depression in the elderly
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Introduction
Also see depression.
Etiology
risk factors
- acute & chronic stressors
- physical disability
- medical illness
- chronic pain
- myocardial infarction or stroke
- common among hospitalized elderly[29]
- death or serious illness of a loved one
- caring for a sick relative
- relocation
- poor social support (social isolation)
- polypharmacy: medications associated with depression
- family history of mood disorders
- women at higher risk than men
- brain structural changes
- cortical atrophy
- white matter infarcts or demyelination
- age-related brain plasticity changes[3]
- generally preceded by cognitive impairment[8]
- hypotension in the elderly[17]
- long-term exposure to air pollution[69]
* religious affiliation plays protective role[1]
Epidemiology
- prevalence of major depression in persons > 65 years
- 4.4% in women
- 2.7% in men
- prevalence of major depression in the elderly is reported to be much higher in ref[1]
- 65-74 (13%)
- 75-85 (15%)
- >= 85 (19%)
- 15-25% of nursing home residents[15]
- prevalence in elderly is < prevalence in persons 24-44 years of age
- major depression is more common in women than men[1]
- prevalence of major depression remained stable from 1998-2008
- prevalence of major depression: hispanics > whites > blacks
- depression less common in community-dwelling elderly than in hospitalized or nursing home patients
- prevalence of depression 12% in hospitalized elderly & 16%-50% in nursing home residents
- depression associated with biopolar disorder in the elderly higher than previously thought[1]
Pathology
- improvement in cerebral blood flow* may accompany improvement in depression in treated elderly[58]
* assessed by MRI
Genetics
- polymorphism on norepinephrine transporter gene is associated with remission, earlier response, & greater change in symptoms[54]
Clinical manifestations
- older adults may present with:
- more memory complaints
- more self-reproach
- less guilt
- less suicidal ideation
- older adults tend to report milder mood symptoms
- somatic complaints often overshadow or mask depressive symptoms
- older adults with depression tend to exhibit more:
- weight loss
- disturbances in sleep
- sexual dysfunction
- loss of appetite
- motor retardation
- lethargy & fatigue
- delusions
- higher frequency of relapse (61% when treatment stopped after 2 years)
- manifestations of major depression in the elderly
- fatigue
- anhedonia
- sadness
- irritabilty
- loss of interest
- poor sleep, insomnia
- appetite changes, weight loss
- psychomotor retardation with slow speach
- hopelessness
- thoughts life not worth living
- also see major depression as these are not the only manifestations
Laboratory
- also see depression
- complete blood count
- serum glucose
- serum TSH
- serum vitamin B12, serum folate[37]
- serum homocysteine[38]
Diagnostic procedures
- cognitive screening with MMSE[37]
- neuropsychiatric testing if cognitive impairment confounds treatment of depression[43]
- hearing assessment[43]
Radiology
- see depression
- florbetapir (18F) positron emission tomography for beta-amyloid is investigational for prediction of response to antidepressants[65]
Complications
- increased mortality in elderly patients
- suicide
- hopelessness is the best predictor of suicide in the elderly[71]
- complications of medical problems
- suicide
- depression in hospitalized elderly persisting after hospital discharge increases risk of functional dependence & death[29]
- increased utilization of healthcare services
- untreated depression in the elderly increases health care utilization & costs > 40% (GRS9)[1][51][52]
- increased risk of hospitalization for pneumonia (RR=1.28)[50]
- diminished functionality
- diminished quality of life
- caregiver stress or family burden
- depressive pseudodementia
- clinically significant depression that increases over time is associated with an increased risk for dementia compared with elderly without consistent depressive symptoms (RR=1.94)[46]
- non-compliance with medical recommendations
- lower participation in rehabilitation
- elderly > 70 with worse outcomes than younger patients[56]
- disease interaction(s) of Alzheimer's disease (AD) with depression in the elderly
- disease interaction(s) of mild cognitive impairment (MCI) with depression in the elderly
- disease interaction(s) of depression in the elderly with anxiety disorder(s)
Differential diagnosis
- bereavement: normal or pathologic
- endocrine disorders: hypothyroidism
- sleep disorder
- sleep apnea
