Treatment of Depression

2017 ◽  
Author(s):  
Martin Steinberg
Keyword(s):  
Suicide Attempts ◽  
Antidepressant Treatment ◽  
Severe Depression ◽  
Poor Response ◽  
Psychosocial Interventions ◽  
The Elderly ◽  
Psychotic Symptoms ◽  
Pharmacological Interventions ◽  
Multiple Risk Factors ◽  
Treatment Of Depression

Most depression in the elderly can be effectively treated in the primary care setting. Psychiatric referral should be considered in the setting of severe depression, suicidal ideation, prior suicide attempts, multiple risk factors, psychotic symptoms, bipolar disorder, poor response to prior treatment, or high medical comorbidity. Combining pharmacological and psychosocial interventions is most likely to be effective. Available antidepressants include serotonin-specific reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, novel mechanism agents, tricyclic antidepressants, and monoamine oxidase inhibitors. Antidepressant selection should take into account adverse effects, medical comorbidities, potential medication interactions, and patient preferences. Additional strategies (e.g. augmentation) are available for treatment resistant depression. Available psychotherapies include supportive, cognitive-behavioral, interpersonal, and problem solving. Lifestyle interventions (e.g. exercise) may be helpful adjuncts. Given limited evidence for antidepressant treatment in cognitive impairment, for those with mild to moderate depression severity, non-pharmacological interventions should be attempted first.

Recent Developments in Geriatric Psychopharmacotherapy

1994 ◽  
Vol 39 (8_suppl) ◽  
pp. 9-18 ◽  
Author(s):  
Alastair J. Flint
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Antidepressant Treatment ◽  
Bipolar Affective Disorder ◽  
Unipolar Depression ◽  
The Elderly ◽  
Blood Levels ◽  
Pharmacological Management ◽  
Treatment Of Depression ◽  
Recent Developments ◽  
Psychiatric Complications

This paper highlights recent advances in the pharmacological management of geriatric affective disorders and dementia. The current roles of tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) in the treatment of depression in old age are discussed. Recent findings pertaining to continuation and maintenance of antidepressant treatment are also addressed. The treatment of bipolar affective disorder in the elderly has received much less study than has unipolar depression. A number of issues relating to efficacy, side-effects and optimal blood levels of lithium, carbamazepine and valproate in bipolar disorder remain unresolved and await further study. Finally, drug treatment of the cognitive impairment and psychiatric complications of Alzheimer's disease is reviewed.

Diagnosis and Treatment of Depression in the Elderly

1989 ◽  
Vol 18 (3) ◽  
pp. 211-221 ◽  
Author(s):  
Kye Y. Kim ◽  
Linda A. Hershey
Keyword(s):  
Depressive Disorders ◽  
Severe Depression ◽  
The Elderly ◽  
Diagnostic Dilemma ◽  
Memory Problems ◽  
Alzheimer Type Dementia ◽  
Dementia Patients ◽  
Treatment Of Depression ◽  
Prevalence Of Depression ◽  
Early Dementia

Depression and suicide are significant problems in the elderly, both in terms of their severity and their prevalence. It is particularly difficult to distinguish depression from early dementia, since elderly depressed patients often deny mood disorder and focus on their memory problems. This differential diagnostic dilemma is further complicated by the fact that 20 percent of Alzheimer-type dementia patients have moderate to severe depression. An even higher prevalence of depression can be seen in elderly patients with stroke or Parkinson's disease. Most all of the depressive disorders of the elderly are amenable to one form or combination of therapies: pharmacologic, electro-convulsive, or psychotherapy. Tricyclic antidepressants are often associated with adverse drug reactions in the elderly, so alternatives such as MAO inhibitors, alprazolam, bupropion and psychostimulants are currently being explored in this patient population.

Geriatric Depression

2001 ◽  
Vol 14 (6) ◽  
pp. 498-510 ◽  
Author(s):  
Stephen C. Cooke ◽  
Melissa L. Tucker
Keyword(s):  
Rating Scales ◽  
Suicide Attempts ◽  
Antidepressant Treatment ◽  
Treatment Options ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Signs And Symptoms ◽  
The Elderly ◽  
Geriatric Depression ◽  
Diagnostic And Statistical Manual

Depression in the elderly is more common than once thought, especially in nursing home settings, where as many as 25% of residents can exhibit signs and symptoms of depression. Depression in the elderly can have a significant impact on overall health and desired outcome. The depressed elderly patient has been shown to have worsened prognosis of concomitant medical conditions, increased use of health care, decreased recovery time, and more likelihood to experience accelerated physical deterioration. Suicide represents the most serious complication of depression of the older depressed individual. The elderly are at a disproportionate risk for suicide attempts and are more likely to be successful. Diagnosis should be made using Diagnostic and Statistical Manual of Mental Disorders(4th ed.) (DSMIV) criteria, and clinicians should use standardized rating scales such as the Geriatric Depression Scale to assist in monitoring the severity of depressive symptoms and the efficacy of antidepressant treatment. Several treatment options are available to the clinician and include psychotherapy, electroconvulsive therapy, older antidepressants such as the tricyclics, and newer more tolerable therapies such as the serotonin reuptake inhibitors. Drug therapy should be individualized and should take into account the pharmacokinetic and pharmacodynamic changes that are associated with normal aging.

