Late-Life Depression

Signs of Depression based on DSM-V

Depressed mood most of the day, nearly every day
Markedly diminished interest or pleasure in almost all
activities
Significant weight loss when not dieting or weight gain or
increase or decrease in appetite
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or excessive/inappropriate guilt
Diminished ability to think or concentrate
Recurrent thought of death, recurrent suicidal intention,
suicide attempt or planning
Symptoms above cause significant distress or impairment in
social/occupation/function
Late-life Depression
One of the most common psychiatric problems in
older adults
8-16% of older adults, 5-10% elderly in outpatient
NOT A NORMAL PROCESS associated with aging
Presenting symptoms is less typical more
difficult to detect
more on women
Higher case of minor or subsyndromal depression
Impairment of physical, cognitive, functional and
social quality decreased quality of life
Suicide, increased risk for cardiac mortality, relaps
and life maintenance of depression
Typical symptoms
Somatic complaints of pain
Unintentional change in weight/appetite,
Chronic constipation
Irritability, agitation
Fatigue, headache, weakness
insomnia, hypersomnia
Geriatric Depression Scale
Self-administered screening tool for
measurement of depressive symptoms in
older adults
Distinguish between symptoms of dementia
and depression
Long form 30 question, higher score
indicates more severe depression
Short form 15 question, suggest more likely
or highly likely to have depression
Brink TL, Yesavage JA, Lum O, Heersema P, Adey MB, Rose TL: Screening tests for geriatric depression. Clinical
Gerontologist 1: 37-44, 1982.
https://www.stanford.edu/~yesavage/GDS.html
Treatment
Antidepressant SSRI, SNRI, tricyclic
Electroconvulsive depression and suicidal
thought not responding to therapy
Psychotherapy
cognitive behaviour therapy (CBT)
Interpersonal therapy (IPT) focus on 4 component
which may lead to depression
Grief, interpersonal disputes, role transition, interpersonal
deficits
Reflective therapy
Pyschodynamic
Life-review therapy
Reminiscence therapy
Reference
American Psychiatric Association. Diagnostic and statistical manual
of mental disorders. 5
th
ed (DSM-V).Washington: American
Psychiatric Publishing; 2013.
Blazer DG. Depression in late life: review and commentary. J
Gerontol A Biol Sci Med Sci. 2003 Mar;58(3):249-65
Downing LJ1, Caprio TV, Lyness JM. Geriatric psychiatry review:
differential diagnosis and treatment of the 3 D's - delirium,
dementia, and depression. Curr Psychiatry Rep. 2013 Jun;15(6):365.
Frank C. Pharmacological treatment of depression in the elderly.
Can Fam Physician. 2014 Feb;60(2):121-6.
Cognitive Impairment in the elderly recognition, diagnosis and
management. Available from:
http://www.bcguidelines.ca/guideline_cognitive.html
Geriatric depression scale. Available from:
http://www.stanford.edu/~yesavage/GDS.html