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Depression in Nursing Homes

Ensuring Adequate Treatment

  • Therapy in Practice
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Abstract

Studies have shown a high prevalence of depressive disorders among nursing home residents around the world. Various losses in old age may precipitate depression, and physical illness and disability are major factors that contribute to the development and persistence of depressive disorders. Demoralisation (existential distress) is common. Recognition of what a nursing home resident has lost is often a key to developing plans for management. The prognosis for recovery from depression is worse for patients who face an ongoing distressing situation or physical condition. For ongoing loss-related distress, including sadness about loss of health, it is important for patients to ventilate feelings, and to either re-acquire what is lost or to grieve and then adapt to the new situation.

For major depression with melancholia, psychotic depression and bipolar disorders, biological treatments are of prime importance. Non-melancholic major depression is best treated with a combination of antidepressants and psychosocial therapies, the latter being particularly indicated when the depression has been precipitated by stressful and depressing events or situations. Psychosocial and environmental interventions are important in all types of depression and may prove more effective than the use of antidepressants for milder disorders.

There has been a welcome increase in the recognition of depression in nursing homes and in the prescription of newer antidepressants, but the published evidence to date does not allow definitive recommendations regarding which antidepressants to use in this setting. Outcome research is needed to assess antidepressant efficacy and to better plan multifaceted treatment strategies for depressions of varying types and aetiologies among nursing home residents.

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Acknowledgements

No specific funding was provided for the preparation of this review. The authors have no conflicts of interest directly relevant to the content of this review.

Dr Llewellyn-Jones has been a sponsored speaker for Roche Pharmaceuticals and GlaxoSmithKline. He has received financial support from Eli Lilly to attend educational meetings, and educational and clinical research grants from Roche Pharmaceuticals.

Professor Snowdon is on the Dementia Drug Advisory Board for Janssen-Cilag, Australia. He has been a sponsored speaker and/or investigator for Janssen-Cilag, Eli Lilly, GlaxoSmithKline, AstraZeneca, Organon and Pfizer, and has received financial support from Novartis, Roche and Lundbeck to attend educational meetings.

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  1. Northern Sydney Central Coast Area Health Service, PO Box 361, Gosford, New South Wales, 2250, Australia

    Robert H. Llewellyn-Jones

  2. Discipline of Psychological Medicine, University of Sydney, Sydney, New South Wales, Australia

    John Snowdon

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Llewellyn-Jones, R.H., Snowdon, J. Depression in Nursing Homes. CNS Drugs 21, 627–640 (2007). https://doi.org/10.2165/00023210-200721080-00002

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