Antipsychotic Prescribing Practices Amongst the Elderly of St. James's Hospital (SJH), Dublin

2017 ◽  
Vol 41 (S1) ◽  
pp. S663-S663
Author(s):  
C. Power ◽  
B. McCarthy ◽  
B.A. Lawlor ◽  
E. Greene
Keyword(s):  
Best Practice ◽  
The Elderly ◽  
Medical Documentation ◽  
Psychotic Symptoms ◽  
Prescribing Practices ◽  
Next Of Kin ◽  
Pharmacological Interventions ◽  
Antipsychotic Medications ◽  
Number Of Patients ◽  
Antipsychotic Prescribing

IntroductionPsychotic symptoms arise commonly in the context of behavioural and psychological symptoms of dementia (BPSD) in the elderly. While non-pharmacological interventions are preferable to manage such symptoms, antipsychotic medications are frequently used. This is largely unlicensed and associated with significant risks, particularly in dementia (1).ObjectivesTo examine antipsychotic prescribing practices in SJH.MethodsOn 23rd February 2016 all inpatients aged over 65 who were prescribed antipsychotic medications were identified. Demographic and medical data were collected from medical and electronic notes and medication kardexes.ResultsComplete data were available for 53 of 59 identified cases. The cohort had a mean age of 80 (range 65–99) and 62% were male. Seventy-four percent (n = 39) had documented cognitive impairment or dementia. Fifty-eight percent (n = 31) were newly prescribed an antipsychotic following admission. The commonest indications for antipsychotics were: delirium (53%) and BPSD (25%). Haloperidol (56%), quetiapine (19%) and risperidone (8%) were prescribed most frequently. Non-pharmacological interventions were documented in 50% however in many cases it is not clear what these interventions were. Antipsychotic use was discussed with patients and/or next of kin in less than 25% of cases. Adverse effects were noted in 6/36 (17%) with equal incidence of falls, EPSEs and ECG changes.ConclusionPositive and negative aspects of current antipsychotic prescribing practices are highlighted. Antipsychotics were prescribed for a small number of patients for appropriate indications. However, there was poor consideration of non-pharmacological interventions and a lack of consultation with the patient/NOK. This may reflect, in part, inadequate medical documentation. A guideline needs to specifically address these areas of concern to improve safety and promote best practice.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Antidepressants for the treatment of depression in people with schizophrenia: a systematic review

2003 ◽  
Vol 33 (4) ◽  
pp. 589-599 ◽  
Author(s):  
C. WHITEHEAD ◽  
S. MOSS ◽  
A. CARDNO ◽  
G. LEWIS
Keyword(s):  
Rating Scale ◽  
Antidepressant Treatment ◽  
Meta Analysis ◽  
Antidepressant Medication ◽  
Clinical Effectiveness ◽  
Cochrane Library ◽  
Psychotic Symptoms ◽  
Stable Phase ◽  
Treatment Of Depression ◽  
Increased Risk

Background. Depression is common in people with schizophrenia and is associated with substantial morbidity and an increased risk of suicide. Our aim was to review systematically all the randomized controlled trials that have investigated the clinical effectiveness of antidepressant medication in the treatment of depression in people who also suffer with schizophrenia.Method. Electronic searches of ClinPsych, the Cochrane Library, the Cochrane Schizophrenia Group's Register of Trials, EMBASE and Medline were completed. Reference lists from identified articles were hand searched.Results. Eleven small studies were identified and all randomized fewer than 30 subjects to each group. We could only perform analyses on a subset of the trials. For five trials (aggregate N=209) the proportion improved in the antidepressant group was 26% (95% CI 10% to 42%) higher than in the placebo group. In six studies (aggregate N=267) the standardized mean difference on the Hamilton Rating Scale for Depression at the end of the trial was −0·27 (95% CI −0·7 to 0·2). There was no evidence that antidepressant treatment given during the stable phase of illness led to a deterioration of psychotic symptoms in the included trials.Conclusions. The literature reviewed was, overall, of poor quality and only a small number of trials could contribute towards the meta-analysis. The results provide weak evidence for the effectiveness of antidepressants in those with schizophrenia and depression and could be explained by publication bias. We need further research to determine the best approach towards treating depression in people with schizophrenia.

