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Depression in the aged. An overview
R G Ruegg1, S Zisook, N R Swerdlow
1Department of Psychiatry, University of California, San Diego, La Jolla, California.
The Psychiatric Clinics of North America
|March 1, 1988
Summary
Depression is common in the elderly, often presenting with physical symptoms and easily missed. Treatment involves addressing causes and using lower doses of antidepressants, with electroconvulsive therapy (ECT) or antipsychotics sometimes needed.
Area of Science:
- Geriatrics
- Psychiatry
- Clinical Psychology
Background:
- Depression in older adults is prevalent, leading to significant health and social issues.
- It is frequently underdiagnosed due to atypical presentations like somatic symptoms and pseudodementia.
- Approximately 2% of the elderly experience major depression, and 33-50% of older psychiatric patients have mood disorders.
Observation:
- Approximately 2% of the elderly population experiences major depression at any given time.
- Mood disorders affect one-third to one-half of older individuals in psychiatric inpatient and outpatient settings.
- Older adults with depression exhibit more somatization, hypochondriasis, anxiety, and delusionality compared to younger individuals, with less reported guilt, loss of libido, and family history.
Findings:
- Medical illnesses common in the elderly and their treatments may contribute to the development of depression.
- Antidepressant therapy is effective for remaining symptoms after precipitating factors are addressed.
- Lower medication dosages are typically required for older patients, but they are more susceptible to side effects.
- Electroconvulsive therapy (ECT) or concurrent antipsychotic medication may be more frequently indicated in this population.
Implications:
- Early recognition and diagnosis of depression in the elderly are crucial to mitigate its severe consequences.
- Tailored treatment approaches, including adjusted medication dosages and alternative therapies like ECT, are necessary for effective management.
- Further research into the etiological links between common geriatric illnesses, medications, and depression is warranted.