Treatments for Later-Life Depressive Conditions: A Meta-Analytic Comparison of Pharmacotherapy and Psychotherapy
Abstract
OBJECTIVE: To improve interventions for depressed older adults, data are needed on the comparative effects of pharmacotherapy versus psychotherapy. Given that most older adults with clinically significant depressive symptoms do not have major depression, data on treatments for minor depression and dysthymia are especially needed. METHOD: Meta-analysis was used to integrate the results of 89 controlled studies of treatments focused on acute major depression (37 studies) and other depressive disorders (52 studies conducted with mixed diagnostic groups, including patients with major depression, minor depression, and dysthymia). A total of 5,328 older adults received pharmacotherapy or psychotherapy in these studies. RESULTS: Clinician-rated depression scores improved, on average, by 0.80 standard deviation (SD) units; self-rated depression scores improved by 0.76 SD units. Clinician-rated depression improved by 0.69 SD units in pharmacotherapeutic studies and by 1.09 SD units in psychotherapeutic studies. Self-rated depression improved by 0.62 SD units and 0.83 SD units, respectively. An interesting finding was the stronger improvements in clinician-rated depression among control subjects participating in medication studies, compared to those in psychotherapeutic studies. CONCLUSIONS: Available treatments for depression work, with effect sizes that are moderate to large. Comparisons of psychotherapy and pharmacotherapy must be interpreted with caution, in part because medication studies are more likely to use a credible active placebo, which may lead to smaller adjusted effect sizes in medication studies. Given that psychotherapy and pharmacotherapy did not show strong differences in effect sizes, treatment choice should be based on other criteria, such as contraindications, treatment access, or patient preferences.
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Psychotherapy is similarly effective as pharmacological approaches in the treatment of late-life depression.
“Meta-analytic data suggest that psychotherapy is similarly effective as pharmacological approaches in the treatment of LLD287,288, with a number needed to treat of 3 (ref. 288).”
From Psychobiological factors of resilience and depression in late life (2019) · cites this paper as [288]
The number needed to treat for psychotherapy in late-life depression is 3.
“Meta-analytic data suggest that psychotherapy is similarly effective as pharmacological approaches in the treatment of LLD287,288, with a number needed to treat of 3 (ref. 288).”
From Psychobiological factors of resilience and depression in late life (2019) · cites this paper as [288]
Meta-analysis of psychotherapy studies in a wide range of late-life depressive syndromes documented that psychotherapy and pharmacotherapy have comparable efficacy.
“Meta-analysis of psychotherapy studies in a wide range of late-life depressive syndromes documented that psychotherapy and pharmacotherapy have comparable efficacy161.”
From Mechanisms and treatment of late-life depression (2019) · cites this paper as [161]
Depression can be treated effectively with different forms of psychotherapies.
“depression can be treated effectively with different forms of psychotherapies [13-18]”
From Long-Term Results of a Web-Based Guided Self-Help Intervention for Employees With Depressive Symptoms: Randomized Controlled Trial (2014) · cites this paper as [18]
Research on the treatment of depression has been extensive.
“Research on the treatment of depression has been extensive [13-16] and many studies have shown positive effects of different psychotherapies (eg, [15,17,18]).”
From Short-Term Effects of a Web-Based Guided Self-Help Intervention for Employees With Depressive Symptoms: Randomized Controlled Trial (2014) · cites this paper as [16]
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- Authors
- Pinquart, M., Duberstein, P. R., & Lyness, J. M.
- Affiliations
- Friedrich Schiller University Jena (DE)
- Venue
- American Journal of Psychiatry
- Published
- 2006-09
- Volume
- 163
- Issue
- 9
- Pages
- 1493-1501
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2128077214
- Cited by
- 204
- References
- 51
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 6 · 2023: 8 · 2022: 8 · 2021: 5 · 2020: 12 · 2019: 7 · 2018: 7 · 2017: 5 · 2016: 14 · 2015: 19 · 2014: 8 · 2013: 16 · 2012: 12
- FWCI
- 16.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01mh061429-05)
- National Institute of Mental Health (R01 MH-61429, R01 MH-64579, R01MH064579)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- geriatric depression, older adults, pharmacotherapy, psychotherapy, major depressive disorder, minor depression, dysthymia, treatment comparison, active placebo, effect size, self-rated depression
- MeSH terms
- Aged, Antidepressive Agents, Depressive Disorder, Major, Major Depressive Disorder, Depressive Disorder, Humans, Psychotherapy, Randomized Controlled Trials as Topic, Treatment Outcome, Dysthymic Disorder
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