Evidence-Based Reviews

Late-life depression: Focused IPT eases loss and role changes

Current Psychiatry. 2005 November;4(11):40-50

References

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Adapting ipt for special populations

Resistant depression. Researchers at the University of Pittsburgh are investigating whether adding IPT can achieve remission in depressed older patients who show partial response to a 6-week trial of escitalopram, 10 mg/d. In this ongoing trial, patients with Hamilton Depression Rating Scale scores of 11 to 14 after 6 weeks receive an increased escitalopram dosage (20 mg/d) and are randomly assigned to medication alone or medication plus 16 weeks of IPT.

Cognitive impairment. An unpublished follow-up to the MTLLD study enrolled 116 patients aged ≥70 and used a similar design, except that:

patients were not required to have had recurrent depressive episodes
paroxetine was used instead of nortriptyline
patients with cognitive impairment (Mini-Mental Status Examination scores ?18/30) were included.

Results are being analyzed, but preliminary findings do not show a protective effect for IPT compared with paroxetine.

Cognitive impairment may have interfered with patients’ ability to benefit from traditional IPT. Thus, to improve the quality of life of depressed, cognitively-impaired elders, researchers are involving caregivers (usually a spouse or adult child) in modified forms of IPT couples therapy.^6,13-18 A team at the University of Pittsburgh is developing a flexible approach that includes meetings with the patient, the caregiver, or both. Two papers on IPT-CI (for cognitive impairment) are under review.

Related resources

International Society for Interpersonal Psychotherapy. Accreditation, training, and research information. www.interpersonalpsychotherapy.org.
Stuart S, Robertson M. Interpersonal psychotherapy: a clinician’s guide. London: Edward Arnold Ltd.; 2002.
Miller MD, Reynolds CF. Interpersonal psychotherapy. In: Hepple J, Pierce J, Wilkinson P (eds). Psychological therapies with older people. East Sussex, UK: Brunner-Routledge; 2002:103-27.
Miller MD, Reynolds CF. Living longer depression-free: a family guide to the recognition, treatment and prevention of depression in later life. Baltimore: Johns Hopkins University Press; 2002.

Drug brand names

Escitalopram • Lexapro
Nortriptyline • Pamelor
Paroxetine • Paxil

Disclosures

Dr. Miller is a consultant to Forest Laboratories and GlaxoSmithKline and is a speaker for Forest Laboratories, GlaxoSmithKline, and Wyeth Pharmaceuticals.