Nearly half of older adults with major depression have treatment-resistant late-life depression (TRLLD). A systematic review of randomized controlled trials up to March 2024 found that aripiprazole (based on two studies), venlafaxine, ketamine, and lithium were associated with reduced depressive symptoms after treatment. Among non-pharmacological approaches, repetitive transcranial magnetic stimulation, sequential bilateral theta burst stimulation, and cognitive remediation also showed significant improvements. However, the quality of evidence ranged from very low to medium, and most studies had small sample sizes. Aripiprazole augmentation appears effective with an acceptable side effect profile, but other treatments lack strong evidence. Large-scale trials are needed for firm conclusions.
Third-wave psychotherapies, particularly mindfulness-based interventions, show promise for reducing psychological distress and improving well-being and quality of life in people with Parkinson's disease, but evidence is limited. A systematic review of ten randomized controlled trials found that nine tested mindfulness-based approaches and one tested acceptance and commitment therapy. Methodological quality was moderate to high, but sample sizes were small, and only one trial was adequately powered. The largest trial reported significant benefits of Mindfulness Yoga for depression, anxiety, psychological well-being, and quality of life. Other findings were mixed. Pilot and feasibility studies indicated mindfulness interventions were well received. No conclusions could be drawn about non-mindfulness therapies due to insufficient data. Larger trials are needed to confirm clinical meaningfulness.