A Cochrane review [Abstract] 1 included 12 studies. Nine trials of cognitive behavioural and psychodynamic therapy approaches, together with a small group of 'active control' interventions, were included in the meta-analysis. No trials relating to other psychotherapeutic approaches and techniques were found. A total of seven trials provided data for inclusion in the comparison between CBT and controls. No trials compared psychodynamic psychotherapy with controls. Trials describing patients as elderly, geriatric, senile or older adults were included, all patients in the trials were aged 55 or over. The severity of depression was minor to major. All trials required a score above a cut-off on a variety of scales used in depression measurement like Beck Depression Inventory (BDI), Geriatric Depression Scale (GDS) or the Hamilton Depression Rating Scale (HDRS). All trials excluded patients with cognitive impairment. Other exclusion criteria included psychosis, bipolar disorder and alcoholism and substance abuse.
Based on five trials (153 participants), cognitive behavioural therapy was more effective than waiting list controls (WMD -9.85, 95% CI -11.97 to -7.73). Only three small trials compared psychodynamic therapy with CBT, with no significant difference in treatment effect. Based on three trials with usable data, CBT was superior to active control interventions when using the Hamilton Depression Rating Scale (WMD -5.69, 95% CI -11.04 to -0.35), but equivalent when using the Geriatric Depression Scale (WMD -2.00, 95% CI -5.31 to 1.32). There was very sparse data on secondary outcomes like treatment acceptability or quality of life.
Comment: The quality of evidence is downgraded by imprecise results (few patients and wide confidence intervals).
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