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.

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.

scholarly journals Treatment of Depression: Are Psychotropic Drugs Overdosed in Women and in the Elderly? Dosages of Psychotropic Drugs by Sex and Age in Clinical Routine

2020 ◽  
Author(s):  
Waldemar Greil ◽  
Mateo de Bardeci ◽  
Xueqiong Bernegger ◽  
Katja Cattapan ◽  
Hans Stassen ◽  
...  
Keyword(s):  
Psychotropic Drugs ◽  
Depressive Disorders ◽  
Age Distribution ◽  
Age Groups ◽  
The Elderly ◽  
Pharmacokinetic Data ◽  
Clinical Routine ◽  
Treatment Of Depression ◽  
Confounding Variables ◽  
Severity Of Depression

Abstract Background:Psychotropic drugs show higher concentration-dose ratios in women and in the elderly. Furthermore, women partially exhibit more adverse drug reactions than men. Lower dosages in most psychotropic drugs may be recommended in women and in the elderly. This study describes prescribed dosages of psychotropic drugs in depressive patients across sexes and age groups in clinical routine. Method:In 32’082 inpatients with depressive disorders (data acquired by the European drug safety program AMSP), the influence of sex and age on prescribed dosages are analysed for the 10 most commonly prescribed drugs in our dataset (descending in the frequency of prescription: mirtazapine, venlafaxine, lorazepam, quetiapine, citalopram, escitalopram, olanzapine, duloxetine, zopiclone and sertraline) and additionally zolpidem. Confounding variables for sex differences, such as severity of depression and age distribution are examined. Dose decline in patients over 65 years is calculated. The observed sex and age differences in prescriptions are compared to differences in pharmacokinetic literature.ResultsAmong patients over 65, a statistically significant decrease in dosages for increasing age (between 0.65% and 2.83% every year of age) was observed, except for zopiclone. On the other hand, only slight or no influence of sex in prescribed dosages was found.ConclusionAge definitely influences physicians’ decisions in most drugs, but to a lower extent than pharmacokinetic data suggests. Although lower dosages of psychotropic drugs are appropriate for females according to pharmacokinetic data, they are usually prescribed the same dosage as males. Thus, various psychotropic drugs may be overdosed in women.

scholarly journals Prevalence of depression among elderly population in rural South India

2020 ◽  
Vol 7 (6) ◽  
pp. 2377
Author(s):  
Vivin Vincent ◽  
Jeevithan Shanmugam ◽  
Shanmugapriya Duraisamy ◽  
Padmavathy Loganathan ◽  
Vijay Ganeshkumar ◽  
...  
Keyword(s):  
Rural Areas ◽  
South India ◽  
Tertiary Care ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Severe Depression ◽  
The Elderly ◽  
Care Hospital ◽  
Cross Sectional ◽  
Prevalence Of Depression

Background: Depression among elderly is the commonest psychiatric disorder however it is commonly misdiagnosed and under treated. Most of the time it is considered as part of aging process rather than a treatable condition. Diagnosing depression in the elderly is often difficult as a result of presence of cognitive impairment as well as reluctance and denial by the elderly and their family members. Objective of the study was to estimate the prevalence of depression among elderly rural population in South India.  Methods: A community based cross sectional study was conducted over a period of 2 months among 575 elderly people aged 60 years and above in the rural field practice area of a tertiary care hospital in south India using a pre validated Geriatric Depression Scale. Data entered and analysed using MS Excel.Results: 77.56% of the study participants were found to be depressed. Among them 74.66% were mild depressive and 25.34% had severe depression. Depression was common in elderly males as compared to females. The prevalence of depression was higher in those who live single and those living with their children without their spouse and those with co morbidities.Conclusions: Prevalence of depression among elderly is high in rural areas. It also increases as the age increases. Early identification and timely intervention would promote healthy old age.

Alzheimer’s Disease

2008 ◽  
Author(s):  
Martin Steinberg
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Depressive Disorders ◽  
Short Term Memory ◽  
Signs And Symptoms ◽  
The Elderly ◽  
Dementia Patients ◽  
Physical Burden ◽  
Degenerative Dementia ◽  
Proper Diagnosis

Alzheimer’s disease (AD), a progressive degenerative dementia, causes suffering for millions of patients as well as their caregivers. Among the elderly, the prevalence of AD increases dramatically with age: it is about 5% to 7% in people 65 years of age and older and rises to 40% to 50% in those older than 90 years of age (Rabins, Lyketsos, and Steele, 1999). AD typically affects short-term memory first; over time, impairment in language, praxis, recognition, and executive function occur. In the late stages, patients become completely dependent on others. In addition to this cognitive and physical burden, psychiatric signs and symptoms are nearly universal. These psychiatric phenomena, which include depression, delusions, hallucinations, apathy, and aggression, affect as many as 90% of patients with dementia over the course of their illness (Steinberg et al., 2003). Psychiatric phenomena often present differently in patients with AD than in the population without dementia. Uncertainty remains regarding how to best classify many of these phenomena. For example, delusions can be described as occurring in isolation, or as part of a psychotic syndrome, with associated features such as irritability and agitation. Delusions can also occur as part of a depressive syndrome or delirium. Little research is currently available to guide treatment. Nevertheless, many syndromes can be accurately diagnosed and can respond to a variety of pharmacologic and nonpharmacologic treatments. Depressive phenomena are common in AD. Estimates for the prevalence of major depression in patients with AD are 20% to 25%, (Lyketsos et al., 2003). Due to their dementia, patients with AD are often poor historians. They may not be aware of Depressive phenomena or able to recall them, and their aphasia may make describing symptoms difficult. Therefore, information from a reliable caregiver is crucial for making a proper diagnosis. Depressive disorders in AD are often somewhat different from those occurring in the absence of dementia. In particular, patients with AD may not endorse hopelessness, suicidal thoughts, or worthlessness (Zubenko et al., 2003). Patients with AD, however, express symptoms such as anxiety, anhedonia, irritability, lack of motivation, and agitation (Rosenberg et al., 2005).

