Effectiveness of pharmacological and non-pharmacological interventions for treatment-resistant depression in older patients: a systematic review and meta-analysis Article Swipe
A Larsen
,
Giulia Teobaldi
,
Rosario Isabel Espinoza Jeraldo
,
Lukas Roell
,
Claudia Cooper
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1136/bmjment-2024-301324
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1136/bmjment-2024-301324
Background Depression in older adults is often undertreated. A 2011 systematic review of treatments for treatment-resistant depression (TRD) in older adults identified one placebo-controlled randomised controlled trial (RCT). We aimed to update this review, synthesising evidence for the effectiveness of treatments for TRD in older people. Methods We systematically searched electronic databases (PubMed, Cochrane, Web of Science) from 9 January 2011 through 10 December 2023 (updating our search on 7 January 2024 for RCTs investigating TRD therapies in adults aged ≥55 years, defining treatment resistance as ≥1 unsuccessful treatment. We assessed bias with the Cochrane Risk of Bias (RoB) 2 tool, meta-analysed remission rates and evaluated evidence using GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria. Results 14 studies (11 newly identified, 3 from previous review) involving 1196 participants (mean age 65.0, male/female 548/648) met the inclusion criteria; 10 were placebo controlled and 4 were rated as low RoB. The pooled proportion of participants in intervention arms remitting was 0.35 (17 arms; 95% CI=0.26; 0.45). Relative to placebo, intervention participants were more likely to remit (9 studies; OR 2.42 (95% CI=1.49; 3.92)). Relative to controls, remission rates favoured ketamine (n=3; OR 2.91 (1.11; 7.65)), with a trend towards transcranial magnetic stimulation (TMS) (n=3; 1.99 (0.71; 5.61)), and in single placebo-controlled studies, selegiline, aripiprazole augmentation, pharmacogenetic-guided prescribing (PGP) and cognitive remediation favoured interventions. Conclusions We identified weak evidence that ketamine therapy and aripiprazole augmentation, and very weak evidence that TMS, PGP and cognitive remediation increased remission. Lack of evidence regarding routinely prescribed antidepressants and psychosocial treatments is problematic, requiring clinicians to extend evidence from younger populations. PROSPERO registration number CRD42023494513.
Related Topics
Concepts
Medicine
Meta-analysis
Placebo
Treatment-resistant depression
Randomized controlled trial
Internal medicine
Systematic review
Depression (economics)
Psychological intervention
Psychiatry
Physical therapy
MEDLINE
Major depressive disorder
Mood
Alternative medicine
Economics
Law
Pathology
Political science
Macroeconomics
Metadata
- Type
- review
- Language
- en
- Landing Page
- https://doi.org/10.1136/bmjment-2024-301324
- https://mentalhealth.bmj.com/content/28/1/e301324.full.pdf
- OA Status
- diamond
- Cited By
- 1
- References
- 38
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4408098176
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W4408098176Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1136/bmjment-2024-301324Digital Object Identifier
- Title
-
Effectiveness of pharmacological and non-pharmacological interventions for treatment-resistant depression in older patients: a systematic review and meta-analysisWork title
- Type
-
reviewOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2025Year of publication
- Publication date
-
2025-03-01Full publication date if available
- Authors
-
A Larsen, Giulia Teobaldi, Rosario Isabel Espinoza Jeraldo, Lukas Roell, Claudia CooperList of authors in order
- Landing page
-
https://doi.org/10.1136/bmjment-2024-301324Publisher landing page
- PDF URL
-
https://mentalhealth.bmj.com/content/28/1/e301324.full.pdfDirect link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
diamondOpen access status per OpenAlex
- OA URL
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https://mentalhealth.bmj.com/content/28/1/e301324.full.pdfDirect OA link when available
- Concepts
-
Medicine, Meta-analysis, Placebo, Treatment-resistant depression, Randomized controlled trial, Internal medicine, Systematic review, Depression (economics), Psychological intervention, Psychiatry, Physical therapy, MEDLINE, Major depressive disorder, Mood, Alternative medicine, Economics, Law, Pathology, Political science, MacroeconomicsTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
1Total citation count in OpenAlex
- Citations by year (recent)
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2025: 1Per-year citation counts (last 5 years)
- References (count)
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38Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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| citation_normalized_percentile.value | 0.8342767 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | True |