Diagnosis and treatment of depression in late life.
Major depression and dysthymia are common and often disabling disorders in late life. Several features of late-life depression, such as its frequent association with general medical conditions, polypharmacy, cognitive disturbances, and adverse life events, make accurate diagnosis a substantial clinical challenge. Yet, prompt diagnosis is an important component of implementing appropriate treatment strategies. An ideal treatment program integrates patient and family education, focused psychotherapy, and pharmacotherapy. Because of pharmacokinetic and pharmacodynamic changes associated with aging, lower doses of medication and more gradual dose increases than are required in younger adults are needed in the treatment of elderly depressed patients. In addition, medications should be selected that have minimal antihistaminic, anticholinergic, and antiadrenergic effects, minimal cardiovascular risk, and minimal drug-drug interactions. Since depression in late life tends to be at least as chronic and/or recurrent as depression earlier in life, treatment for acute depressive episodes should last at least 6-8 months, and long-term maintenance treatment should be considered in selected individuals.
Zisook
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Department of Psychiatry, University of California, San Diego, La Jolla 92093-0603, USA.
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D000328:Adult; D000367:Age Factors; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D016642:Bupropion / Q000627:therapeutic use; D003072:Cognition Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D003131:Combined Modality Therapy; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D004334:Drug Administration Schedule; D019263:Dysthymic Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D004565:Electroconvulsive Therapy; D005190:Family; D006266:Health Education; D006801:Humans; D008016:Life Change Events; D008875:Middle Aged; D010353:Patient Education as Topic; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy; D012720:Severity of Illness Index
D000928:Antidepressive Agents; D016642:Bupropion