Depression in the elderly
Depression in the elderly occurs in people over 65 years of age. In old age, depression occurs in people with chronic diseases, various other physical and mental illnesses.
Depression in the elderly is not a natural part of old age. Within the elderly population, 1.4% suffer from severe depression. Compared to the rest of the population, the frequency of severe depression is twice as high in the age group of 70-85 years. Minor depressions have instances of 4-13%. Twice as many women have depression as men. In Norway, they found that the incidence of depression in 32% of patients in nursing homes. The incidence of depression is especially high in the elderly with dementia.
Depression is the most common mental health disorder in the elderly, 10-15 percent of the elderly suffer from depression.
Suicide prevention is the main goal of treatment for the elderly. Antidepressants, psychological interventions, and electroconvulsive therapy are known to be just as effective as in younger adults, but depression is often undiagnosed and untreated in the elderly. Gerontopsychiatry recommends treatment 12 months after the first episode, 24 months after the second, and at least three years or more after the third episode.
Psychogeriatrics deals with mental disorders of old age. 65 years is considered the boundary separating middle from older age. Cultural attitudes towards the elderly are different, the modern family is away from home most of the time and family members do not stay in one place, leading to an increasing number of older people being referred to institutions for help at a later age. Sometimes at this age it is difficult to distinguish phenomena related to the aging process from disease processes. A number of diseases can cause depressive processes, and also a depressed patient finds it harder to experience his physical illness, so it can be difficult to participate in its treatment. When there is comorbidity, it is often difficult to diagnose because the symptoms are presented in an atypical way. Older people have a weaker ability to cope with physical, emotional and economic stressful situations.
Psychosocial situations that can disrupt the normal processes of aging are the death of a spouse, close friends, changes in place of residence, disagreement in the family as well as dependence on the family. These stressful events can cause depression in the elderly, often accompanied by agitation, states of confusion and even psychotic reactions. A common problem is the differential diagnosis between depression and the initial organic psychosyndrome. Since pseudodementia also occurs as part of depression, it is important to distinguish between the two disorders because depression is a reversible disease. This disorder can manifest with common depressive symptoms such as decreased energy and vitality, insomnia, impaired concentration, loss of appetite, and weight loss. The most common symptoms of depression at this age are preoccupation, insomnia, constipation, loss of appetite, headache, fatigue, pain.
The syndrome that occurs only at this age is involutive melancholy. Melancholy is a term often used for depression characterized by severe anhedonia (loss of pleasure in all or almost all activities, lack of response to commonly pleasant stimuli), early morning awakening at least two hours earlier than usual, worsening morning depression, noticeable anorexia and loss. body weight, significant psychomotor retardation or agitation, and excessive or inappropriate guilt.
Treatment of depressive disorder in old age is carried out with antidepressants, anxiolytics, hypnotics in a dose of appropriate age, which are less than in adulthood. Treatment should be initiated at a low dose and the drug should be gradually titrated respecting the maximum dose range. Frequent assessment of the effect of treatment, monitoring of side effects, interactions with other drugs and adjust the drug accordingly. The first-line antidepressant drug for mild to moderate depression in the elderly is certainly from the group of selective serotonin reuptake inhibitors. Older people tolerate them well.
Due to slower metabolism in the elderly, the initial and maximum doses are lower (on average half the starting dose in adults. In addition to SIPPS as the drug of first choice (citalopram, sertraline paroxetine, escitalopram, fluoxetine), especially in the elderly with hepatic dysfunction). Tianeptine, raboxetine and mirtazapine are also effective. If 4 weeks of treatment with the maximum dose of antidepressant is not effective, the drug should be changed within SIPPS. and in psychotic depression, both antipsychotics are introduced and low-dose antidepressants are recommended to be taken for 6 months with gradual discontinuation in line with clinical improvement.
1. Ljubomir Hotujac and authors: Psychiatry
2nd Journal of Medix July 2013: Issue Topic Depression.