Pharmacologic vs

Non-pharmacologic
Treatments for
Depression
Ferris State University
Brittany Torok, Heather Torre,
Erin VanderHorst, and Jamie
Wilson
NURS 315

Introduction
Depression

is common in the terminally

ill person and frequently these
symptoms will go unrecognized.
It is important to remember persistent
feelings of helplessness, hopelessness,
inadequacy, and suicidal ideations are
not normal at the end of life (Dodds,
Kumar & Veering, 2014).

 Depressive

symptoms can respond quickly

and positively to pharmacological and nonpharmacolgic treatment.

Medications Used alone of in combination

with other psychotropics.
Antidepressants

- (SSRIs- fluoxetine, sertraline &

citalopram)
Stimulants (methylphenidate, Concerta/Ritalin)
Non-benzodiazepines (Buspirone hydrocholoride)

Analysis of Pharmacological Studies

Brown University Report
300 participants over the age of 60 years in a
12-week, double blind, placebo-controlled trial
yielded:
o 86% of the patients treated with paroxetine
and 55% of the patients given the placebo
responded to treatment
o 12.3% patients receiving paroxetine
discontinued treatment due to adverse side
effects, compared to 8.3% of the placebotreated patients that stopped use.
(Paxil CR has favorable tolerability in elderly
depression, 2003)

Analysis: Non-Pharmacological Studies

Psychotherapy: Cognitive Behavior Therapy

Meta-analysis of literature from 23 randomized

controlled trials (RCTs) were chosen from 485
studies.
Participants were older adults with major or
minor depressive symptoms, and selected from
the community and clinical settings.
In most studies, the subjects were from similar
demographics and not very generalized.
Active controls = social support, placebo, case
management, discussion group, etc.
Non-active controls = Treatment as usual.
(Gould et al., 2012)

Psychotherapy: Cognitive Behavior

Therapy
This research is competitive since:
Meta-analyses, as well as randomized
controlled trials, are considered to have
stronger levels of evidence.
______________________

Results:
CBT is more effective at reducing
depressive symptoms than nonactive,
but not active controls.
(Gould et al., 2012)

Analysis: Pharmacological +
Non-pharmacological
Combination
Reynolds Study of
paroxetine+therapy
116 patients over 59 years participated.
28 took paroxetine plus psychotherapy.
35 took placebo plus psychotherapy.
35 took paroxetine and only clinical
management.
18 took placebo and only clinical
management.

Reynolds Study of paroxetine+therapy

o
o

Paroxetine plus psychotherapy had the

lowest recurrence rate of depression.
Paroxetine and only clinical management
was more effective than placebo plus
psychotherapy
(Renyolds et al., 2012)

Descriptive Summary
Psychotherapy

There is an abundance in opportunities

for psychotherapy interventions in our
aging population
Psychotherapy can assist family
members and other care givers to
provide enhanced care to the elderly
Psychotherapy can be a life-saving
measure for elderly who are
considering suicide

Psychotherapy

Psychotherapy can be an effective nonpharmacological option to treat

depression in elderly. Especially when:
Pharmacological treatment produces
undesired side effects.
Noncompliance or forgotten doses are a
problem.

Descriptive Summary
Psychotherapy Combination
When

used in combination with Paxil

lead to a reduction of reoccurrence of
depression in the elderly
Where as a placebo use in combination
with psychotherapy did not show a
reduction in reoccurrence of depression

Descriptive Summary
Pharmalogical Intervention
Paxil

Reynolds 2-year study revealed: the risk

of reoccurrence in depression was 2.4
times higher in individuals who took a
placebo rather than Paxil.
Many elderly have comorbidities, which
can lead to drug interactions with Paxil

Recommendations
Psycotherapy VS paroxetine

According to the analysis of evidence above,

depression is best treated with both
Paroxetine and psychotherapy.
Using both treatments together can lower
the recurrence rate of depression.
Treatment also depends on how depressed
the patient is. In patients that are severely
depressed, antidepressant drug therapy is
more effective than psychotherapy. (Long,
1988)

 Patients

that have non-severe

depression usually recover in less than 4
months.
If the average episode of major
depression lasts 4 months, then for
these mild cases, all that is required is
seeing a therapist frequently for brief,
supportive visits until the depression
spontaneously recovers. (Long, 1988)

If a patient has severe major depression an

antidepressant is highly effective and must
be given.
In this case the drug must be given for at
least 6-12 months (Long, 1988)
Severely depressed patients suffer greatly
and are high suicide risks. It takes weeks
before antidepressant drug therapy starts
to work, thus these patients desperately
need a caring professional who will
emotionally support them and their family
until their body recovers. (Long, 1988)

Conclusion/Summary
Psychotherapy

is an effective treatment for mild

cases of depression
Paxil is effective for mild-severe depression
The combination of psychotherapy and Paxil can
improve effectiveness rather than when used
alone
Similar to other medications used to treat
depression Paxil or psychotherapy may not be
effective for every patient and different
pharmalogical or nonpharmalogical interventions
may need to be tried before finding the right
medication or combination

References
Anderson, D., Wattis, J. (2014). Psychotherapeutic
approaches in the elderly. GM. 8. Retrieved from
http://www.gmjournal.co.uk/psychotherapeutic_approaches_
to_the_elderly_25769815462.aspx
Dodds, C.,Kumar, C., Veering, B. (2014). Oxford textbook of
anesthesiology for the elderly patient. New York, NY. Oxford
University Press.
Long, P. (1988, February 9). Major Depressive Disorder:
Treatment. Retrieved February 28, 2015, from
http://www.mentalhealth.com/rx/p23-md01.html#Head_2av
Paxil CR has favorable tolerability in elderly depression.
(News Updates). (2003, January). The Brown University
Geriatric Psychopharmacology Update, 7(1), 8. Retrieved
from http://0-go.galegroup.com.libcat.ferris.edu/ps/i.do?
id=GALE
%7CA96381216&v=2.1&u=lom_ferrissu&it=r&p=ITOF&sw=
w&asid=7f608b010d1c0a973cba307164e48e7b

References

Frank, C. (2014). Pharmacologic treatment of

depression in the elderly. Canadian Family Physician,
60(2), 121-126. Retrieved from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3922554/
Reynolds, Frank, E., Perel, J. (2006). Trial tests
maintenance paroxetine and psychotherapy in elderly
patients. The Brown University Pshychopharmacology
Update.(17.6)p1. Retrieved from: http://0go.galegroup.com.libcat.ferris.edu/ps/i.do?&id=GALE|
A146790178&v=2.1&u=lom_ferrissu&it=r&p=ITOF&s
w=w

References

Gould, R., Coulson, M., Howard R. (2012).

Cognitive Behavioral Therapy for Depression in
Older people: A meta-analysis and metaregression of randomized controlled trials.
Journal of the American Geriatrics Society
(60)pp1817-1830. Retrieved from: http://0onlinelibrary.wiley.com.libcat.ferris.edu/doi/10.1
111/j.1532-5415.2012.04166.x/epdf