Pharmacotherapy, Somatic Therapies, and Psychotherapy in Late Life

  • Ana Hategan
  • James A. Bourgeois
  • Tracy Cheng
  • Julie Young


Management of psychiatric conditions not only requires thorough assessment and evaluation but also involves the development of a comprehensive treatment plan. In treating an older adult, there are often special considerations that need to be taken into account given the effects of aging. An older adult may not respond the same way we would expect for a younger adult because of direct effects of aging or because of other comorbid medical conditions. The following section provides an overview of some of the considerations to take into account when developing a treatment plan—whether that involves pharmacological interventions, somatic therapies, or psychotherapies.


Pharmacotherapy Pharmacological intervention Polypharmacy Somatic therapy Neurostimulation ECT Psychotherapy Cognitive behavioral therapy Problem-solving therapy 


  1. 1.
    Maher RL, Hanlon JT, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57. Scholar
  2. 2.
    Lim LM, McStea M, Chung WW, Azmi NN, Aziz SAA, Alwi S, et al. Prevalence, risk factors and health outcomes associated with polypharmacy among urban community-dwelling older adults in multi-ethnic Malaysia. PLoS One. 2017;12(3):e0173466. Scholar
  3. 3.
    Al-Hashar A, Al Sinawi H, Al Mahrizi A, Al-Hatrushi M. Prevalence and covariates of polypharmacy in elderly patients on discharge from a tertiary care hospital in Oman. Oman Med J. 2016;31(6):421–5.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Slabaugh SL, Maio V, Templin M, Abouzaid S. Prevalence and risk of polypharmacy among the elderly in an outpatient setting: a retrospective cohort study in the Emilia-Romagna region, Italy. Drugs Aging. 2010;27(12):1019–28.CrossRefPubMedGoogle Scholar
  5. 5.
    Vestal RE. Aging and pharmacology. Cancer. 1997;80(7):1302–10.CrossRefPubMedGoogle Scholar
  6. 6.
    Klotz U. Pharmacokinetics and drug metabolism in the elderly. Drug Metab Rev. 2009;41(2):67–76.CrossRefPubMedGoogle Scholar
  7. 7.
    Bowie MW, Slattum PW. Pharmacodynamics in older adults: a review. Am J Geriatr Pharmacother. 2007;5(3):263–303.CrossRefPubMedGoogle Scholar
  8. 8.
    Turnheim K. When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly. Exp Gerontol. 2003;38:843–53.CrossRefPubMedGoogle Scholar
  9. 9.
    American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–46.CrossRefGoogle Scholar
  10. 10.
    Lenze EJ, Rogers JC, Martire LM, Mulsant BH, Rollman BL, Dew MM, et al. The association of late-life depression and anxiety with physical disability: a review of the literature and prospectus for future research. Am J Geriatr Psychiatry. 2001;9(2):113–35.CrossRefPubMedGoogle Scholar
  11. 11.
    Gebara MA, Lipsey KL, Karp JF, Nash MC, Iaboni A, Lenze EJ. Cause of effect? Selective serotonin reuptake inhibitors and falls in older adults: a systematic review. Am J Geriatr Psychiatry. 2015;23(10):1016–28.CrossRefPubMedGoogle Scholar
  12. 12.
    Gitlin M. Lithium side effects and toxicity: prevalence and management strategies. Int J Bipolar Disord. 2016;4:27.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Azab AN, Shnaider A, Osher Y, Wang D, Bersudsky Y, Belmaker RH. Lithium nephrotoxicity. Int J Bipolar Disord. 2015;3:13.CrossRefPubMedCentralGoogle Scholar
  14. 14.
    McKnight RF, Adida M, Budge K, Stockton S, Goodwin GM, Geddes JR. Lithium toxicity profile: a systematic review and meta-analysis. Lancet. 2012;379(9817):721–8.CrossRefPubMedGoogle Scholar
  15. 15.
