Comprehensive treatment of depression in older adults

The approach to depression in older adults should be comprehensive, personalized, and consider the clinical, cognitive, social, and emotional characteristics specific to this stage of life. The fundamental pillars of treatment are described below.

Basic principles of pharmacological treatment

The use of antidepressants in older adults requires caution and knowledge of the medical comorbidities that are common in this population.

Selective serotonin reuptake inhibitors (SSRIs), such as sertraline, fluoxetine, escitalopram, or citalopram, are first-line treatments due to their efficacy and relatively safe profile. However, risks such as polypharmacy, which is very common in this population and can lead to drug interactions, must be taken into account.

In addition, conditions such as renal or hepatic impairment or cardiovascular risks should be carefully evaluated before prescribing. Some SSRIs may increase the risk of gastrointestinal bleeding or affect cardiac conduction.

Alternative therapies in refractory cases

In patients with treatment-resistant depression, or when symptoms are very severe and severely impair functioning or there is a high risk of suicide, electroconvulsive therapy (ECT) may be considered.

This technique has been shown to be effective and safe in older people, especially when there are psychotic symptoms, catatonia, or profound functional impairment. Despite its stigma, ECT is a valid therapeutic tool with rapid effects in many critical cases.

Duration, adherence, and long-term management of pharmacological treatment

Once treatment has been established and symptom remission has been achieved, it is advisable to continue medication for at least 12 months to reduce the risk of relapse. Adherence can be challenging due to polypharmacy, adverse effects, or misperceptions about mental illness. Patient and family education is key to promoting continuity. Regular medical follow-up allows for dose adjustments, monitoring of side effects, and assessment of the need to safely continue or discontinue treatment.

Role of psychotherapy in older adults

Although often underestimated, psychotherapy can be as effective as pharmacotherapy, especially in mild to moderate cases. Individual psychotherapy tailored to the geriatric patient should consider the decline in processing speed, memory, and comprehension.

Modalities such as cognitive-behavioral therapy, reminiscence therapy, and meaning-centered intervention have shown benefits. The focus is often on reorganizing routines, reframing experiences of loss, and strengthening personal resources.

Family support psychotherapy: it is essential to include the patient's environment. Depression in older adults often develops in contexts of isolation, loss of roles, or poorly processed grief. Intervention with the family can help improve communication, reduce stigma, and distribute the burden of care more healthily.

In summary, comprehensive treatment of depression in older adults combines safe pharmacological interventions, adapted psychotherapeutic strategies, and a social environment that promotes recovery. The approach should be empathetic, flexible, and focused on preserving quality of life.