Published online by Cambridge University Press: 18 December 2009
Introduction
Most patients with depression are managed in primary care settings; however, a substantial number of patients are not recognized, and those who are diagnosed often do not receive effective treatment (Kessler et al. 1999). There is, however, a good evidence base for the management of depression in older people. Treatments that have been shown to work are the same as for younger adults: antidepressants, psychosocial and psychological interventions, or combinations of these and electroconvulsive treatment (ECT) for severe life-threatening or therapy-resistant cases. There is evidence to show that there are effective pharmacological (Wilson et al. 2001), psychological (Karel and Hinrichsen 2000) and psychosocial (Scogin and McElreath 1994) interventions for late-life depression, but these have yet to be adopted in primary care (Unützer 2002), in part because although cost-effective, they may involve added resource and investment to begin with. Only one in four depressed people receives effective pharmacological treatment and fewer than one in ten a talking therapy (Singleton et al. 2001). However, this is despite the fact that many people want and prefer ‘talking treatments’ (Rogers et al. 1993).
General principles of treatment
Goals of treatment
Table 2.1 provides a framework and summary of the goals for depression management (Baldwin et al. 2002).
Resolving all the symptoms of depression is the goal rather than getting the patient a bit better, as partial recovery is a predictor of future relapse.
To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Find out more about the Kindle Personal Document Service.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.