Recognition and management of depression in the elderly

The Geriatric Depression Scale (GDS) is intended for easy measurement of symptoms of depression in elderly patients. The scale initially had 30 items but was reduced to a 15-item scale (GDS-15). This scale was translated into Swedish. However, five items were added: insomnia, anxiety, panic, aches and pain, and hypochondria. A total of 1002 elderly patients were rated by a research nurse using this scale. The results showed that 13.3% of the patients were considered to have affective disorders. The introduction of selective serotonin reuptake inhibitors has been of great importance for elderly patients, as these patients have difficulty in tolerating traditional tricyclic antidepressants. In a study of 133 elderly depressed patients, including those with somatic disorders and dementia, citalopram was tested. This drug provided significantly greater improvement than placebo. In another, inter-Nordic study, including 98 patients, citalopram was tested in patients with Alzheimer-type dementia. Depressed mood, and also other emotional disturbances, improved in these patients. Ratings have shown that in victims of Alzheimer-type dementia and vascular dementia, about 80% suffer from emotional disturbances. Drugs that influence both serotonin and noradrenaline metabolism have been introduced recently; these are of great interest in the treatment of elderly people.