Talk therapy may be best for depressed seniors

NEW YORK, Nov 30 (Reuters) Talk therapy may beat medication for older adults' depression, particularly when therapists work along with the patient's primary care doctor, a research review suggests.

The review involved eight previous clinical trials, which found that psychological counseling was more effective, compared with the ''usual care;'' from family doctors for older adults with depression.

Usual care was up to each patient's primary care doctor, but typically involved antidepressant medication.

The other patients received various forms of cognitive-behavioral therapy -- in combination with medication in some studies, and as a stand-alone therapy in others.

In general, researchers found, these latter patients did better than those given routine treatment. But the most positive results came from two studies that used an ''interdisciplinary'' approach -- meaning mental health providers worked along with patients' primary care doctors to design their treatment.

This is important, according to the researchers, because studies have found that older adults prefer to seek depression therapy from their primary care doctors -- but, at the same time, they also favor talk therapy over antidepressants.

''We think the findings give us some valuable information about what works,'' lead study author Dr. Karyn M. Skultety, of the VA Palo Alto Health Care System in California, said in a statement.

Still, only two of the eight studies assessed cognitive-behavioral therapy as a stand-alone treatment for depression, and there needs to be more research into using it as a ''first-line'' therapy, Skultety's team reports in the journal Health Psychology.

There is already substantial evidence that, in contrast to traditional ''clinical lore,'' older adults do not prefer drugs over psychological counseling, the researchers note.

''They're on a lot of medications already,'' Skultety said, ''and usually they're trying to work with their doctors to reduce the number of medications they're on, not increase.'' What's more, the researchers point out, older adults' depression is often related to physical illnesses and disabilities -- the very things for which they see their primary care doctors. And these depression symptoms not only stem from medical conditions, but can also exacerbate them.

''Given the reciprocal relationship of health problems and depression in older adults,'' the study authors write, ''providing integrated care for physical and mental health problems in the same setting seems unarguably indicated.'' Reuters RL DB0927