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Long-term Effects of Cognitive-Behavioural Therapy and Lithium Therapy on Depression in the Elderly

Published online by Cambridge University Press:  02 January 2018

K. C. M. Wilson*
Affiliation:
Institute of Human Ageing, Liverpool
M. Scott
Affiliation:
Institute of Human Ageing, Liverpool
M. Abou-Saleh
Affiliation:
Institute of Human Ageing, Liverpool
R. Burns
Affiliation:
Institute of Human Ageing, Liverpool
J. R. M. Copeland
Affiliation:
Institute of Human Ageing, Liverpool
*
Dr Wilson, Institute of Human Ageing, University of Liverpool, P. O. Box 147, Liverpool L69 3BX

Abstract

Background

We examine the effects of cognitive-behavioural therapy (CBT) as an adjuvant to acute physical treatment and lithium maintenance therapy in reducing depression severity over a follow-up year in elderly depressed patients.

Method

The study consists of three phases. During the acute treatment and continuation phase, 17 of 31 patients received CBT as an adjuvant to treatment as usual. During the maintenance phase of 1 year, subjects were entered into a double-blind, placebo-controlled study of low-dose lithium therapy.

Results

Receiving adjuvant CBT significantly reduced patients' scores on the Hamilton Rating Scale for Depression during the follow-up year (repeated measures analyses of variance; P = 0.007). No significant differences were found between lithium and placebo maintenance therapy.

Conclusions

CBT can be adapted as an adjuvant therapy in the treatment of severely depressed elderly patients and reduces depression severity during follow-up. The prophylactic failure of long-term lithium therapy may be explained through poor compliance.

Type
Papers
Copyright
Copyright © 1995 The Royal College of Psychiatrists 

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References

Abou-Saleh, M. T. & Coppen, A. (1983) The prognosis of depression in old age: the case for lithium therapy. British Journal of Psychiatry, 143, 527528.Google Scholar
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
Beck, A., Rush, J., Shaw, B., et al (1979) Cognitive Therapy of Depression. New York: Guilford Press.Google Scholar
Burvill, P., Stampfer, H., & Hall, W. (1991) Issues in the assessment of outcome in depressive illness in the elderly. International Journal of Geriatric Psychiatry, 6, 269277.Google Scholar
Carney, M., Roth, M. & Garside, R. (1969) The diagnoses of depressive syndromes and the prediction of ECT response. British Journal of Psychiatry, 111, 659674.CrossRefGoogle Scholar
Cole, M. (1990) The prognosis of depression in the elderly. Canadian Medical Association Journal, 143, 633639.Google Scholar
Copeland, J. R. M., Dewey, M. E. & Griffiths-Jones, H. M. (1986) A computerised psychiatric diagnostic system and case nomenclature for elderly subjects: gms and agecat. Psychological Medicine, 16, 8999.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. & McHugh, P. R. (1975) Mini mental state; a practical method of grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.Google Scholar
Frank, E., Prien, R. & Kupfer, D. J. (1985) Implications of non-compliance on research in affective disorders. Psychopharmacology Bulletin, 21, 3742.Google Scholar
Freeman, C. & Tyrer, P. (1992) Research Methods in Psychiatry. London: Gaskell.Google Scholar
Gallagher, D. E. & Thompson, L. W. (1983) Effectiveness of psychotherapy for both endogenous and non-endogenous depression in older adult outpatients. Journal of Gerontology, 38, 707712.Google Scholar
Ghose, K. (1977) Lithium salts – therapeutic and unwanted effects. British Journal of Hospital Medicine, 18, 578583.Google Scholar
Guscott, R. & Taylor, L. (1994) Lithium prophylaxis in recurrent affective illness: efficacy, effectiveness and efficiency. British Journal of Psychiatry, 164, 741746.CrossRefGoogle ScholarPubMed
Hamilton, M. (1967) Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychiatry, 6, 278296.Google Scholar
Montgomery, S. (1993) Failure to demonstrate prophylactic efficacy of dothiepin. British Journal of Psychiatry, 163, 257264.CrossRefGoogle ScholarPubMed
Montgomery, S., & Åsberg, M. (1979) A new depression rating scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382389.Google Scholar
NIH Consensus Development Conference (1994) Diagnoses and Treatment of Depression in Late Life (eds Schneider, L., Reynolds, C., Lebowitz, B., et al). Washington, DC: American Psychiatric Press.Google Scholar
Old Age Depression Interest Group (1993) How long should the elderly take antidepressants? A double-blind, placebo-controlled study of continuation/prophylaxis therapy with dothiepin. British Journal of Psychiatry, 162, 175182.CrossRefGoogle Scholar
Shulman, K. I., Mackenzie, S. & Hardy, B. (1987) The clinical use of lithium carbonate in old age; a review. Progressions in Neuropsychopharmacology, Biology and Psychiatry, 11, 159164.Google Scholar
Taves, D. R. (1974) Minimisation: a new method of assigning patients to treatment and control groups. Clinical Pharmacology and Therapeutics, 15, 443453.Google Scholar
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