Depression in old age

2011 ◽  
Vol 26 (S2) ◽  
pp. 702-702
Author(s):  
B. Vukovic ◽  
D. Markovic-Zigic
Keyword(s):  
Old Age ◽  
Elderly Population ◽  
Severe Depression ◽  
The Elderly ◽  
Chronic Illnesses ◽  
Age Group ◽  
Old People ◽  
Population Prevalence ◽  
Prevalence Of Depression ◽  
Mental Diseases

Depression in older people is related to the population over 65 years. The age of depression often go with chronic illnesses, various physical and mental diseases.Depression in old age is not a natural part. In the elderly population 1.4% suffered from severe depression. Compared with the rest of the population prevalence of major depression is twice as large in the age group of 70–85 years. Less severe depression have an instance 4–13%. Twice as many women than men have depression. The prevalence of depression is particularly high in the elderly with dementia.In this report we present how many old people in Serbia suffer of depression and what is new tendence in therapy.

The prevalence of depression among Australian nursing home residents: results using draft ICD-10 and DSM-III-R criteria

1991 ◽  
Vol 21 (3) ◽  
pp. 739-748 ◽  
Author(s):  
C. J. Phillips ◽  
A. S. Henderson
Keyword(s):  
Nursing Home ◽  
Depressive Episode ◽  
Depressive Disorders ◽  
Nursing Home Residents ◽  
The Elderly ◽  
The Social ◽  
Prevalence Of Depression ◽  
Icd 10 ◽  
Environmental Measures ◽  
State Examination

SYNOPSISThe aims of this study were, first, to estimate the prevalence of depressive disorders in Australian nursing home residents using international diagnostic criteria, and second, to explore environmental determinants of such disorders. Residents of 24 nursing homes were surveyed using the Canberra Interview for the Elderly (CIE) and a range of environmental measures was also taken. Of 323 residents who were screened for cognitive impairment, 165 (51%) scored 18 or above on the Mini-Mental State Examination (Folstein et al. 1975), and were interviewed with the CIE. According to DSM-III-R criteria and the CIE, the prevalence of major depressive episode was 9·7%. Using ICD-10 criteria, 6·1% of residents suffered from a severe depressive episode, 6·7% from a moderate depressive episode and 6·7% from a mild depressive episode. Some measures of the social environment were significantly related to depressive symptoms.

HOW DEPRESSED ARE THE ELDERLY PERSONS IN OLD-AGE HOMES? A PILOT STUDY IN AN OLD-AGE HOME OF SILIGURI

2021 ◽  
pp. 47-49
Author(s):  
Louis Tirkey ◽  
Ramanandi Ananya Jyotirmay ◽  
Suvajit Chakraborty
Keyword(s):  
Old Age ◽  
Severe Depression ◽  
The Elderly ◽  
Clinical Depression ◽  
Mood Disturbance ◽  
Elderly Persons ◽  
Cross Sectional ◽  
Prevalence Of Depression ◽  
Cross Sectional Design ◽  
Old Age Homes

INTRODUCTION: With the increasing trend of nuclear families in the society, the care of older persons in the families gets difcult and they are forced to shift to old age homes. There are lack of close family ties and reduced connections with their culture of origin, which leads to high risk of depression among olders. OBJECTIVE:Determine the Prevalence of depression among the inmates of old-age home and identify associated factors METHODS: Study type and design: 7 Observational study, Cross sectional design Study setting:The study was conducted in Aapnaghar old-age home of Siliguri, West Bengal (The old age home was chosen by lottery method). Study population:In-mates of Aapnaghar old-age home Study period: 2 months Sample size: All inmates of Aapnaghar old-age home was included by complete enumeration method; total 75 participants DISCUSSION:In Mild mood disturbance to borderline clinical depression, 28 (54.9%) patients were Male and 9 (37.5%) patients were Female. In Moderate to severe depression, 15 (29.4%) patients were Male and 15 (62.5%) patients were Female. Association of Gender vs Normal, Mild mood disturbance to borderline clinical depression and Moderate to severe depression was statistically signicant (p<0.0001). In Normal, 6 (42.9%) patients were married, 1 (4.2%) patients were unmarried and 1 (2.7%) patients were others. In Mild mood disturbance to borderline clinical depression, 7 (50%) patients were married, 19 (79.2%) patients were unmarried and 11 (29.7%) patients were others. CONCLUSION: In the current study, the BDI has been utilized to detect the prevalence of depression. Although it is not designed for diagnostic purposes, its epidemiologic utility has been evaluated in several studies. Depression was a common nding among the elderly in old-age home. These results could help to clarify the attributes of target populations for depression and provide insight to prevent depression among elderly

