Scribd
Upload
130 views22 pages

Understanding Depression in Seniors

The document discusses depression in older adults, including symptoms, causes, diagnosis, and treatment options. Depression is common in older adults and can have negative health impacts if left untreated. Treatment may involve medication and therapy, with the goals of improving mood and ability to function.

Uploaded by

Dr. Shanojan Thiyagalingam, FRCPC FACP
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
130 views22 pages

Understanding Depression in Seniors

The document discusses depression in older adults, including symptoms, causes, diagnosis, and treatment options. Depression is common in older adults and can have negative health impacts if left untreated. Treatment may involve medication and therapy, with the goals of improving mood and ability to function.

Uploaded by

Dr. Shanojan Thiyagalingam, FRCPC FACP
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Depression In Older Adults

Dr. Shanojan Thiyagalingam


Geriatrician & Assistant Professor of Medicine
September 2021
Disclosure
• I have no actual or potential con ict of interest in relation to this
presentation

• I have no nancial interests or relationships to disclose


fi
fl
Outline
• What is depression?

• Symptoms

• Why does it matter?

• Causes

• Diagnosis

• Treatment

• Community Resources
[Link]
What is Depression?
• persistent feeling of sadness, loss of interest

• misdiagnosed, under-diagnosed

• sadness may not be main symptom

• may not be willing to talk about their feelings


Symptoms

[Link]
[Link] les/documents/health/publications/older-adults-and-depression/19-mh-8080-
[Link]
fi
Why Does it Matter?
•Prevalence

•clinics: 10%

•nursing home: 20%

•Impact
•emotional, behavioural and health impact

•decreased ability to function at home or work

•worse if untreated

•ie: weight increase, pain, family con ict, social isolation,


self-mutilation, suicide, memory impairment

fl
Causes
• exact cause unknown; many factors involved

• biological di erence (di erences in brain, signi cance not understood)

• brain chemistry (neurotransmitters) involved in mood

• hormone (ie: thyroid, pregnancy, menopause, etc)

• inherited
ff
ff
fi
Risk Factors
• females

• personal or family history of depression

• certain medications

• chronic medical diseases (ie: stroke, heart attack)

• disability

• poor sleep

• loneliness

• stressful events (ie: loss of spouse)

[Link]
Diagnosis
• Interview

• screening questions (classic symptoms not always present)

• collateral from family/caregiver

• secondary causes

• Physical exam, Lab tests

• +/- Psychiatric evaluation

[Link]
Types of Depression
• Major Depressive Disorder

• with psychosis

• Minor Depression

• Bipolar Disorder Type 1 or 2 with depression

• Complicated Grief

• if prolonged or severe
Major Depressive Disorder
• atleast 2 weeks
• single or recurrent

• depressed mood or loss of • +/- psychosis

interested; •delusions, hallucinations

[Link]
communities/depression-in-older-adults
Bipolar Disorder
• mania

• in ated self-esteem, grandiosity

• leads to hospitalization

• late-onset mania

• psychosis, sleep disturbance, aggressiveness

• di cult to identify

• +/- depression
fl
ffi
Pharmacologic Treatment
• Anti-depressants (ie: SSRI, SNRI, MAO-I, TCA, etc)

• side e ects:

• falls, nausea/diarrhea, confusion, sexual


problems, weight gain, sleepiness

• Duration

• Genetic testing

• Don’t stop medication on your own

[Link]

• Anti-psychotics, stimulants
depression-seniors-focus-13-5-million-study/

• Mood stabilizers (anticonvulsant, antipsychotics,


lithium)
ff
Treatment
• 4 weeks for initial improvement, 12 weeks for full bene t

• 4th week: 1/3 nonresponders, 1/3 full response, 1/3 partial response

fi
Non-Pharmacologic Treatment
Electroconvulsive Therapy (ECT)

• rst line depression treatment if

• serious risk of suicide

• life-threatening loss of appetite

• delusions

• e ective for depression, bipolar disorder


mania

• amnesia (retrograde)
[Link]
psychiatry/divisions-and-programs/divisions/
bsl/ect
• no lasting cognitive e ects, improves memory

• maintenance therapy
fi
ff
ff
Non-Pharmacologic Treatment
Repetitive Transcranial Magnetic Stimulation (rTMS)

• newer treatment

• ECT better remission rates than


rTMS;

• older adults response not as


robust as younger adults

• not covered by medicare/


medicaid
[Link]
magnetic-stimulation/about/pac-20384625
Non-Pharmacologic Treatment
• coping, problem solving, identify negative beliefs, replace with positive,
develop positive relationships, setting life goals

• cognitive behavioural therapy, aerobic exercise etc

• disease management models (e ective!)

• phone-based screening, assessment, followup

• collaborative (ie: doctor, nurse, patient, therapist)


ff
Community Resources
• The Friendship Line (Institute of Aging)

• well-being check-ins, referrals, emotional


support

• Berkeley County Senior Center

• see your doctor, mental health professional,


faith leader, friend, family,

• call 911; nearest emergency department

• National Suicide Prevention Lifeline


Prevention
• no perfect answer, but these will help:

• reduce stress

• reach out to family/friends especially during di cult times

•exercise

•get treatment early to prevent depression from worsening

[Link]
of-health/ways-for-seniors-to-remain-active-this-winter
ffi
[Link]
Reference
• Mayo Clinic

• National Institute of Mental Health

• Annals of Long Term Care

• American Psychiatric Association

• American Geriatrics Society - Geriatrics Review Syllabus

You might also like