A sad elderly person sitting on a couch.

Finding the Right Mix for Older Adults With Depression

The number of older adults with treatment-resistant depression has risen during the pandemic. How do we ensure they don't get left behind?


Depression is one of the most common mental health issues in our country, and older Canadians face particular risks. Unfortunately, the COVID-19 pandemic has only made this worse, with 1 in 8 older Canadians now coping with depression for the first time.

Thanks to a new study from the Centre for Addiction and Mental Health (CAMH) and the University of Toronto, however, there’s hope for older Canadians facing depression. By assessing medication options for treatment-resistant depression in older adults, the researchers found a combination of medicines that may be just what the doctor ordered.

The study included contributions from Daniel Blumberger, Clinician Scientist at CAMH and Director of the Temerty Centre for Therapeutic Brain Intervention, and was published in The New England Journal of Medicine.

Older adults are at risk for depression

Today, depression is the most common mental health issue faced by older adults in Canada. To make matters worse, up to 1 in 3 Canadians with depression are considered treatment-resistant, meaning at least two courses of treatment have been unable to alleviate their symptoms.

To address this issue, the researchers behind these new results carried out a study of 742 adults over the age of 60 who were suffering from treatment-resistant depression. Their goal was to assess the efficacy of different medications, and determine whether combinations of different medications might be able to help.

Study participants were assigned to one of five groups, and then monitored over the course of 10 weeks. Three of the groups had new medications added to their existing medication regime — either an antipsychotic (aripiprazole), another antidepressant (bupropion), or lithium — while the other two groups tapered off their current antidepressants and switched to either bupropion or nortriptyline (another antidepressant that is also used to treat nerve pain).

New treatment options may help

In encouraging news, all of the study participants showed improvements in their mental health over course of the 10-week study. Yet the participants who were given the antipsychotic drug aripiprazole in addition to their current antidepressants showed the greatest improvements in their depression, with 30% of participants going into remission.

While 20% of participants in the bupropion group also went into remission, the researchers found that this drug could have potentially dangerous side effects for older adults, including increasing their risk of injury due to falls. These results will help mental health practitioners decide the safest course of action for treatment-resistant depression in this vulnerable population.

“By establishing the likelihood that different treatment options will be effective, and the risks attached to each treatment, we can ensure that we are choosing the best option to help patients with treatment-resistant depression,” Blumberger said in a press release.

“We may not know for certain which treatments will work, but we know which ones are most likely to. In this way, we can quantify that we are making the best choices for our patients.”

The researchers are hopeful that their results will help alleviate depression in older adults — a population which is often understudied when it comes to mental health.

There are ways that we can help the older adults in our lives too. For example, recent research has shown that green spaces and virtual arts workshops can reduce symptoms of depression and other mental health issues in this population. By helping older adults access these resources — in combination with improved medicinal options — we can create a brighter future for older adults dealing with depression.

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Emily Deibert is a PhD student in the Department of Astronomy & Astrophysics at the University of Toronto with a passion for science outreach and communication. She earned her HBSc (Astronomy, English, and Mathematics) at the University of Toronto. She is excited about turning scientific research into stories and sharing these stories with the public.