scholarly journals Community study of depression in old age in Taiwan

2001 ◽  
Vol 178 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Mian-Yoon Chong ◽  
Chwen-Cheng Chen ◽  
Hin-Yeung Tsang ◽  
Tzung-Lieh Yeh ◽  
Cheng-Sheng Chen ◽  
...  
Keyword(s):  
High Risk ◽  
Old Age ◽  
Life Events ◽  
Educational Level ◽  
Depressive Disorders ◽  
The Elderly ◽  
Community Dwelling ◽  
Community Study ◽  
Prevalence Of Depression ◽  
Demographic Correlates

BackgroundPublished studies of prevalence of depression in old age in Taiwan have yielded equivocal results.AimsTo study the prevalence of depressive disorders among community-dwelling elderly; further, to assess socio-demographic correlates and life events in relation to depression.MethodA randomised sample of 1500 subjects aged 65 and over was selected from three communities. Research psychiatrists conducted all assessments using the Geriatric Mental State Schedule. The diagnosis of depression was made with the GMS–AGECAT (Automated Geriatric Examination for Computerised Assisted Taxonomy); data on life events were collected with the Taiwanese version of the Life Events and Difficulties Schedule.ResultsOne-month prevalence of psychiatric disorders was 37.7%, with 15.3% depressive neurosis and 5.9% major depression. A high risk of depressive disorders was found among widows with a low educational level living in the urban community, and among those with physical illnesses.ConclusionsContrary to most previous reports, we found that the prevalence of depressive disorders among the elderly in the community in Taiwan is high and comparable to rates reported in some studies of UK samples.

Summary of Guideline for the Treatment of Depression

2003 ◽  
Vol 11 (1) ◽  
pp. 34-38 ◽  
Author(s):  
Pete M. Ellis ◽  
Ian B. Hickie ◽  
Don A. R. Smith
Keyword(s):  
Depressive Disorders ◽  
Severe Depression ◽  
Subsequent Treatment ◽  
Recurrent Depression ◽  
Behaviour Therapy ◽  
Mild Depression ◽  
First Line ◽  
Atypical Depression ◽  
Treatment Of Depression ◽  
Cognitive Behaviour

Depression is common, serious and treatable. The Australian and New Zealand Clinical Practice Guideline for the Treatment of Depression by Specialist Services provides evidence-based treatment guidance across the spectrum of depressive disorders and delineates where specialist treatment and primary care management is indicated. The present summary version covers the key contents of the guideline. It includes assessment, treatment and general management issues by category type and severity of depressive disorder. Algorithms of first-line and subsequent treatment choices are provided for: (i) mild depression without complications; (ii) moderately severe depression (including with comorbid anxiety) and dysthymia; (iii) uncomplicated, melancholic or atypical depression; (iv) moderately severe depression with comorbid substance abuse; (v) moderate to severe depression with physical disorders; (vi) severe depression with melancholia; (vii) recurrent depression or failure to respond to a preferred first-line treatment; and (viii) psychotic depression, and severe depression with risk of suicide. Continuing and maintenance treatments for recurrent depression are discussed. Emerging evidence of the equal value of cognitive behaviour therapy (CBT) and interpersonal psychotherapy (IPT) to pharmacological treatments for some depression is discussed, and the need to ensure that they are provided by suitably trained practitioners. Indications for hospitalization and electroconvulsive therapy (ECT) are also provided.

Computed Tomography in the Elderly

1986 ◽  
Vol 148 (1) ◽  
pp. 80-85 ◽  
Author(s):  
Jonathan M. Bird ◽  
Raymond Levy ◽  
Robin J. Jacoby
Keyword(s):  
Ct Scan ◽  
Depressive Disorders ◽  
Late Onset ◽  
Disease Process ◽  
The Elderly ◽  
Ventricular Size ◽  
Computed Tomographic ◽  
Early Dementia ◽  
Over Time

The clinical, psychometric, and computed tomographic (CT) status of previously fit elderly volunteers is described at follow-up for up to four years. A number of relationships were found between psychometric and CT scores, but a dementing group could not be determined on the basis of a single scan. However, a subtle reduction in cognition over time was significantly related to CT changes, and occurred in 10%. Larger ventricles were also found in a small sub-group, who developed late-onset depressive disorders; recent bereavement was related to ventricular size. Thus a single CT scan may not be a useful discriminatory test in early dementia, but a repeat demonstrating ventricular enlargement, is likely to be significant. In the elderly, cognitive and CT scan deterioration should not be expected unless a disease process is occurring; this may be indicated by subtle cognitive impairment or by late-onset depressive disorder.

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