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Psychotherapy for older adults with depression: a narrative review

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Abstract

The purpose of this narrative review was to examine the efficacy and effectiveness of psychotherapy for older adults with depressive disorders or clinically significant depressive symptoms; describe extensions of psychotherapy across populations, settings, providers, and modalities; review mechanisms and predictors of treatment response; and consider future directions. Numerous systematic reviews and meta-analyses demonstrate that psychotherapy benefits many depressed older adults, with the strongest evidence for a variety of cognitive-behavioral therapy (CBT) approaches, including problem-solving therapy (PST) and behavioral activation (BA), and consistent evidence for interpersonal, reminiscence, and life review therapies as well. Great advances have been made extending these interventions, particularly CBT-based interventions, such as adaptations for older adults with psychiatric, physical, or cognitive comorbidities; in primary care, aging services, and residential settings; and low-intensity, often technology-based interventions. Several neurobiological, psychological, behavioral, social, and treatment-related mechanisms and predictors of psychotherapy response have been identified, which may explain heterogeneity of treatment effects and may lead towards more personalized, tailored interventions to achieve better outcomes for more older adults. More research is needed in all areas, including expanding from traditional psychotherapy models to novel technology-based, neuroscience-informed interventions, and implementation research to continue expanding the reach, feasibility, and acceptability of evidence-based psychotherapy.

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Funding

Neither author received funding to produce this manuscript. During the time in which this manuscript was written, both authors were funded through an NIMH multi-site study of lay-led behavioral activation for depressed older adults (MH124956 and MH124956-S1, PI: Gum; R01MH124975 and R01MH124975-S1; PI: Raue; R01 MH 124966 and R01 MH 124966-S1, PI: Sirey). The first author was also funded through PCORI to conduct a study of the Care Transitions Intervention and peer support for older adults discharged after hospitalization (AD-2019C1-16066, PIs: Conner/Gum).

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  1. Department of Behavioral Health Science & Practice, University of South Florida, Tampa, FL, USA

    Amber M. Gum & Nicole O. Crawford

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AMG and NOC made substantial contributions to all aspects of the manuscript: planning and outlining the contents, acquiring references used, and drafting and revising the manuscript. AMG and NOC approved the final version to be submitted for review, and both authors agree to be accountable for all aspects of the work to ensure that questions related to the work are appropriately resolved.

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AMG and NOC are licensed mental health providers who receive part of their funding through the delivery of psychotherapy and behavioral interventions to adults and older adults.

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Gum, A.M., Crawford, N.O. Psychotherapy for older adults with depression: a narrative review. Neuropsychopharmacol. (2026). https://doi.org/10.1038/s41386-026-02327-z

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