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Depression in the Elderly: The Unique Features Related to Diagnosis and Treatment

Published online by Cambridge University Press:  07 November 2014

Katherine Shear ,
David L. Ginsberg ,
Steven P. Roose ,
Eric J. Lenze ,
George S. Alexopoulos  and
Eric Hollander
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Abstract

Depression affects 6.5 million of the 35 million Americans ≥65 years of age. While depression usually begins earlier in life and recurs periodically, it can present for the first time in people 80–90 years of age as well. Depression throughout the lifespan has a genetic/biological component but is also very much affected by social environmental factors. As people age, demographic factors, social support, and negative life events remain important to overall mental health, while physical illness and disability begin to take on a much more prominent role. Depression in the elderly is associated with impairment, dependency, disability, and significant distress for the individual and their family. This population is likely to present with concomitant cognitive dysfunction and medical illness, which can complicate the identification and treatment of psychiatric conditions. Bereavement is almost universal in late life and is sometimes a deterrent to appropriate diagnosis and treatment of depression. Physical frailty and diminishing social resources further complicate the treatment of depression in the elderly. Elderly individuals respond well to standard pharmacotherapy and psychotherapy treatments for depression. However, due to the high rate of relapse of depression in this population, continuous treatment is often warranted. This monograph will review depression in the elderly in the context of social disruptions, such as bereavement, caregiver strain, interpersonal conflict, role transitions, and social isolation; late-onset vascular depression and cognitive impairment; and physical illness including disability.

Type
Research Article
Information
CNS Spectrums , Volume 10 , Issue S8 , 2005 , pp. 1 - 41
Copyright
Copyright © Cambridge University Press 2005