scholarly journals Antidepressant Treatment of Depression in the Elderly: Efficacy and Safety Considerations

2021 ◽  
Vol 05 (04) ◽  
pp. 1-1
Author(s):  
Trevor R Norman ◽  
Keyword(s):  
Elderly Patients ◽  
Antidepressant Treatment ◽  
Clinical Problem ◽  
The Elderly ◽  
Term Treatment ◽  
Considerable Proportion ◽  
Treatment Of Depression ◽  
Long Term Treatment ◽  
Antidepressant Efficacy ◽  
Safety Considerations

Depression in the elderly is a significant clinical problem which is likely to endure as an ongoing issue as the cohort of individuals aged over 65years continues to increase as a proportion of the total population. While there are a multiplicity of approaches to the treatment of depression, the mainstay for moderate to severe cases is pharmacotherapy. The majority of extant antidepressants have demonstrated efficacy, at least in short term (6-12weeks) clinical evaluations. There is demonstrable efficacy over and above that of placebo in the majority of clinical trials for most agents. Within the classes of antidepressants there is no difference between individual agents, while between classes differences have not been demonstrated consistently. Thus, there appears to be little to choose between the various agents. However, considerations other than efficacy play a role in the choice of an antidepressant for an individual patient. A systematic review of the efficacy of antidepressant agents based on trials in elderly populations is presented. Factors influencing the choice of a medication over and above efficacy are presented along with a brief review of adverse events of particular concern in elderly patients. A considerable proportion of elderly patients have comorbid medical conditions, which may also influence the choice of agent due to drug-drug interaction considerations. A brief overview of interactions likely to influence medication selection is also canvassed. While there is every reason to be optimistic about outcomes in elderly patients, there are still unanswered questions about antidepressant efficacy in this population: effectiveness in long-term treatment and in the population of so-called ‘old-old’ elderly are principal among them.

Neuropsychiatric Symptoms and Antipsychotic Therapy in the Elderly Patients with Dementia

Psychiatry ◽  
2020 ◽  
Vol 18 (4) ◽  
pp. 6-15
Author(s):  
I. V. Kolykhalov
Keyword(s):  
Neuropsychiatric Symptoms ◽  
The Elderly ◽  
Psychotic Symptoms ◽  
Mixed Dementia ◽  
Short Term ◽  
Antipsychotic Therapy ◽  
Dementia Patients ◽  
Frequency Of Use ◽  
Number Of Patients ◽  
High Incidence

The objective of the study was to investigate syndromal-nosological specificities of neuropsychiatric symptoms (NPS) and the frequency of use of antipsychotics in patients with various types of dementias, institutionalized to geriatric units of mental hospitals.Patients and methods: a total of 106 in-patients of three psychogeriatric units were examined. The median age of patients is 75 years [69; 80].The diagnostic distribution of patients at the time of the examination was as follows: in 33 subjects (31.1%) Alzheimer’s disease (AD) was diagnosed, in 25 (23.6%) - mixed dementia (MD), in 32 (30.2%) - vascular dementia (VD) and in 16 (15.1%) patients had dementia of complex origin (DCO).Results: a high incidence (54.7%) of NPS was found in patients with dementia of various origins. The greatest number of patients with behavioral and psychotic symptoms was found in AD and MD. The proportion of dementia patients with such disorders in each of these types of dementia is about 70%, while in CGD and VD, the proportion of patients with NPS is noticeably smaller (30% and 40%, respectively). For the treatment of NPS, antipsychotics were most often prescribed, but their use caused adverse events (AEs) in 1/3 of cases. Patients with VD are most susceptible to the development of AE, and AD patients are the least susceptible.Conclusion: the study showed that NPS are one of the important components of dementia, regardless of the nosology and stage of the disease. The treatment of NPS in dementia is particularly challenging because, although the symptoms cause significant distress, there are currently no effective alternative therapies. The risk of AE can be minimized by carefully considering the indications for prescribing antipsychotics and their short-term use, regular monitoring of the patient’s condition, and educating caregivers.