- circadian disturbance
- fatigue & apathy due to poor health
- structural brain lesion
- vascular depression (ischemic stroke)
- demyelination
- depressive component of bipolar disorder
- dementia in 1/3 of depressed elderly within 5 years[1]
- major depression
- treatment-resistant depression
Management
- general
- see depression
- depression associated with bipolar disorder in the elderly should be treated as bipolar disorder[1]
- most patients do not achieve even 50% improvement[2]
- cognitive impairment may portend poor response to treatment[18]*
- major depression with comorbid anxiety is more treatment resistant than depression alone[1]
- exercise reduces symptoms of depression in the elderly[1]
- videoconferencing with family helps with depression due to loneliness[1]; trumps robotic companion[1]
- assess access to & comfort with using technology for social interaction[1]
- treatment-resistant depression likely to respond to cognitive behavioral therapy[1]
- structured case management approach is more effective than standard care[2][9][14][15]
- longer duration & more severe depression predict likelihood of response to medication[19]
- involving a depression care manager in primary care practices can improve survival among older adults[21]
- stepped care beneficial for elderly with visual impairment (each step lasting ~3 months)
- watchful waiting
- cognitive behavioral therapy
- problem-solving therapy
- physician referral
- psychotherapy
- cognitive behavioral therapy, behavioral therapy, & reminiscence therapy may reduce depressive symptoms in long-term care residents[72]
- combination of medication & psychotherapy for best results[1]
- medications & psychotherapy are comparably effective[1][36]
- medication better than psychotherapy[12]
- psychotherapy of no benefit in preventing recurrence[10]
- psychosocial interventions improve response to medications, improve function, & decrease risk of relapse[1]
- treatment of patients with dementia is ineffective[15]
- elderly with depression that is not longstanding have little response (beyond a placebo effect) to a single antidepressant within 2-3-months[22]
- American Geriatrics Society (AGS/GRS8) suggests treatment for minor depression, acknowledging evidence is lacking regarding effective treatment[1]
- selection of antidepressant for elderly patient*
- SSRIs are 1st line agents[37]
- favorable safety profile
- start with low dose (start low & go slow)
- clinical response may take 4-8 weeks
- if inadequate response
- consider another class of antidepressant
- no indication for switching to another agent in same class
- drug to placebo difference not large[27]
- sertraline seems to strike the best balance between efficacy & tolerability[41]
- low risk among SSRI of QTc prolongation
- SSRI not effective in patients with Alzheimer's disease
- atypical antipsychotics & tricyclic antidepressants are 2nd line agents
- anticholinergic effects of concern[43]
- tricyclic antidepressants less appropriate for the elderly
- may worsen constipation & narrow-angle glaucoma
- cardiac complications are also a concern[43]
- amitriptyline associated with more frequent adverse effects than citalopram[26]
- anticholinergic effects of concern[43]
- for 1st episode, treat for at least 1 year; after 2-3 episodes, treat for 2-3 years; for > 3 episodes, treat indefinitely
- switch agents for patients in whom the initial agent failed[1]
- augmentation therapy is best strategy for partial response[1]
- maximize dose over 4-8 weeks, then add a second agent after 2-3 months only if needed[1]
- a partial response does predict increased likelihood of full remission[1]
- addition of bupropion to mirtazapine after failed therapy with sertraline & venlafaxine, ignoring frequent family conflict (GRS9)[1]
- augumentation of antidepressant with aripiprazole more effective than placebo or switching antidepresant to bupropion[68]
- fluoxetine & venlafaxine less effective in elderly patients, number needed to treat: 17-39 vs 4-6 for children & younger adults[16]
- addition of aripiprazole (Abilify) 10 mg/day to venlafaxine may improve treatment-resistant depression[2][47]
- addition of aripiprazole (15 mg QD) marginally better than addition of bupropion for suboptional response to SSRI. SNRI, or mirtazapine (22-29%)[59]
- levodopa improves processing speed & gait in elderly with depression but without Parkinson's disease[60]
- stimulants such as methylphenidate
- indicated at end of life if prognosis < 6 weeks[43]
- fast onset of action
- methylphenidate 5-10 mg BID plus citalopram up to 60 mg QD better than citalopram alone[40]
