Conclusions

• Many elderly with depression do not benefit sufficiently from the use of antidepressants. In short-term studies, selective serotonin reuptake inhibitors (SSRIs) are not significantly more effective than placebo for elderly with depression. But for those who improved during treatment with SSRI, maintenance treatment up to one year can prevent relapse.
• The selective serotonin and norepinephrine reuptake inhibitor duloxetine has been evaluated specifically for recurrent depression in elderly and has a slightly better effect than placebo in the short term, but often causes adverse effects that may be problematic for the elderly.
• Psychotherapy in the form of problem-solving therapy may decrease depression symptoms for patients with poor health aged 65 years and over, but access to such treatment is lim­ited. More and larger studies on the effects of other psychotherapies and on the effects of physical activity, is warranted to elucidate their benefit and risk balance in depression of the elderly.
• Treatments that are effective, according to this evaluation, have not yet been evaluated in health economic studies. However, since the treatment cost per individual is often relatively low, it is likely that effective treatment is also cost-effective.
• The benefits and risks of depression treatment are insufficiently studied for the frail elderly aged 65 years and over. More knowledge is warranted to determine how treatment for depression can be individualized.
• Due to the lack of knowledge about effective depression treatment for the elderly, it is particularly important to monitor treatment outcome carefully and to reconsider treatment strategy when the patient do not recover.