Pozuelo Moyano, Beatriz;
Gomez-Bautista, Denise;
Porras Ibarra, Karla Jocelyn;
Mueller, Christoph;
von Gunten, Armin;
Pierre, Vandel;
Ranjbar, Setareh;
... Orgeta, Vasiliki; + view all
(2025)
Systematic review of clinical effectiveness of interventions for treatment resistant late-life depression.
Ageing Research Reviews
, 107
, Article 102710. 10.1016/j.arr.2025.102710.
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Abstract
BACKGROUND: Treatment-resistant late-life depression (TRLLD) affects nearly half of older adults with major depression. This systematic review evaluates published evidence of effectiveness of both pharmacological and non-pharmacological treatments for TRLLD. METHODS: A search of MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Library, and online trial registries up to March 2024 was conducted to identify randomized controlled trials (RCTs) evaluating pharmacological and non-pharmacological interventions for TRLLD. RESULTS: Seven studies assessed the effectiveness of pharmacological interventions (antidepressants, antipsychotics, mood stabilizers, or ketamine) and another seven examined non-pharmacological approaches (psychotherapy, electroconvulsive therapy, repetitive transcranial magnetic stimulation (rTMS), and computerized cognitive remediation). Aripiprazole (2 studies), venlafaxine (1 study), ketamine (1 study), and lithium (1 study) were associated with a reduction in depressive symptoms post-treatment compared to the comparator treatment group. rTMS (2 studies), sequential bilateral theta burst stimulation (1 study) and cognitive remediation (1 study) also showed significant improvements in depressive symptoms post-treatment compared to a comparator treatment group. Quality of evidence varied from very low to medium among the included studies. Most studies reported data on small sample sizes. CONCLUSIONS AND IMPLICATIONS: We identified a small number of RCTs evaluating treatments for TRLLD. Aripiprazole augmentation appears to be an effective treatment based on two studies, with an acceptable side effect profile. Other treatments may be effective, but the evidence is based on very low-quality evidence. Future large-scale RCTs are urgently needed to draw firm conclusions.
| Type: | Article |
|---|---|
| Title: | Systematic review of clinical effectiveness of interventions for treatment resistant late-life depression |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.arr.2025.102710 |
| Publisher version: | https://doi.org/10.1016/j.arr.2025.102710 |
| Language: | English |
| Additional information: | © 2025 Published by Elsevier B.V. under a Creative Commons license (http://creativecommons.org/licenses/by/4.0/). |
| Keywords: | Late life depression, Resistant depression, Treatment, Older people., Randomized controlled trials |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry > Mental Health of Older People |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10205225 |
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