- indicated at end of life if prognosis < 6 weeks[43]
- addition of intranasal esketamine to oral antidepressant not helpful for treatment-resistant depression[61]
- aspirin of no benefit in prevention of depression[63]
- vitamin D of no benefit in prevention of depression[64]
- pharmacogenomic test-informed medication selection improves only secondary outcomes[62]
- SSRIs are 1st line agents[37]
- recurrence is common[13]
- residual symptoms after treatment may be due to
- persisting anxiety &/or residual sleep disorder[35]
- neurologic disorder[47]
- neuropsychologic testing for cognitive impairment or functional impairment[43]
- bright light therapy effective in younger patients
- alleviates depression +/- seasonal affective disorder
- superior to fluoxetine (study in Canada)[44]
- alternative medicine
- see depression
- vitamin B6, vitamin B12, & folate supplementation in addition to antidepressants may diminish relapses in depressed patients with elevated serum homocysteine[38]
- exercise may be of benefit
- significant antidepressant benefits observed for moderate to vigorous physical activity at doses below current recommendations for overall health[70]
- greater doses of physical activity are associated with greater benefits[70]
- significant antidepressant benefits observed for moderate to vigorous physical activity at doses below current recommendations for overall health[70]
- consider ECT if depression is life-threatening
- lifelong follow-up to identify recurrence
- minor depression may harold major depression[11]
* both hippocampal volume & cognitive processing speed (known to be linked with white matter integrity) predict antidepressant response to sertraline, consistent with other literature tying hippocampal plasticity & neogenesis to depression & treatment outcomes
More general terms
Additional terms
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - ↑ 2.0 2.1 2.2 2.3 Journal Watch 23(3):25, 2003 Unutzer J, Katon W, Callahan CM, Williams JW Jr, Hunkeler E, Harpole L, Hoffing M, Della Penna RD, Noel PH, Lin EH, Arean PA, Hegel MT, Tang L, Belin TR, Oishi S, Langston C; IMPACT Investigators. Improving Mood-Promoting Access to Collaborative Treatment. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA. 2002 Dec 11;288(22):2836-45. PMID: https://www.ncbi.nlm.nih.gov/pubmed/12472325
- ↑ 3.0 3.1 Yerevanian BI. In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 29-Oct 2, 2004
- ↑ Thompson LW, Cognitive-behavioral therapy and treatment of late life depression, J. Clin. Psychiatry 57(suppl 5):29-37, 1996
- ↑ Alexopoulous GS et al, ECT in the high risk geriatric patient, Convuls Ther 5:75, 1989
- ↑ NIH Consensus Development Panel on Depression in Late Life, JAMA 268:1018, 1992
- ↑ Rothchild AJ, The diagnosis and treatment of late life depression, J Clin Psychiatry 57(suppl 5):29, 1996 PMID: https://www.ncbi.nlm.nih.gov/pubmed/8647792
- ↑ 8.0 8.1 Journal Watch 24(24):184, 2004 Vinkers DJ, Gussekloo J, Stek ML, Westendorp RG, van der Mast RC. Temporal relation between depression and cognitive impairment in old age: prospective population based study. BMJ. 2004 Oct 16;329(7471):881. Epub 2004 Sep 02. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/15345599 <Internet> http://bmj.bmjjournals.com/cgi/content/full/329/7471/881
- ↑ 9.0 9.1 Hunkeler EM et al, Long-term outcomes from the IMPACT randomised trial for depressed elderly patients for primary care BMJ 2006; 332:259 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16428253
- ↑ 10.0 10.1 Reynolds CF III et al, Maintenance treatment of major depression in old age. N Engl J Med 2006; 354:1130 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16540613
Reifler BV Play it again, Sam - Depression is recurring N Engl J Med 2006; 354:1189 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16540621 - ↑ 11.0 11.1 Lyness JM, Heo M, Datto CJ, Ten Have TR, Katz IR, Drayer R, Reynolds CF 3rd, Alexopoulos GS, Bruce ML. Outcomes of minor and subsyndromal depression among elderly patients in primary care settings. Ann Intern Med. 2006 Apr 4;144(7):496-504. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16585663
Kroenke K. Minor depression: midway between major depression and euthymia. Ann Intern Med. 2006 Apr 4;144(7):528-30. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16585668 - ↑ 12.0 12.1 Dombrovski AY, Lenze EJ, Dew MA, Mulsant BH, Pollock BG, Houck PR, Reynolds CF 3rd. Maintenance Treatment for Old-Age Depression Preserves Health-Related Quality of Life: A Randomized, Controlled Trial of Paroxetine and Interpersonal Psychotherapy. J Am Geriatr Soc. 2007 Sep;55(9):1325-1332. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17767673
