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Depression in Older Adults
Aka: Depression in Older Adults, Geriatric Depression
- See Also
- Major Depression
- Depression in Dementia
- Epidemiology
- Prevalence: One third of hospitalized elderly
- Screening
- See Geriatric Depression Scale
- Signs
- May present with many physical complaints
- Labs
- Serum Sodium
- Consider monitoring while on SSRI, SNRI (SIADH)
- Risk Factors: Suicide
- Grief
- Living alone and other social isolation
- Male gender
- Comorbidity and secondary Disability
- Poor sleep quality
- Substance Abuse (e.g. Alcohol Abuse)
- White race
- Turvey (2002) Am J Geriatr Psychiatry 10(4): 398-406 [PubMed]
- Differential Diagnosis
- See Medication Causes of Depression
- See Organic Causes of Major Depression
- Dementia (contrast with depression with sudden onset, rapid progression)
- Insidious onset and long duration
- Progressive worsening
- Often associated with neurologic deficits
- Patient tries to conceal Disability
- Memory impaired without benefit of cuing
- Management
- See Depression Management
- See Depression Medical Management
- Non-medication management
- Psychotherapy
- Encourage socialization and daily Exercise
- SSRI Agents (Highly responsive: 60-80% of cases)
- Preferred agents due to low side effect profiles, fewer Drug Interactions, less adverse effect on cognition
- Escitalopram (Lexapro)
- Citalopram (Celexa)
- Sertraline (Zoloft)
- Agents that improve appetite, maintenance of weight
- Mirtazapine (Remeron) promotes weight gain
- Agents to consider in concurrent neuropathic path (with caution, as SNRIs may be more Anticholinergic)
- Duloxetine
- Venlafaxine
- Agents to avoid
- Avoid Fluoxetine (due to Drug Interactions)
- Avoid Paroxetine (due to Anticholinergic effects)
- Monitoring
- Observe for Hyponatremia while on SSRI (SIADH) with periodic Serum Sodium
- Observe for seroronin syndrome
- Observe for increased fall risk, sedation, Blurred Vision on SSRI
- Start dosing low (half dose)
- Increasing slowly every 2-4 weeks
- Advance until effective dose reached or maximum based on Renal Function, age
- Expect full effect by 12 weeks
- Adjunctive agents
- Methylphenidate (Ritalin)
- Consider short-term use (e.g. 3 months) while starting and titrating SSRI in severe Major Depression
- Avoid in severe anxiety, unstable or recent Coronary Artery Disease or Arrhythmia
- Example dose: Start Methylphenidate immediate release 2.5 mg in morning and afternoon
- Limit dose to <20 mg daily
- References
- (2016) Presc Lett 23(5):28
- Lavretsky (2015) Am J Psychiatry 172(6):561-9 +PMID:25677354 [PubMed]
- References
- (2018) Presc Lett 25(12): 71
- Morley (2010) J Am Med Dir Assoc 11(5):301-3 [PubMed]
- Reynolds (2006) N Engl J Med 354(11): 1130-8 [PubMed]
- Spoelhof (2011) Am Fam Physician 84(10): 1149-54 [PubMed]
- Thakur (2008) J Am Med Dir Assoc 9(2): 82-7 [PubMed]
- Unutzer (2007) N Engl J Med 357(22): 2269-76 [PubMed]