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References

1. US Census Bureau Web site. Available at: http://www.census.gov/prod/2003pubs/c2kbr-30.pdf. Accessed July 2, 2005.Google Scholar
2. Stroebe, M, Schut, H. The dual process model of coping with bereavement: rationale and description. Death Stud. 1999;23(3):197–224.Google ScholarPubMed
3. Buechner, F. The Sacred Journey. San Francisco, CA: Harper; 1991.Google Scholar
4. Hall, D. Without. New York, NY: Houghton Mifflin; 1998.Google Scholar
5. Zisook, S. Shuchter SR. Depression through the first year after the death of a spouse. Am J Psychiatry. 1991;148:1346–1352.Google ScholarPubMed
6. Zisook, S, Devaul, RA. Grief, unresolved grief, and depression. Psychosomatics. 1983;24:247–256.CrossRefGoogle ScholarPubMed
7. Zisoook, S, Shuchter, SR. Major depression associated with widowhood. Am J Geriatr Psychiatry. 1993;1:316–326.CrossRefGoogle Scholar
8. Reynolds, CF 3rd, Miller, MD, Pasternak, RE, et al. Treatment of bereavement-related major depressive episodes in later life: a controlled study of acute and continuation treatment with nortriptyline and interpersonal psychotherapy. Am J Psychiatry. 1999;156(2):202–208.CrossRefGoogle ScholarPubMed
9. Pasternak, RE, Reynolds, CF 3rd, Schlernitzauer, M, et al. Acute open-trial nortriptyline therapy of bereavement-related depression in late life. J Clin Psychiatry. 1991;52(7):307–310.Google ScholarPubMed
10. Zisook, S, Shuchter, SR, Pedrelli, P, Sable, J, Deaciuc, SC. Bupropion sustained release for bereavement: results of an open trial. J Clin Psychiatry. 2001;62(4):227–230.CrossRefGoogle ScholarPubMed
11. Boerner, K, Schulz, R, Horowitz, A. Positive aspects of caregiving and adaptation to bereavement. Psychol Aging. 2004;19(4):668–675.CrossRefGoogle ScholarPubMed
12. Shear, K, Frank, E, Houck, PR, Reynolds, CF 3rd. Treatment of complicated grief: a randomized controlled trial. JAMA. 2005;293(21):2601–2608.CrossRefGoogle ScholarPubMed
13. Figiel, GS, Krishnan, KR, Doraiswamy, PM, Rao, VP, Nemeroff, CB, Boyko, OB. Subcortical hyperintensities on brain magnetic resonance imaging: a comparison between late age onset and early onset elderly depressed subjects. Neurobiol Aging. 1991;12(3):245–247.CrossRefGoogle ScholarPubMed
14. Hickie, I, Scott, E, Mitchell, P, Wilhelm, K, Austin, MP, Bennett, B. Subcortical hyperintensities on magnetic resonance imaging: clinical correlates and prognostic significance in patients with severe depression. Biol Psychiatry. 1995;37(3):151–160.CrossRefGoogle ScholarPubMed
15. Bots, ML, van Swieten, JC, Breteler, MM, et al. Cerebral white matter lesions and atherosclerosis in the Rotterdam Study. Lancet. 1993;341(8855):1232–1237.CrossRefGoogle ScholarPubMed
16. Alexopoulos, GS, Meyers, BS, Young, RC, Campbell, S, Silbersweig, D, Charlson, M. Vascular depression’ hypothesis. Arch Gen Psychiatry. 1997;54(10):915–922.CrossRefGoogle ScholarPubMed
17. Alexopoulos, GS, Meyers, BS, Young, RC, Kakuma, T, Silbersweig, D, Charlson, M. Clinically defined vascular depression. Am J Psychiatry. 1997;154(4):562–565.Google ScholarPubMed
18. Krishnan, KR, Hays, JC, Blazer, DG. MRI-defined vascular depression. Am J Psychiatry. 1997;154(4):497–501.Google ScholarPubMed
19. Schleifer, SJ, Macari-Hinson, MM, Coyle, DA, et al. The nature and course of depression following myocardial infarction. Arch Intern Med. 1989;149:1785–1789.CrossRefGoogle ScholarPubMed
20. Kalayam, B, Alexopoulos, GS. Prefrontal dysfunction and treatment response in geriatric depression. Arch Gen Psychiatry. 1999;56(8):713–718.CrossRefGoogle ScholarPubMed
21. Baldwin, I, Jeffries, S, Jackson, A, et al. Treatment response in late-onset depression: relationship to neuropsychological, neuroradiological, and vascular risk factors. Pyschol Med. 2004;34:125–136.CrossRefGoogle ScholarPubMed
22. Alexopoulos, GS, Meyers, BS, Young, RC, et al. Executive dysfunction and long-term outcomes of geriatric depression. Arch Gen Psychiatry. 2000;57(3):285–290.CrossRefGoogle ScholarPubMed
23. Dew, MA. Psychiatric disorder in the context of physical illness. In: BP, Dohrenwend, ed. Adversity, Stress, and Psychopathology. London: Oxford University; 1998:177–218.Google Scholar
24. Whyte, EM, Mulsant, BH. Post stroke depression: epidemiology, pathophysiology, and biological treatment. Biol Psychiatry. 2002;52(3):253–264.CrossRefGoogle ScholarPubMed
