Treatment-Resistant Depression in Older Adults

Treatment-Resistant Depression in Older Adults

• Treatment-resistant depression is common in older adults with depression and is associated with several biologic, psychological, and social factors, as well as with adverse clinical and functional outcomes.

• A commonly accepted definition of treatment-resistant depression is a lack of improvement despite adequate trials of two different classes of antidepressants for at least 8 weeks.

• Assessment of treatment-resistant depression includes screening for coexisting medical and psychiatric conditions.

• Measurement-based collaborative care with the use of validated instruments (e.g., the nine-item Patient Health Questionnaire) is recommended for the management of depression, with continuous monitoring and adjustment of treatment until remission is reached and sustained.

• The best evidence for a pharmacologic approach to the management of treatment-resistant depression rests on augmentation strategies, such as the use of second-generation antipsychotic agents, lithium, or another antidepressant agent, or a switch to a different class of agent.

• Referral for a psychiatric evaluation for consideration of electroconvulsive therapy or other treatment is recommended for patients with severe depression, worsening suicidal ideation, psychosis, or coexisting cognitive impairment.

Treatment-Resistant Depression in Older Adults

Treatment-resistant depression in older adults is common and can be difficult to manage. Strategies include ensuring adequate antidepressant therapy and addressing concomitant psychiatric and medical needs.