Transcript Treating Depression in the Elderly - Psychopathology

Treating Depression in the Elderly
A Multi-disciplinary Approach
12/11/2003
Who are the elderly?
 Over 65 years old, but less than 75:
“young elderly”—often still active and
independent
 Over 75
 “Frail elderly”: many living in institutions
with multiple chronic conditions
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Major Depression Episode
 At least 2 weeks of sustained symptoms
 Feelings of sadness or loss of interest
PLUS at least four other symptoms:
Agitation or Fatigue
 Loss or increase in appetite
 Insomnia or hypersomnia
 Feelings of worthlessness, hopelessness,
powerlessness
 Inability to concentrate, memory problems, and
distractability

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Rule Out:
 Caused by medical condition such as
hypothyroidism, hormonal imbalance,
metabolic disorder, anemia, stroke etc
 Caused by substance such as alcohol,
prescription medication, drugs or toxin
exposure
 Other mood disorders
 Dementia
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Manifestations in the Elderly
 Present with
 Irritability or anxiety
somatic complaints
rather than mood
dysfunction
 Loss of function,
ability to get things
done
 Social withdrawal
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 Changes in hygiene
or grooming
 Feelings of
uselessness and
loneliness
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Manifestations in Elderly
 Cognitive function impairment
 Confusion
 Disorientation
 Memory
impairment
 Lack of concentration
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Risk Factors
 Significant loss(es), sometimes concurrent
 Spouse due to death
 Friends and other family
 Mobility and/or stamina
 Hearing and vision
 General health
 Income
 Sense of identity
 Independence
 Home and/or neighborhood due to relocation
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Risk Factors
 Chronic medical conditions
 Arthritis
 Anemia
 Stroke
 Metabolic disorders
 Hormonal imbalances
 Parkinson’s disease
 Cardiac conditions
 Hypertension
 Glaucoma or cataracts
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Risk Factors
 Female
 Lack of social supports
 Family or personal history of depression
 Alcohol or substance abuse
 Family conflict
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Special Concerns
 Depression is undiagnosed or misdiagnosed
in elderly
 Can exacerbate existing medical conditions
due to degeneration of self care, poor eating
habits, and increased perception of pain
 Social withdrawal and increasing isolation
compound feelings of loneliness
 Increases dependence
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Special Concerns
 Increased risk for falls and injury,
infections, and poor nutrition
 Increased risk for premature admission
to a nursing facility
 Can lead to a downward spiral in
general health and functioning
 Economic problems
 Reduced mobility
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Assessment Critical
 Make sure medical issues, including drug
side effects and interactions, have been ruled
out.
 Because the elderly tend to have multiple
issues occurring simultaneously, it is
important to do a thorough evaluation to
determine all the factors involved in the
situation.
 May need to use a modified version of Beck
depression assessment tool, the Geriatric
Depression Scale, developed particularly for
elderly.
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Treatment Options
 Drug Therapy Only
 Psychotherapy Only
 Combination of Psychotherapy and
Drug Therapy
 Electroconvulsive Therapy (ECT)
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Treatment Phases
 Acute or Initial Phase
 6 to 8 weeks, longer for psychotherapy
alone (16 – 20 weeks)
 Fully resolve depressive symptoms
 Phase 2, Continuation of Treatment
 Maintenance Phase
 Can be a year or more, depending on
history
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Medication
 Types of medication used to treat
depression:
 Cyclic
antidepressants
 Monoamine oxidase inhibitors (MAOIs)
 Lithium salts
 Serotonin reuptake inhibitors (SSRIs)
 Each medication has its own side
effects and dosage requirements
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Psychotherapy Options
 Interpersonal
 Cognitive
 Behavioral
 Cognitive-Behavioral (CBT)
 Reminiscence or Life Review
 Family Therapy
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Combination Therapy
 Use medication to reduce acute
symptoms of depression
 Type
of medication depends on evaluation
 Follow with psychotherapy
 Type of therapy depends on evaluation,
however, CBT is shown to be effective
 Monitor for adverse reactions to
medication and compliance
 Address psychosocial stressors
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Treatment Issues
 If dementia is present, effectiveness of
treatment is affected for psychotherapy
as well as drug therapy
 Side effects of medications can lead to
non-compliance
 In psychotherapy, inconvenience,
conflict, and resistance may lead to lack
of attendance to sessions
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Summary
 Depression is not an inevitable part of
aging
 Depression is highly treatable through
different approaches
 Once acute symptoms are reduced
through drug therapy, some form of
psychotherapy can help person address
other factors that are contributing to the
situation
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