- ↑ 13.0 13.1 Luidendijk HJ et al, Incidence and recurrence of late-life depression. Arch Gen Psychiatry 2008, 65:1394 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19047526
- ↑ 14.0 14.1 Bruce ML et al. Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: A randomized controlled trial. JAMA 2004 Mar 3; 291:1081-91. PMID: https://www.ncbi.nlm.nih.gov/pubmed/14996777
- ↑ 15.0 15.1 15.2 15.3 Alexopoulos GS et al Reducing suicidal ideation and depression in older primary care patients: 24-month outcomes of the PROSPECT study. Am J Psychiatry 2009 Jun 15; [e-pub ahead of print] <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19528195 <Internet> http://dx.doi.org/10.1176/appi.ajp.2009.08121779
- ↑ 16.0 16.1 Journal Watch March 13, 2012, Massachusetts Medical Society Gibbons RD et al. Benefits from antidepressants: Synthesis of 6-week patient- level outcomes from double-blind placebo-controlled randomized trials of fluoxetine and venlafaxine. Arch Gen Psychiatry 2012 March 5; PMID: https://www.ncbi.nlm.nih.gov/pubmed/22393205
- ↑ 17.0 17.1 17.2 Godin O et al. Body mass index, blood pressure, and risk of depression in the elderly: A marginal structural model. Am J Epidemiol 2012 Aug 1; 176:204 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22781426
- ↑ 18.0 18.1 Sheline YI et al. Treatment course with antidepressant therapy in late-life depression. Am J Psychiatry 2012 Oct 3; PMID: https://www.ncbi.nlm.nih.gov/pubmed/23034601
- ↑ 19.0 19.1 Nelson JC et al. Moderators of outcome in late-life depression: A patient- level meta-analysis. Am J Psychiatry 2013 Jun 1; 170:651 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23598969 <Internet> http://ajp.psychiatryonline.org/article.aspx?articleid=1680036
- ↑ Leontjevas R et al. A structural multidisciplinary approach to depression management in nursing-home residents: A multicentre, stepped-wedge cluster-randomised trial. Lancet 2013 May 2 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23643110
Steffens DC. Exercise for late-life depression? It depends. Lancet 2013 May 2
Underwood M et al. Exercise for depression in elderly residents of care homes: A cluster-randomised controlled trial. Lancet 2013 May 2 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23643109
Stewart R. Reducing depression in nursing homes: So little, so late. Lancet 2013 May 2; PMID: https://www.ncbi.nlm.nih.gov/pubmed/23643108 - ↑ 21.0 21.1 Gallo JJ Long term effect of depression care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care. BMJ 2013;346:f2570 http://www.bmj.com/content/346/bmj.f2570
- ↑ 22.0 22.1 Nelson JC et al. Moderators of outcome in late-life depression: A patient- level meta-analysis. Am J Psychiatry 2013 Jun 1; 170:651. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23598969
- ↑ Alexopoulos GS, Raue PJ, Kiosses DN et al Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction: effect on disability. Arch Gen Psychiatry. 2011 Jan;68(1):33-41. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21199963
- ↑ Katon WJ, Lin EH, Von Korff M Collaborative care for patients with depression and chronic illnesses. N Engl J Med. 2010 Dec 30;363(27):2611-20 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21190455
- ↑ Meyers BS, Flint AJ, Rothschild AJ et al A double-blind randomized controlled trial of olanzapine plus sertraline vs olanzapine plus placebo for psychotic depression: the study of pharmacotherapy of psychotic depression (STOP-PD). Arch Gen Psychiatry. 2009 Aug;66(8):838-47 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19652123
- ↑ 26.0 26.1 Rosenberg C, Lauritzen L, Brix J Citalopram versus amitriptyline in elderly depressed patients with or without mild cognitive dysfunction: a danish Psychopharmacol Bull. 2007;40(1):63-73. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17285097
- ↑ 27.0 27.1 Schneider LS, Nelson JC, Clary CM et al An 8-week multicenter, parallel-group, double-blind, placebo- controlled study of sertraline in elderly outpatients with major depression. Am J Psychiatry. 2003 Jul;160(7):1277-85. PMID: https://www.ncbi.nlm.nih.gov/pubmed/12832242
- ↑ Lynch TR, Schneider KG, Rosenthal MZ, Cheavens JS A mediational model of trait negative affectivity, dispositional thought suppression, and intrusive thoughts following laboratory stressors. Behav Res Ther. 2007 Apr;45(4):749-61. Epub 2006 Aug 28. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16934744
