Geriatric Depression

Group 1
Introduction
• Depression is under-recognized and undertreated in
the older people.
• 5% - 27% older adults in community & up to 37% in
primary care setting experience depressive
symptoms.
• Untreated depression can delay recovery or worsen
the outcome of other medical illnesses via
increased morbidity or mortality
• Depression is NOT a part of normal aging
DSM-5 Definition
• Five or more of the following must have
been present during the same 2-week interval
and represent a change from baseline
functioning
• One of the symptoms must be depressed
mood or loss of interest or pleasure.
• Depressed mood
• Loss of interest in all or almost all activities
or pleasure
• Appetite change or weight loss
• Insomnia or hypersomnic
• Psychomotor agitation or retardation
• Loss of energy or fatigue
• Feelings of worthlessness or excessive guilt
• Difficulty with thinking, concentration, or
decision making
• Recurrent thoughts of death or suicide
• Preoccupation with somatic
symptoms,health status, or physical
limitations
• Minor depression is common
• 15% of older persons
• 1 Causes T use of health services, excess disability,
poor
• health outcomes, including 1 mortality
• Major depression is not common
• 1%-2% of physically healthy community dwellers
• " Elders less likely to recognize or endorse
depressed mood
RISK FACTORS
• Alcohol or substance abuse
• Current use of a medication associated with a high
risk of depression
• Hearing or vision impairment severe enough to
affect function
• History of attempted suicide
• History of psychiatric hospitalization
• Female gender
• Bereavement
COGNITIVE DEFICITS IN
GERIATRIC DEPRESSION
• Cognitive symptoms of severe depression can be
misdiagnosed as an early stage dementing disorder.
The neuropsychological impairment seen frequently in
geriatric depression span across multiple cognitive
domains. These include impairments in episodic
memory, recognition memory,verbal
fluency ,psychomotor speed.
• The specific structural abnormalities that contribute
to symptoms of depression have been identified in
the orbitofrontal cortex, antcingulate. putamen,
caudate head, hippocampus, amygdala
 CAUSES
• As you grow older, you face significant life changes that can put
you at risk for depression.
• Health problems - llness and disability; chronic or severe pain;
cognitive decline; damage to body image due to disease.
• Loneliness and isolation - Living alone; a dwindling social circle
due to deaths or relocation;
• Reduced sense of purpose - Feelings of purposelessnes or loss of
identity due to retirement or physical limitations on activities
• Fears - Fear of death or dying; anxiety over financia problems or
health issues.
• Recent bereavement - The death of friends, family members, and
pets; the loss of a spouse or partner.
• Angiotension-converting • Captopril, enalapril
enzyme inhibitors. Ciprofloxacin,
• Antibiotics dapsone,metronidazole
• Anticholinergic Dicyclomine
• Antivirals Acyclovir, nevirapine
• Benzodiazepines Alprazolam, clonazepam,
• Calcium-channel blockers lorazepam
• Opioids Verapamil, ditiazem
• NSAIDS Codeine.morphine
• Parkinson drugs lbuprofen , indomethacin ,
naproxen
The Geriatric Depression Scale
Screening Tools
• Geriatric Depression Scale (GDS; validated) 15 item
• scale ( > 5 points or positive responses is
• diagnostic)
• Cornell Scale for Depression in Dementia (scoring
• system: >12 means probable depression)
• Center for Epidemiologic Studies of Depression
• Scale (CES-D)
• Patient Health Questionnaire 9 (9 item self-rating
• scale)
Treatment

• Pharmacotherapy

• Psychotherapy

• Electroconvulsive therapy (ECT)

Pharmacotherapy
Individualize choice of drug on basis of:-
• Patient's comorbidities
• Drug's side-effect profile
• Patient's sensitivity to these effects
• Drug's potential for interacting with other
medications
• Tricyclic antidepressants should be avoided for
being highly anticholinergic, sedating and causing
orthostatic hypotension.
• Nortriptyline should probably the tricyclic-of-first-
choice in treating an elderly patient with major
depression.
• safe starting dose of nortriptyline for the elderly is
30 mg per day.
• SSRIs considered to have the best safety profile in
the elderly are citalopram, escitalopram, and
sertraline.
• fluoxetine is not recommended for use in the
elderly because of its long half-life and prolonged
side effects.
• sertraline 25 mg PO per Day initially; may increase
by 25 mg every 2-3 days; not to exceed 200 mg per
Day.
• Do not exceed citalopram 20 mg PO qDay
• escitalopram 10 mg PO qDay; no additional benefits
observed with 20 mg/day