Psychotherapy for Late-Life Depression 晚发抑郁的心理治疗.doc

Psychotherapy for Late-Life DepressionTreating older patients with MDD presents a different set of challenges to the clinician than treating younger adults. Older patients may have more comorbid medical illnesses, take more medications, and metabolize medications more slowly than young patients. Cognitive impairment, the lack of a social support network, problems with transportation, financial constraints, and disability may be barriers to older patients receiving treatment. These clinical problems make it likely that older adults will be excluded from clinical trials, thus leading to a paucity of data-based treatment information. For this reason, a team of investigators1 convened in 2001 to address some of the clinical questions regarding the treatment of late-life depression. The team sent a written survey to 50 national experts regarding treatment options for geriatric patients, and consensus was reached by the experts on the majority of options presented. Guidelines based on the treatment strategies preferred by the experts were then developed to aid clinicians in treating older patients with depression. The consensus was that the treatment for dysythmic disorder or persistent minor depression should consist of an antidepressant combined with psychotherapy, or possibly either an antidepressant or psychotherapy alone.1,2 The preferred treatment strategy for unipolar nonpsychotic major depression of any severity was an antidepressant plus psychotherapy, although ECT was also considered for severe depression unresponsive to antidepressants.2 The SSRIs were considered the preferred antidepressant class; for an update on pharmacotherapy, please see HYPERLINK /newcme/launcher.asp?test=1212 \t _blank “Pharmacotherapy for Late-Life Depression.” The preferred psychotherapies were CBT, supportive psychotherapy, PST, and IPT. In addition, the Expert Consensus Guidelines affirmed that psychosocial interventions such as family counseling and visiting nurse services are inte