- ↑ 29.0 29.1 29.2 Barry LC, Murphy TE, Gill TM. Depression and functional recovery after a disabling hospitalization in older persons. J Am Geriatr Soc. 2011 Jul;59(7):1320-5.Epub 2011 Jun 13. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21668916
Pierluissi E, Mehta KM, Kirby KA, et al. Depressive symptoms after hospitalization in older adults: function and mortality outcomes. J Am Geriatr Soc. 2012;60:2254-2262 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23176725 - ↑ Gonzalez HM, Haan MN, Hinton L. Acculturation and the prevalence of depression in older Mexican Americans: baseline results of the Sacramento Area Latino Study on Aging. J Am Geriatr Soc. 2001 Jul;49(7):948-53. PMID: https://www.ncbi.nlm.nih.gov/pubmed/11527487
- ↑ Barry LC, Allore HG, Bruce ML, Gill TM. Longitudinal association between depressive symptoms and disability burden among older persons. J Gerontol A Biol Sci Med Sci. 2009 Dec;64(12):1325-32. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19776217
- ↑ Grabovich A, Lu N, Tang W, Tu X, Lyness JM Outcomes of subsyndromal depression in older primary care patients. Am J Geriatr Psychiatry. 2010 Mar;18(3):227-35 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20173424
- ↑ Hegerl U, Schonknecht P, Mergl R. Are antidepressants useful in the treatment of minor depression: a critical update of the current literature. Curr Opin Psychiatry. 2012 Jan;25(1):1-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22156931
- ↑ Lyness JM, Kim J, Tang W et al The clinical significance of subsyndromal depression in older primary care patients. Am J Geriatr Psychiatry. 2007 Mar;15(3):214-23. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17213374
- ↑ 35.0 35.1 Dombrovski AY, Mulsant BH, Houck PR et al Residual symptoms and recurrence during maintenance treatment of late-life depression. J Affect Disord. 2007 Nov;103(1-3):77-82. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17321595
- ↑ 36.0 36.1 Pinquart M, Duberstein PR, Lyness JM. Treatments for later-life depressive conditions: a meta- analytic comparison of pharmacotherapy and psychotherapy. Am J Psychiatry. 2006 Sep;163(9):1493-501. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16946172
- ↑ 37.0 37.1 37.2 37.3 Taylor WD Depression in the Elderly. N Engl J Med 2014; 371:1228-1236. September 25, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25251617 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcp1402180
- ↑ 38.0 38.1 38.2 Almeida OP et al. B vitamins to enhance treatment response to antidepressants in middle-aged and older adults: Results from the B-VITAGE randomised, double-blind, placebo-controlled trial. Br J Psychiatry 2014 Sep 25; PMID: https://www.ncbi.nlm.nih.gov/pubmed/25257064
- ↑ Mojtabai R. Diagnosing depression in older adults in primary care. N Engl J Med. 2014;370:1180-1182 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24670164
- ↑ 40.0 40.1 Lavretsky H et al. Citalopram, methylphenidate, or their combination in geriatric depression: A randomized, double-blind, placebo-controlled trial. Am J Psychiatry 2015 Feb 13 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25677354 <Internet> http://psychiatryonline.org/doi/abs/10.1176/appi.ajp.2014.14070889
- ↑ 41.0 41.1 Thorlund K et al. Comparative efficacy and safety of selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors in older adults: A network meta-analysis. J Am Geriatr Soc 2015 May; 63:1002 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25945410 <Internet> http://onlinelibrary.wiley.com/doi/10.1111/jgs.13395/abstract
- ↑ Lenze EJ et al Efficacy, safety, and tolerability of augmentation pharmacotherapy with aripiprazole for treatment-resistant depression in late life: a randomised, double-blind, placebo- controlled trial. Lancet. Published Online: 27 September 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26423182 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2900308-6/abstract
Thomas A, O'Brien JT Management of late-life depression: a major leap forward. Lancet. Published Online: 27 September 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26423179 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2900304-9/abstract - ↑ 43.0 43.1 43.2 43.3 43.4 43.5 43.6 Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 44.0 44.1 Lam RW et al Efficacy of Bright Light Treatment, Fluoxetine, and the Combination in Patients With Nonseasonal Major Depressive Disorder. A Randomized Clinical Trial. JAMA Psychiatry. Published online November 18, 2015. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26580307 <Internet> http://archpsyc.jamanetwork.com/article.aspx?articleid=2470681
