A summary of research on depression in older adults has uncovered a need for health professionals to take a more active role in its prevention.
In his review of the risk factors associated with depression in this age group, Osvaldo Almeida from the West Australian Centre for Health and Ageing suggests mental health professionals work collaboratively to develop preventative interventions that can be incorporated easily into clinical practice.
"Doctors are aware of their role in treating and preventing many diseases such as cardiovascular diseases and cancer," says Professor Almeida.
"They are trained to identify and treat depression, yet few know that they have an important role in its prevention."
Prof Almeida reviewed current observational and trial data on the prevention of depression. He studied associated risk factors and has suggested strategies for primary, secondary and tertiary preventions.
"People vary genetically in their ability to cope with physiological stress, and this interaction between vulnerability and exposure to harmful factors throughout life determines the development of depression in later years," he says.
"Understanding these factors and how they interact with each other opens several possibilities for the introduction of preventive strategies."
Risk factors include limited access to education, adoption of hazardous lifestyle practices, poor social support, financial strain, lack of a confidence, chronic medical problems and significant life events. Some factors can also be quite remote, such as childhood abuse.
Data suggests that they do not occur in isolation—instead a chain of events, together, may lead to depression.
Prof Almeida suggests the management strategy of each individual will vary according the risk factors present.
"Antidepressants reduce the risk of relapse among people who have had recent depressive episodes," says Professor Almeida.
"However, there is no evidence to support the preventive use of antidepressants or various types of psychotherapy outside this context."
Observational data indicates that physical activity, normal weight, non-hazardous alcohol use, smoking abstinence and healthy diet are associated with decreased risk of depression.
Prof Almeida says decreasing the incidence of depression in people as they get older is certainly an achievable outcome.
"Many people seem ready to accept depressive symptoms as part of the ageing process—that is certainly not the case."
Prof Almeida recently completed a trial investigating the role of vitamin B12 and folate on depression and will continue research in the area with a trial that tests a new model to prevent depression in people at high risk.
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