Diagnosis, assessment, and treatment of depression in advanced disease

2018 ◽  
Author(s):  
Matthew Hotopf
Keyword(s):  
Palliative Care ◽  
Advanced Disease ◽  
Antidepressant Treatment ◽  
Population Level ◽  
Care Staff ◽  
Care Services ◽  
Treatment Of Depression ◽  
Assessment And Treatment ◽  
Palliative Care Services ◽  
Key Issues

Depression in palliative care is common, under-recognised and has significant impacts for sufferers. There are effective treatments but often a shortage of staff to provide them. This chapter sets out a number of key issues to consider when assessing and treating individual patients and considers the way in which palliative care services can innovate to provide a population level response to depression. Palliative care staff can be trained to deliver basic depression care and follow simple protocols to initiate, monitor and adjust antidepressant treatment. These approaches have been tested in trials in cancer care but the challenge is to take these approaches from research trials conducted in centres of excellence with good resources, to other settings.

scholarly journals Management Strategies for Antipsychotic-Related Sexual Dysfunction: A Clinical Approach

2021 ◽  
Vol 10 (2) ◽  
pp. 308
Author(s):  
Angel L. Montejo ◽  
Rubén de Alarcón ◽  
Nieves Prieto ◽  
José Mª Acosta ◽  
Bárbara Buch ◽  
...  
Keyword(s):  
Sexual Dysfunction ◽  
Management Strategies ◽  
Drop Out ◽  
Adjunctive Treatment ◽  
Psychotic Symptoms ◽  
Clinical Approach ◽  
Clinical Perspective ◽  
Pharmacological Interventions ◽  
Dopaminergic Agonist ◽  
Low Rate

Antipsychotic medication can be often associated with sexual dysfunction (SD). Given its intimate nature, treatment emergent sexual dysfunction (TESD) remains underestimated in clinical practice. However, psychotic patients consider sexual issues as important as first rank psychotic symptoms, and their disenchantment with TESD can lead to important patient distress and treatment drop-out. In this paper, we detail some management strategies for TESD from a clinical perspective, ranging from prevention (carefully choosing an antipsychotic with a low rate of TESD) to possible pharmacological interventions aimed at improving patients’ tolerability when TESD is present. The suggested recommendations include the following: prescribing either aripiprazole or another dopaminergic agonist as a first option antipsychotic or switching to it whenever possible. Whenever this is not possible, adjunctive treatment with aripiprazole seems to also be beneficial for reducing TESD. Some antipsychotics, like olanzapine, quetiapine, or ziprasidone, have less impact on sexual function than others, so they are an optimal second choice. Finally, a variety of useful strategies (such as the addition of sildenafil) are also described where the previous ones cannot be applied, although they may not yield as optimal results.

scholarly journals Protocol of a Multi-centric Randomized Controlled Trial to Evaluate Efficacy of Telephone-Based Psychosocial Interventions on Future Suicide Risk in Suicide Attempters

2020 ◽  
Vol 42 (6_suppl) ◽  
pp. S39-S45
Author(s):  
Ram Pratap Beniwal ◽  
Priya Sreedaran ◽  
Uttara Chari ◽  
Ashok MV ◽  
Triptish Bhatia
Keyword(s):  
Mental Health ◽  
Randomized Controlled Trial ◽  
Mental Health Treatment ◽  
Suicide Attempts ◽  
Controlled Trial ◽  
Psychosocial Interventions ◽  
Health Treatment ◽  
Risk Of Death ◽  
Randomized Controlled ◽  
Telephone Reminders

Background: Persons with previous history of a suicide attempt are at increased future risk of death by suicide. These vulnerable individuals, however, do not seek receive or seek help from mental health services. Telephone-based psychosocial interventions are potential strategies in augmenting mental health care in such persons. Methods: We aim to compare the efficacy of telephone-based psychosocial interventions (TBPI) with routine telephone reminders in persons with recent suicide attempts using a multi-site, parallel group, rater-blind, two-arm randomized controlled trial design in 362 participants. In the first group, participants will receive three sessions of TBPI comprising of brief supportive interventions, problem-solving strategies, and reminders for adherence to prescribed mental health treatment at weekly intervals. In the second group, participants will receive three telephone reminders for adherence to prescribed mental health treatment at weekly intervals. We will follow up participants for 6 months. Primary outcomes are suicidal ideation scores on Beck’s Scale for Suicide Ideation and number of repeat suicide attempts. Secondary outcomes are scores on Beck’s Hopelessness Scale, Beck’s Depression Inventory, Connor–Davidson Resilience Scale and Visual Analogue Rating Scales for acceptability of interventions. Outcomes will be assessed at 1, 3, and 6 months after receiving telephone interventions or reminders. Results: The trial is currently underway after prospective registration under Clinical Trials Registry of India and has recruited 260 participants till August 15, 2020. Conclusion: This study has potential to generate evidence on additional strategies for use along with standard mental health treatments in management of high-risk suicide behaviors.

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