25. Lenze, EJ, Rogers, JC, Martire, LM, et al. The association of late-life depression and anxiety with physical disability: a review of the literature and prospectus for future research. Am J Geriatr Psychiatry. 2001;9(2):113–135.CrossRefGoogle ScholarPubMed
26. Penninx, BW, Beekman, AT, Honig, A, et al. Depression and cardiac mortality: results from a community-based longitudinal study. Arch Gen Psychiatry. 2001;58(3):221–227.CrossRefGoogle ScholarPubMed
27. Frasure-Smith, N, Lesperance, F, Talajic, M. Depression following myocardial infarction. Impact on 6-month survival. JAMA. 1993;270(15):1819–1825.CrossRefGoogle ScholarPubMed
28. Zellweger, MJ, Osterwalder, RH, Langewitz, W, Pfisterer, ME. Coronary artery disease and depression. Eur Heart J. 2004;25(1):3–9.CrossRefGoogle ScholarPubMed
29. Katon, WJ, Lin, E, Russo, J, Unutzer, J. Increased medical costs of a population-based sample of depressed elderly patients. Arch Gen Psychiatry. 2003;60(9):897–903.CrossRefGoogle ScholarPubMed
30. Lin, EH, Von Korff, M, Katon, W, Bush, T, Simon, GE, Walker, E, Robinson, P. The role of the primary care physician in patients’ adherence to antidepressant therapy. Med Care. 1995;33(1):67–74.CrossRefGoogle ScholarPubMed
31. Schatzberg, AF. New indications for antidepressants. J Clin Psychiatry. 2000;61(Suppl 11):9–17.Google ScholarPubMed
32. Roose, SP, Sackeim, HA, Krishnan, KR, et al; Old-Old Depression Study Group. Antidepressant pharmacotherapy in the treatment of depression in the very old: a randomized, placebo-controlled trial. Am J Psychiatry. 2004;161(11):2050–2059.CrossRefGoogle Scholar
33. Bondareff, W, Alpert, M, Friedhoff, AJ, et al. Comparison of sertraline and nortriptyline in the treatment of major depressive disorder in late life. Am J Psychiatry. 2000;157(5):729–736.CrossRefGoogle ScholarPubMed
34. Newhouse, PA, Krishnan, KR, Doraiswamy, PM, et al. A double-blind comparison of sertraline and fluoxetine in depressed elderly outpatients. J Clin Psychiatry. 2000;61(8):559–568.CrossRefGoogle ScholarPubMed
35. Thompson, LW, Coon, DW, Gallagher-Thompson, D, Sommer, BR, Koin, D. Comparison of desipramine and cognitive/behavioral therapy in the treatment of elderly outpatients with mild-to-moderate depression. Am J Geriatr Psychiatry. 2001;9(3):225–240.CrossRefGoogle ScholarPubMed
36. Reynolds, CF 3rd, Frank, E, Perel, JM, et al. Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression: a randomized controlled trial in patients older than 59 years. JAMA. 1999;281(1):39–45.CrossRefGoogle ScholarPubMed
37. Arean, PA, Cook, BL. Psychotherapy and combined psychotherapy/pharmacotherapy for late life depression. Biol Psychiatry. 2002;52(3):293–303.CrossRefGoogle ScholarPubMed
38. Sackeim, HA, Haskett, RF, Mulsant, BH, et al. Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. JAMA. 2001;285(10):1299–1307.CrossRefGoogle ScholarPubMed
39. Alexopoulos, GS, Kiosses, DN, Murphy, C, Heo, M. Executive dysfunction, heart disease burden, and remission of geriatric depression. Neuropsychopharmacology. 2004;29(12):2278–2284.CrossRefGoogle ScholarPubMed
40. Larson, SL, Owens, PL, Ford, D, Eaton, W. Depressive disorder, dysthymia, and risk of stroke: thirteen-year follow-up from the Baltimore epidemiologic catchment area study. Stroke. 2001;32(9):1979–1983.CrossRefGoogle ScholarPubMed
41. Gainotti, G, Antonucci, G, Marra, C, Paolucci, S. Relation between depression after stroke, antidepressant therapy, and functional recovery. J Neurol Neurosurg Psychiatry. 2001;71(2):258–261.CrossRefGoogle ScholarPubMed
42. Rasmussen, A, Lunde, M, Poulsen, DL, Sorensen, K, Qvitzau, S, Bech, P. A double-blind, placebo-controlled study of sertraline in the prevention of depression in stroke patients. Psychosomatics. 2003;44(3):216–221.CrossRefGoogle ScholarPubMed
43. Jorge, RE, Robinson, RG, Arndt, S, Starkstein, S. Mortality and poststroke depression: a placebo-controlled trial of antidepressants. Am J Psychiatry. 2003;160(10):1823–1839.CrossRefGoogle ScholarPubMed
44. Alexopoulos, GS, Raue, P, Arean, P. Problem-solving therapy versus supportive therapy in geriatric major depression with executive dysfunction. Am J Geriatr Psychiatry. 2003;11(1):46–52.CrossRefGoogle ScholarPubMed