Full Length Research Paper

Treatment-resistant depression amongst older adults: Risk factors and treatment options

Esther G. Ebenezer

Department of Psychiatry, UniKL, Royal College of Medicine, Perak, Malaysia.

E-mail: esthergunamy@yahoo.com. Tel: 605 – 2432635. Fax: 605 – 2432636. Mobile: 6013 – 5201220.

 Abstract

Depression is one of the most common mental health disorders of the elderly. Though depression is a treatable condition, approximately one-third of patients do not respond to treatment and fall into the category of ‘treatment resistant depression’ (TRD). The aim of this paper is: (1) to investigate the definition for TRD, (2) to review the risk factors that contribute to TRD in later life and (3) to describe the treatment options for TRD in later life. Electronic MEDLINE literature search (Ovid) from 1981 to 2002 using the key words ‘treatment resistant depression’ and ‘elderly’ was carried out. Additional relevant articles cited by the retrieved papers were manually searched and screened to ensure that they met the following inclusion criteria: (1) use of an acceptable diagnostic criteria for depression, (2) TRD defined as failure to respond to one or more adequate trials of antidepressant for at least 6 weeks, (3) participants’ mean age of 60 years or more and (4) sample size of at least 10 subjects. The concept of TRD remains contentious and poorly defined. Few cross-sectional studies have systematically investigated the risk factors associated with TRD. At present, there are no well-conducted randomised trials investigating how best to treat older adults with TRD. TRD in later life remains poorly defined and understood. There is an urgent need for the introduction of a widely accepted definition of treatment resistant depression, as well as the reliable identification of populations at risk and development of evidence-based treatment algorithms for patients.

Key words: Depression, elderly, treatment resistance, treatment refractory, management, risk factors.