The treatments studied include cognitive-behavioral, brief psychodynamic, interpersonal, reminiscence/life review, and psychoeducational modalities. For extensive reviews, see other sources.55,56 (Reminiscence and life-review therapies, relatively specific to the elderly, emphasize the recall and recounting of past life experiences, sometimes with reinterpretation of their meanings or reworking of issues previously left unresolved.57) Table IV Controlled clinical trials of psychosocial interventions with elderly patients with major depression. * Approximate mean or median age; CBT, cognitive-behavioral Inhibitors,research,lifescience,medical therapy; IPT, interpersonal therapy In general, efficacy appears comparable

for cognitivebehavioral therapy and brief psychodynamic treatments, showing significantly reduced depression over 6 weeks, relative to a delayed-treatment control condition. Interpersonal therapy has not been directly compared

with other psychosocial approaches, but generally Inhibitors,research,lifescience,medical shows equivalent responses. 51 The evidence suggests that reminiscence Inhibitors,research,lifescience,medical therapy or psychocducational interventions show efficacy in reducing depressive symptoms and dysphoric affect in elders with subclinical (or possibly dysthymic) forms of depression, but their efficacy in treating older adults who already manifest clinically diagnosable depression has not been adequately established. Psychosocial treatments – generally variants of cognitive-behavioral therapy58 or interpersonal therapy59 – with depressed older adults who had concomitant medical illness Inhibitors,research,lifescience,medical or physical impairments, such as nursing-home residents, generally show some antidepressant efficacy, but often with limitations in the effect or duration of the benefit. In summary, various forms

of psychotherapy (particularly cognitive-behavioral, psychodynamic, and interpersonal approaches) have demonstrated efficacy in decreasing depression in older adults, and the various psychotherapi.es studied have generally proven equivalent in their effects. These findings have been supported by a meta-analysis of 17 published studies of psychosocial treatments for depressed elderly patients, including cognitive, Inhibitors,research,lifescience,medical psychodynamic, others reminiscence, and eclectic approaches.60 Overall, these treatments are reliably more EPZ004777 in vitro effective than no-treatment conditions in reducing depression, the short-term effect size comparing favorably with the effect sizes for psychosocial treatments with adults of younger ages. There is no clear advantage, however, for group versus individual therapy or for any particular treatment approach. In general, the findings regarding treatment outcomes are comparable to those found in psychotherapy research with younger adults. Long-term maintenance approaches are discussed elsewhere61 and in this issue (Reynolds, pp 95-97). Electroconvulsive therapy in the elderly ECT remains the most effective treatment for severe major depression, despite its controversy.