Geri
Depression in Older Adults
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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 Interaction
s, 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
SNRI
s may be more
Anticholinergic
)
Duloxetine
Venlafaxine
Agents to avoid
Avoid
Fluoxetine
(due to
Drug Interaction
s)
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]
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