Diagnosis and treatment of depression in late life
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1. Introduction 2. Epidemiology of Depression in Late Life 3. Economic Burden of Depression in Late Life 4. Biology of Depression in the Elderly 5. Recognition of Depression in Elderly Patients 6. Course of Depression in the Elderly 7. Management of Depression in the Elderly 8. Conclusions 9. References 10. IndexKeywords:
Depression
Management of depression
Late life depression
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With the increase of life expectancy the ratio of elderly people in our society also increases and consequently health problems related to old age gain more attention. The prevalence of depression does not decrease in the elderly, affective disorders in old people, however, often manifest masked by physical illness worsening the course of these somatic disorders. Elderly depression also tends to present with a peculiar clinical picture. Atypical and also only few symptoms are characteristic of depression in the elderly. Vegetative symptoms are often primary and depression in old people often manifests solely in somatic symptoms. Typical cognitive alterations and pseudodementia are also characteristic features. At the same time, typical affective symptoms of depression are often absent, and instead of psychomotor retardation, psychomotor agitation manifested as irritability or motor restlessness is frequent. In the diagnostic process depression in the elderly should be separated from somatic diseases and dementia. The correct diagnosis and treatment of depression in the elderly is very important, since old age depression does not only cause significant distress, but often leads to suicide, and in addition, it generally increases morbidity and mortality, worsens the general somatic condition of the patient and increases social isolation.
Depression
Irritability
Psychomotor retardation
Psychomotor agitation
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Depression
Late life depression
Pharmacotherapy
Physical illness
Depressed mood
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1. Introduction 2. Classification and epidemiology 3. Clinical Features 4. Self harm and suicide 5. Aetiology 6. Medical co-morbidity and depression in late life 7. Assessment and management 8. Depression in primary care 9. Prognosis 10. Prevention 11. Resources
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Late life depression
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The diagnosis and treatment of elderly depression has gained growing importance because of its major impact on the patients's wellbeing, personal, social, and familial achievements. Depressive disorders are characterized by mood-affect, thought-cognition, psychomotor activity and somatic manifestations. Especially geriatric depression is more represented by thought-cognition and somatic manifestations. And it is also associated with comorbid mental or physical conditions that may lead to a decrease in life expectancy. Diagnosis of geriatric depression consists of history taking, laboratory, neurocognitive test, brain imaging technique and genetic study. As for its treatment, physical treatment such as pharmacological treatments, electroconvulsive therapy, and phototherapy have been emphasized but should also include psychosocial intervention such as supportive, family and cognitive-behavioral psychotherapy.
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There is strong evidence that, in antiquity, physicians were well aware of senile depression as a condition apart from dotage (Post, 1986). In the eighteenth century, even nonmedical writers were conversant with recoverable senile depressions. In the nineteenth century, however, the flourishing of brain pathology generated the widespread belief that depressions occurring for the first time during old age were early indicators of cerebral deterioration and precursors of dementia. Post (1951) and Roth & Morrissey (1952) were the first to distinguish the comparatively hopeful outcome of depressed patients from the outcome of those suffering from organic disorders.
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17Jul 2017 TREATMENT OF DEPRESSION IN ELDERLY. Bhavya K Bairy and Laxminarayana K Bairy. Department of Psychiatry, St. John?s Medical College Hospital, Bengaluru, Karnataka, India. Department of Pharmacology, RAK College of Medical Sciences, RAK Medical and Health Sciences University, Ras Al Khaimah, UAE.
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Preface Acknowledgments PART I. DEPRESSION: SYMPTOMS & THEORIES ABOUT THERAPIES 1. The Symptoms, Signs, & Diagnosis of Depression 2. Theories about Therapies for Depression PART II. DEPRESSION ACROSS THE LIFESPAN 3. Depression in Children 4. Depression in Adolescents 5. Depression in Adults 6. Depression in Older Adults PART III. COMORBID CONDITIONS & OTHER SYMPTOMS, SIGNS, & PROBLEMS ASSOCIATED WITH DEPRESSION 7. Additional Psychiatric Disorders & Severely Distressed Close Relationships Associated with Depression 8. Chronic Health Problems Associated with Depression 9. Suicide & Depression PART IV. TREATMENT OF DEPRESSION 10. Psychotherapy 11. Pharmacotherapy 12. Relapse Prevention Epilogue References Author Index Subject Index About the Authors
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