- ↑ van der Aa HPA et al Stepped care for depression and anxiety in visually impaired older adults: multicentre randomised controlled trial. BMJ 2015;351:h6127 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26597263 <Internet> http://www.bmj.com/content/351/bmj.h6127
- ↑ 46.0 46.1 Kaup AR et al. Trajectories of depressive symptoms in older adults and risk of dementia. JAMA Psychiatry 2016 Mar 16 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26982217
- ↑ 47.0 47.1 47.2 Kaneriya SH et al. Predictors and moderators of remission with aripiprazole augmentation in treatment-resistant late-life depression: An analysis of the IRL-GRey randomized clinical trial. JAMA Psychiatry 2016 Mar 9; PMID: https://www.ncbi.nlm.nih.gov/pubmed/26963689
- ↑ Aziz R, Steffens DC. What are the causes of late-life depression? Psychiatr Clin North Am. 2013 Dec;36(4):497-516. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24229653 Free PMC Article
- ↑ VanItallie TB. Subsyndromal depression in the elderly: underdiagnosed and undertreated. Metabolism. 2005 May;54(5 Suppl 1):39-44. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15877312
- ↑ 50.0 50.1 Davydow DS, Hough CL, Zivin K, Langa KM, Katon WJ. Depression and risk of hospitalization for pneumonia in a cohort study of older Americans. J Psychosom Res. 2014 Dec;77(6):528-34. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25139125 Free PMC Article
- ↑ 51.0 51.1 Katon WJ, Lin E, Russo J, Unutzer J. Increased medical costs of a population-based sample of depressed elderly patients. Arch Gen Psychiatry. 2003 Sep;60(9):897-903. PMID: https://www.ncbi.nlm.nih.gov/pubmed/12963671
- ↑ 52.0 52.1 Unutzer J, Schoenbaum M, Katon WJ Healthcare costs associated with depression in medically Ill fee-for-service medicare participants. J Am Geriatr Soc. 2009 Mar;57(3):506-10. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19175438
- ↑ Shanmugham B, Karp J, Drayer R et al Evidence-based pharmacologic interventions for geriatric depression. Psychiatr Clin North Am. 2005 Dec;28(4):821-35, viii. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16325731
- ↑ 54.0 54.1 Marshe VS, Maciukiewicz M, Rej S et al. Norepinephrine transporter gene variants and remission from depression with venlafaxine treatment in older adults. Am J Psychiatry 2017 Jan 10; [e-pub]. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28068779 <Internet> http://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2016.16050617
- ↑ Kok RM, Reynolds CF III. Management of Depression in Older Adults. A Review. JAMA. 2017;317(20):2114-2122 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28535241 <Internet> http://jamanetwork.com/journals/jama/article-abstract/2627976
- ↑ 56.0 56.1 Schaakxs R, Comijs HC, Lamers F et al. Associations between age and the course of major depressive disorder: A 2-year longitudinal cohort study. Lancet Psychiatry 2018 Jun 7; PMID: https://www.ncbi.nlm.nih.gov/pubmed/29887519
Ng TP. Old age depression: Worse clinical course, brighter treatment prospects? Lancet Psychiatry 2018 Jun 7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29887520 - ↑ Hashem AH, M N, Gomaa MA, Khalaf OO. Late versus Early Onset Depression in Elderly Patients: Vascular Risk and Cognitive Impairment. Curr Aging Sci. 2017;10(3):211-216. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28382870
- ↑ 58.0 58.1 Wei W, Karim HT, Lin C et al. Trajectories in cerebral blood flow following antidepressant treatment in late-life depression: Support for the vascular depression hypothesis. J Clin Psychiatry 2018 Oct 23; 79:18m12106 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30358242 https://www.psychiatrist.com/JCP/article/Pages/2018/v79/18m12106.aspx
- ↑ 59.0 59.1 Zisook S, Johnson GR, Tal I et al. General predictors and moderators of depression remission: A VAST-D report. Am J Psychiatry 2019 Apr 5; PMID: https://www.ncbi.nlm.nih.gov/pubmed/30947531 https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2018.18091079
- ↑ 60.0 60.1 Rutherford BR, Slifstein M, Chen C et al. Effects of L-DOPA monotherapy on psychomotor speed and [11C]raclopride binding in high risk depressed older adults. Biol Psychiatry 2019 Apr 15; PMID: https://www.ncbi.nlm.nih.gov/pubmed/31178096 https://www.biologicalpsychiatryjournal.com/article/S0006-3223(19)31272-7/fulltext
- ↑ 61.0 61.1 Ochs-Ross R, Daly EJ, Zhang Y, et al. Efficacy and safety of esketamine nasal spray plus an oral antidepressant in elderly patients with treatment-resistant depression.
