Tuma (Reference Tuma2000) reported disappointing outcomes in the treatment of late-life depression. Suicide rates are highest in the elderly in many countries (Reference Shah and DeShah & De, 1998), while treatment with drugs and electroconvulsive therapy consistently results in full recovery rates of less than 30% (Reference MurphyMurphy, 1983). Some studies show slightly more optimistic findings, such as Baldwin & Jolley (Reference Baldwin and Jolley1986) and Brodaty et al (Reference Brodaty, Harris and Peters1993) who demonstrated prognosis in later life approaching that in younger adults at one year. Yet others suggest that longer follow-up reveals a worse outcome (Reference Forsell, Jorm and WinbladForsell et al, 1994). These studies use standard physical treatments but make no mention of adjunctive psychological treatments of any kind.
There are still too few studies demonstrating the effects of psychological interventions in older people (Reference O'Rourke and HadjistavropoulosO'Rourke & Hadjistravropoulos, 1997). More recently published data have shown improved outcome using a combination of drug and psychological treatments, including interpersonal therapy and cognitive-behavioural therapy (Reference Reynolds, Frank and PerelReynolds et al, 1999). In addition, important research by Ong et al (Reference Ong, Martineau and Lloyd1987) demonstrated relapse prevention for individuals attending a support group.
In a recent postal survey, I enquired of members of the Royal College of Psychiatrists' Faculty for the Psychiatry of Old Age whether elderly patients in their care had specifically requested psychotherapy. The overall response rate was 65%, of which 49% had experience of patients asking for psychotherapy. One can only assume that those already in receipt of such treatments would not ask for it. Patients rarely demand drug treatments as they are often already taking medication. The National Health Service (NHS) Executive (1996) review of psychotherapy services endorses the need for older patients to have access to similar service opportunities as the young.
Since elderly consumers of our service are asking for psychotherapy, and because there is some evidence (Reference Roth and FonagyRoth & Fonagy, 1996) that it is a useful adjuvant in the war against late-life depression, why are we still producing research which appears to ignore this approach?
eLetters
No eLetters have been published for this article.