title: [Depression in the elderly].
abstract: The incidence of depression is higher than that of dementia in the elderly. Unlike depression in other age groups, that in the elderly is characterized by frequent physical complaints, irritation, and delusional tendencies. The treatment of depression in the elderly requires the complex incorporation of psychiatric and gerontological viewpoints. Psychiatrically, difficulty in accepting decreases in psychological and physical functions and solitude is important, as a psychological characteristic, inducing the development of depression. Biochemically, there is an underlying decrease in the function of brain monoaminergic nerve activated, such as by serotonin and noradrenalin. Radiologically, damage to the cerebral white matter and a decrease in the frontal lobe function have been frequently reported. Depression is difficult to differentiate from dementia and is also often complicated by dementia. Since a depressive state often precede Alzheimer's disease, evaluation of cognitive function is also necessary in patients with a depressive state. Although apathy is often observed as a symptom of dementia and tends to be confused with a depressive symptom, caution is necessary because of differences in the treatment method. Gerontologically, depression is one of geriatric syndrome and isa frequently observed in the elderly in the later stage and closely associated with a decrease in activities of daily life. Depression is also closely associated with lifestyle-related diseases, and its incidence is high in the presence of cerebrovascular disease, ischemic heart disease, hypertension, and diabetes mellitus, and conversely, depression is often complicated by lifestyle-related disease. Anxiety and depression are frequently observed in the frail elderly, but few studies on the assessment and appropriate approach for psychological matters. Further studies are necessary. The treatment of depression in the elderly could be classified into 3 stages. In the acute stage, the treatment method is the same as that in other age groups, mainly consisting of physical and psychological rest and medication. The drug of first choice is a selective serotonin re-uptake inhibitors (SSRI). In intractable cases, electroconvulsive therapy (ECT) is recommended. In the chronic stage, the prevention of disuse syndrome is necessary, and activating approaches such as exercise therapy are used. In addition, support for patients with decreased activities of daily living and the establishment of a community-based cooperation system for the prevention of suicides are future areas to be tackled. It is important that concomitant dementia and physical illness are appropriately assessed and treated in all stages.
authors.affiliation: Department of Behaviour and Psychological Therapy, National Hospital for Geriatric Medicine.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Hattori
mesh_terms: D000368:Aged; D003704:Dementia / Q000150:complications; D003863:Depression / Q000523:psychology / Q000628:therapy; D016330:Frail Elderly / Q000523:psychology; D006801:Humans; D008019:Life Style