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Pharmacological management of depression in older people
Published in Stephen Curran, John P Wattis, Practical Management of Affective Disorders in Older People, 2018
Stephen Curran, Andrew Byrne, John P Wattis
Late-life depression is similar to depression at other times of life. However, ageing and other factors may alter the presentation in older people. In particular older people are less likely to complain of sadness compared with younger patients; they are more likely to complain of physical symptoms, memory complaints and anxiety symptoms.1 In addition, depression in patients with dementia may lead to behavioural disturbance.2 Consequently, diagnosis can be more difficult and therefore missed and patients may go untreated. Some of the issues to do with diagnosis are discussed in Chapter 2.
The Exercise Effect on Mental Health in Older Adults
Published in Henning Budde, Mirko Wegner, The Exercise Effect on Mental Health, 2018
Inna Bragina, Claudia Niemann, Claudia Voelcker-Rehage
Depressive disorders are associated with an increased risk of morbidity and suicide as well as decreased physical, cognitive, and social functioning (Blazer 2003). The prevalence and the underlying mechanisms of late-life depression seem not to differ from depression in younger age but the phenomenology may be partly different. In older adults, depression seems to be especially associated with cognitive decline, somatic symptoms, and loss of interest. In younger adults, emotional conspicuity seems to be more prevalent (Fiske, Wetherell, & Gatz 2009; Hegeman, Kok, van der Mast, & Giltay 2012).
Depression, Anxiety, and Apathy
Published in Marc E. Agronin, Alzheimer's Disease and Other Dementias, 2014
Methylphenidate has a rapid onset of action, short half-life, and a brief duration of action. For example, onset of action is observed within one hour of administration, and its effects last three to six hours. In the elderly, dosing is begun at 2.5 to 5 milligrams in the morning. Look for a positive effect in two to four hours, and titrate to 5 to 10 milligrams at morning and noon. Doses given later in the day can lead to insomnia. Pulse and blood pressure should be monitored during the first week of titration, although changes are usually minimal. Aside from immediate release methylphenidate, there are several controlled-release methylphenidate and amphetamine preparations that provide stimulant action throughout an entire day, but these are only indicated for individuals with attention deficit hyperactivity disorder (ADHD) and have not been studied in individuals with late-life depression or in individuals with dementia. Similarly, neither the noradrenergic agent atomoxetine (an FDA-approved treatment for ADHD) nor the stimulants modafinil and its R-enantiomer armodafinil (FDA-approved medications to treat narcolepsy, shift work sleep disorder, and excessive daytime sleepiness associated with obstructive sleep apnea) have been studied in individuals with late-life depression or dementia.
A different outlook to consequences of anemia in older adults
Published in Postgraduate Medicine, 2023
Ercüment Öztürk, Ahmet Çiğiloğlu, Eyyüp Murat Efendioğlu, Zeynel Abidin Öztürk
Late-life depression is a common health problem and affected by gender, socioeconomic status, physical activity, and nutrition, and it is associated with serious consequences ending up in morbidity and mortality [16,17]. There is a strong association of negative outcomes of geriatric depression with the medical comorbidities, cognitive declines, functional worsening, high ratios of suicide risk, and overall mortality [18]. Moreover, the increasing age of depressed patients is related to inadequate treatment response, delayed function recovery, and high rates of relapse [19]. Anemia is closely related to depression and negative alterations of Hb levels even above determined levels defined for anemia may lead to depression and dependency, both of which are components of the frailty syndrome [20].
Depression in the elderly: a call for novel therapeutics
Published in International Journal of Mental Health, 2023
Soumia Benbrika, Lucie Metivier, Eric Bui
The optimal treatment of late-life depression consists on pharmacological, psychological biophysical (physical activity) and psychosocial interventions. The efficacy of antidepressant treatments, including Selective Serotonin Receptors Inhibitors has been clearly demonstrated in the treatment of moderate to severe depression in the elderly (Blazer, 2003). Problem-solving therapy, cognitive behavioral therapy, and interpersonal therapy are effective in late-life depression and must to be used in association with to anti-depressant medications to improve the likelihood of remission (Alexopoulos, 2019). Nevertheless, depression in the elderly is often resistant with predictors of poorer therapeutic response including physical and sexual abuse in childhood, age at onset, lower education, number of previous recurrences, day of untreated episode and executive cognitive impairment (Alexopoulos, 2019; Knochel et al., 2015). Medical comorbidities, vascular depression, apathy and dementia including Alzheimer’s disease are other factors that negatively influence treatment outcome (Subramanian et al., 2023). Additionally, older age has been found as a moderating factor of treatment resistance probably due to the severity of symptoms at diagnosis (Kautzky et al., 2023) and to normal physiological changes associated with aging in the pharmacodynamics and pharmacokinetic process in which medication are metabolized (Balaram & Balachandran, 2022).
The Link between Activities of Daily Living and Cortisol in Late-Life Depression
Published in Clinical Gerontologist, 2020
Cydney Shindel, Jason M. Holland, Dolores Gallagher-Thompson
Participants in this study were recruited as part of a larger study on cognitive-behavioral therapy for late-life depression (Marquett et al., 2013). To be eligible, individuals had to be at least 60 years of age, receive a score of five or higher on the Patient Health Questionnaire-9 (PHQ-9; Kroenke, Spitzer, & Williams, 2001), score 16 or higher on the Center for Epidemiological Studies Depression Scale (CES-D; Radloff, 1977), and meet diagnostic criteria for a current depressive disorder (e.g., major depression, dysthymic disorder, adjustment disorder with depressed mood). Depression diagnoses were determined by the MINI-International Neuropsychiatric Interview (M.I.N.I.; Sheehan et al., 1998). Terms for exclusion included, active suicidal ideation, plan, or intent, active psychosis or a manic episode within the last year, substance abuse issues in the past year, and frank evidence of any type of dementia.