TRANSFORM-3. Am J Geriatr Psychiatry 2020 Feb; 28:121. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31734084 Free Article https://www.sciencedirect.com/science/article/pii/S1064748119305330 - ↑ 62.0 62.1 Forester BP, Parikh SV, Weisenbach S et al. Combinatorial pharmacogenomic testing improves outcomes for older adults with depression. Am J Geriatr Psychiatry 2020 May 19. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32513518 https://www.sciencedirect.com/science/article/pii/S1064748120303341
- ↑ 63.0 63.1 Berk M, Woods RL, Nelson MR et al. Effect of aspirin vs placebo on the prevention of depression in older people: A randomized clinical trial. JAMA Psychiatry 2020 Jun 3;:e201214. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32492080 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2766709
- ↑ 64.0 64.1 Okereke OI, Reynolds CF 3rd, Mischoulon D et al. Effect of long-term vitamin D3 supplementation vs placebo on risk of depression or clinically relevant depressive symptoms and on change in mood scores: A randomized clinical trial. JAMA 2020 Aug 4; 324:471 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32749491 https://jamanetwork.com/journals/jama/fullarticle/2768978
- ↑ 65.0 65.1 Taylor WD et al. Preliminary evidence that cortical amyloid burden predicts poor response to antidepressant medication treatment in cognitively intact individuals with late-life depression. Am J Geriatr Psychiatry 2020 Sep 28; PMID: https://www.ncbi.nlm.nih.gov/pubmed/33032927 https://www.sciencedirect.com/science/article/abs/pii/S1064748120305017
- ↑ Alexopoulos G. Mechanisms and treatment of late-life depression. Transl Psychiatry. 2019;9:188 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31383842 PMCID: PMC6683149 Free PMC article https://www.nature.com/articles/s41398-019-0514-6
- ↑ Blazer DG. Depression in late life: review and commentary J Gerontol A Biol Sci Med Sci. 2003 Mar;58(3):249-65 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12634292 Review.
- ↑ 68.0 68.1 Lenze EJ, Mulsant BH, Roose SP et al Antidepressant Augmentation versus Switch in Treatment-Resistant Geriatric Depression. N Engl J Med 2023. March 3 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36867173 https://www.nejm.org/doi/full/10.1056/NEJMoa2204462
- ↑ 69.0 69.1 Qiu X, Shi L, Kubzansky LD et al Association of Long-term Exposure to Air Pollution With Late-Life Depression in Older Adults in the US. JAMA Netw Open. 2023;6(2):e2253668 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36763364 PMCID: PMC9918878 Free PMC article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2801241
- ↑ 70.0 70.1 70.2 Laird E, Rasmussen CL, Kenny RA, Herring MP. Physical Activity Dose and Depression in a Cohort of Older Adults in The Irish Longitudinal Study on Ageing. JAMA Netw Open. 2023 Jul 3;6(7):e2322489. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37428505 PMCID: PMC10334250 Free PMC article.
- ↑ 71.0 71.1 Alexopoulos GS, Raue PJ, Banerjee S et al Modifiable predictors of suicidal ideation during psychotherapy for late-life major depression. A machine learning approach. Transl Psychiatry. 2021 Oct 18;11(1):536. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34663787 Free PMC article. Clinical Trial.
- ↑ 72.0 72.1 Davison TE, Bhar S, Wells Y, et al. Psychological therapies for depression in older adults residing in long-term care settings. Cochrane Database Syst Rev. 2024 Mar 19;3(3):CD013059. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38501686 PMCID: PMC10949416 (available on 2025-03-19)
- ↑ Older Adults: Depression and Suicide Facts http://www.nimh.nih.gov/publicat/elderlydepsuicide.cfm