    De Fazio P, Gaetano R, Caroleo M, Pavia M, De Sarro G, Fagiolini A, et al. Lithium in late-life mania: a systematic review. Neuropsychiatr Dis Treat. 2017;13:755–66.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Stübner S, Rustenbeck E, Grohmann R, Wagner G, Engel R, Neundörfer G, et al. Severe and uncommon involuntary movement disorders due to psychotropic drugs. Pharmacopsychiatry. 2004;37(Suppl 1):S54–64.PubMedGoogle Scholar
  17. 17.
    Berman BD. Neuroleptic malignant syndrome: a review for neurohospitalists. Neurohospitalist. 2011;1(1):41–7.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.CrossRefGoogle Scholar
  19. 19.
    Frank C. Recognition and treatment of serotonin syndrome. Can Fam Physician. 2008;54(7):988–92.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Atreja A, Bellam N, Levy SR. Strategies to enhance patient adherence: making it simple. MedGenMed. 2005;7(1):4.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Jung HH, Kim CH, Chang JH, Park YG, Chung SS, Chang JW. Bilateral anterior cingulotomy for refractory obsessive-compulsive disorder: long-term follow-up results. Stereotact Funct Neurosurg. 2006;84:184–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Pagnin D, de Queiroz V, Pini S, Cassano GB. Efficacy of ECT in depression: a meta-analytic review. J ECT. 2004;20(1):13–20.CrossRefPubMedGoogle Scholar
  23. 23.
    Gitlin M. Treatment-resistant bipolar disorder. Mol Psychiatry. 2006;11(3):227–40.CrossRefPubMedGoogle Scholar
  24. 24.
    Milev RV, Giacobbe P, Kennedy SH, Blumberger DM, Daskalakis ZJ, Downar J, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 4. Neurostimulation treatments. Can J Psychiatr. 2016;61(9):561–75.CrossRefGoogle Scholar
  25. 25.
    Blumberger DM, Hsu JH, Daskalakis ZJ. A review of brain stimulation treatments for late-late depression. Curr Treat Options Psychiatry. 2015;2(4):413–21.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Pompili M, Lester D, Dominici G, Longo L, Marconi G, Forte A, et al. Indications for electroconvulsive treatment in schizophrenia: a systematic review. Schizophr Res. 2103;146(1–3):1–9.Google Scholar
  27. 27.
    Luchini F, Lattanzi L, Bartolommei N, Cosentino L, Litta A, Kansky C, et al. Catatonia and neuroleptic malignant syndrome: two disorders on a same spectrum? Four case reports. J Nerv Ment Dis. 2013;201(1):36–42.CrossRefPubMedGoogle Scholar
  28. 28.
    Fegni F, Simon DK, Wu A, Pascual-Leone A. Non-invasive brain stimulation for Parkinson’s disease: a systematic review and meta-analysis of the literature. J Neurol Neurosurg Psychiatry. 2005;76:1614–23.CrossRefGoogle Scholar
  29. 29.
    Borisovskaya A, Bryson WC, Buchholz J, Samii A, Borson S. Electroconvulsive therapy for depression in Parkinson’s disease: systematic review of evidence and recommendations. Neurodegener Dis Manag. 2016;6(2):161–76.CrossRefPubMedGoogle Scholar
  30. 30.
    Hausner L, Damian M, Sartorius A, Frölich L. Efficacy and cognitive side effects of electroconvulsive therapy (ECT) in depressed elderly inpatients with coexisting mild cognitive impairment or dementia. J Clin Psychiatry. 2011;72(1):91–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Currier MD, Murray GB, Welch CC. Electroconvulsive therapy for post-stroke depressed geriatric patients. J Neuropsychaitry Clin Neurosci. 1992;4(2):140–4.CrossRefGoogle Scholar
  32. 32.
    Abbott CC, Gallegos P, Rediske N. A review of longitudinal electroconvulsive therapy. J Geriatr Psychiatry Neurol. 2014;27(1):33–46.CrossRefPubMedGoogle Scholar
  33. 33.
    Nordanskog P, Dahlstrand U, Larsson MR, Larsson EM, Knutsson L, Johanson A. Increase in hippocampal volume after electroconvulsive therapy in patients with depression: a volumetric magnetic resonance imaging study. J ECT. 2010;26(1):62–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Anderson IM, Fergusson GM. Mechanism of action of ECT. In: Waite J, Easton A, editors. The ECT handbook. 3rd ed. London: RCPsych Publications; 2013. p. 1–7.Google Scholar
