT | FULL TEXT  

Depression and Aging: A Look to the Future
Reynolds and Kupfer
Psychiatr. Serv. 1999;50:1167-1172.
ABSTRACT | FULL TEXT  

Infant Health Care Use and Maternal Depression
Mandl et al.
Arch Pediatr Adolesc Med 1999;153:808-813.
ABSTRACT | FULL TEXT  

Treatment of 70+-Year-Olds With Recurrent Major Depression: Excellent Short-Term But Brittle Long-Term Response
Reynolds et al.
AJGP 1999;7:64-69.
ABSTRACT | FULL TEXT  

Nortriptyline and Interpersonal Psychotherapy as Maintenance Therapies for Recurrent Major Depression: A Randomized Controlled Trial in Patients Older Than 59 Years
Reynolds III et al.
JAMA 1999;281:39-45.
ABSTRACT | FULL TEXT  

Depression in the Elderly -- Falls and Pitfalls
Avorn
NEJM 1998;339:918-920.
FULL TEXT  

Effects of adrenalectomy and subsequent corticosterone replacement on rat sleep state and EEG power spectra
Bradbury et al.
Am. J. Physiol. Regul. Integr. Comp. Physiol. 1998;275:R555-R565.
ABSTRACT | FULL TEXT