IPT for Late-Life Depression
Major depression occurs across the life cycle, and the diagnostic criteria in older people are those of a standard major depressive episode. Elderly depressed patients, however, tend to focus more than younger patients on somatic symptoms such as physical pains and bowel habits.
As the American population ages, geriatric depression is rising ( Sholomskas et al., 1983). Mood disorders are the most common psychiatric diagnoses among the elderly, with a point prevalence of 10-15 percent among the general population ( Blazer and Williams, 1980; Frank et al., 1993). Geriatric depression is also associated with a disproportionate suicide rate and a major source of morbidity ( Lebowitz et al., 1997).
There have been three formal trials of IPT in this population as well as a couple of clinical series. The first two, by Rothblum and colleagues ( 1983) and Sloane and colleagues ( 1985), employed a standard IPT approach based on the original manual ( Klerman et al., 1984), in small, acute treatment studies. The latest, a large trial by the Pittsburgh group, used a manual developed for maintenance IPT for late-life depression (IPT-LLM [ Frank and Frank, 1988 (unpublished)]). This study, comparing IPT, nortriptyline pharmacotherapy, and combined IPT/pharmacotherapy in a discontinuation treatment design, is modeled on the Pittsburgh study on recurrent major depression ( Frank et al., 1989, 1990; see Chapter 11). The encouraging results of these trials are discussed below.