  35. 35.
    Mishra BR, Sarkar S, Praharaj SK, Mehta VS, Diwedi S, Nizamie SH. Repetitive transcranial magnetic stimulation in psychiatry. Ann Indian Acad Neurol. 2011;14(4):245–51.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Gálvez V, Ho K, Alonzo A, Martin D, George D, Loo CK. Neuromodulation therapies for geriatric depression. Curr Psychiatry Rep. 2015;17(7):59.CrossRefPubMedGoogle Scholar
  37. 37.
    Agarkar S, Mahgoub N, Young RC. Use of transcranial repetitive stimulation in bipolar disorder. J Neuropsychiatry Clin Neurosci. 2011;23(2):E12–3.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Jelovac A, Kolshus E, McLoughlin DM. Relapse following successful electroconvulsive therapy for major depression: a meta-analysis. Neuropsychopharmacology. 2013;38(12):2467–74.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Burn DJ, Tröster AI. Neuropsychiatric complications of medical and surgical therapies for Parkinson’s disease. J Geriatr Psychiatry Neurol. 2004;17(3):172–80.CrossRefPubMedGoogle Scholar
  40. 40.
    Groiss SJ, Wojtecki L, Südmeyer M, Schnitzler A. Deep brain stimulation in Parkinson’s disease. Ther Adv Neurol Disord. 2009;2(6):20–8.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Chand SP, Grossberg GT. How to adapt cognitive-behavioral therapy for older adults. Curr Psychiatr Ther. 2013;12(3):10–4.Google Scholar
  42. 42.
    Miller MD, Cornes C, Frank E, Ehrenpreis L, Silberman R, Schlemitzauer MA. Interpersonal psychotherapy for late-life depression: past, present and future. J Psychother Pract Res. 2001;10(4):231–8.PubMedPubMedCentralGoogle Scholar
  43. 43.
    Canadian Coalition for Seniors Mental Health. National guidelines for senior’s mental health—the assessment and treatment of depression. [internet] May 2006. Accessed 9 Nov 2017.
  44. 44.
    Kuerbis A, Sacco P, Blazer DG, Moore AA. Substance abuse among older adults. Clin Geriatr Med. 2015;30(3):629–54.CrossRefGoogle Scholar
  45. 45.
    Cummings SM, Cooper RL, Cassie KM. Motivational interviewing to affect behavioral change in older adults. Res Soc Work Pract. 2009;19(2):195–204.CrossRefGoogle Scholar
  46. 46.
    Malouff JM, Thorsteinsson ED, Schutte NS. The efficacy of problem solving therapy in reducing mental and physical health problems: a meta-analysis. Clin Psychol Rev. 2007;27(1):46–57.CrossRefPubMedGoogle Scholar
  47. 47.
    McCambridge J, Saitz R. Rethinking brief interventions for alcohol in general practice. BMJ. 2017;356:j116.CrossRefPubMedGoogle Scholar
  48. 48.
    Bertholet N, Daeppen JB, Wietlisbach V, Fleming M, Burnand B. Reduction of alcohol consumption by brief alcohol intervention in primary care: systematic review and meta-analysis. Arch Intern Med. 2006;165(9):986–95.CrossRefGoogle Scholar
  49. 49.
    Gordon AJ, Conigliaro J, Maistro SA, McNeil M, Kraemer KL, Kelley ME. Comparison of consumption effects of brief interventions for hazardous drinking elderly. Subst Use Misuse. 2003;38(8):1017–35.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Ana Hategan
    • 1
  • James A. Bourgeois
    • 2
    • 3
  • Tracy Cheng
    • 4
  • Julie Young
    • 5
  1. 1.Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonCanada
  2. 2.Department of PsychiatryBaylor Scott and White Health Central Texas DivisionDallasUSA
  3. 3.Department of PsychiatryTexas A&M University Health Science Center, College of MedicineTempleCanada
  4. 4.St. Joseph’s Healthcare Hamilton, McMaster UniversityHamiltonUSA
  5. 5.Mercy San Juan Medical CenterFarmingtonUSA

Personalised recommendations