Updated Canadian Guidelines on the Prevention, Assessment and Treatment of Depression among Older Adults

Depression is one of the leading causes of disease burden especially in middle and higher income countries and is a major contributor to healthcare costs. Depression among older adults is associated with significant suffering and disability, increased mortality and worse outcomes from physical illness. It is also important to note that proportionally more people over the age of 65 die from suicide than any other age group, especially among older men. The COVID-19 pandemic has affected the mental health of all age groups especially older adults where there has been a significant negative impact on the levels of isolation, loneliness and lack of support. 

The Canadian Coalition for Seniors Mental Health (CCSMH) published “Guidelines on the assessment and treatment of depression among older adults” in 2006 (CCSMH, 2006; Buchanan et al, 2006). CCSMH has now updated these Guidelines (CCSMH, 2021). The new guidelines update a number of recommendations to align with current evidence. They also now include a number of recommendations focused on preventing depression. 

Some highlights of the updated guidelines include:

• Evidence that a variety of interventions can reduce the incidence of depressive disorders, especially in those with sub-threshold depressive symptoms. These include group-based interventions such as reminiscence therapy; social prescribing; a stepped care approach; increasing levels of physical activity and the instillation of hope.
• Promising evidence for a variety of exercise and mind-body interventions such as tai chi, yoga, and mindfulness-based stress reduction in reducing depressive symptoms either alone or in combination with other therapies.
• Recommendations regarding first line antidepressant medication for an acute episode of major depression have been updated. Sertraline or duloxetine are considered optimal choices, with alternatives including citalopram and escitalopram.
• A call for advocacy for the availability of psychotherapies and psychosocial interventions for older adults with depression across all regions of Canada.
• Repetitive transcranial magnetic stimulation (rTMS) has been added as a recommended treatment for unipolar depression in individuals who have failed to respond to at least one adequate trial of an antidepressant.
• Recommendations for special populations such as individuals with depression associated with dementia, Parkinson's disease or stroke have been updated.
• Recommendations regarding optimal models of care, including collaborative interprofessional models, have been updated with additional emphasis on access to virtual clinical services through “senior friendly” technologies

CCSMH has also developed a brochure titled: Depression in Older Adults: You Are Not Alone, which has been translated in English, French, Punjabi, Traditional Chinese and Simplified Chinese. Depression – Canadian Coalition for Seniors' Mental Health (ccsmh.ca)

Refs: Buchanan, D., Tourigny-Rivard, M-F., Cappeliez, P. et al. (2006) National Guidelines for Seniors’ Mental Health: The Assessment and Treatment of Depression. Canadian Journal of Geriatrics 9: S52-58. Canadian Coalition for Seniors Mental Health (CCSMH). National Guidelines for Seniors’ Mental Health: The Assessment and Treatment of Depression. 2006 Canadian Coalition for Seniors Mental Health (CCSMH). Canadian Guidelines on the Prevention, Assessment and Treatment of Depression among Older Adults. 2021

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