[Depression and the elderly].
"Depression" and "old age" are often associated among our contemporaries. In this case, "depression" is understood to be "existential despair" and not a "depressive disease": an amalgam is made of the tragedy of the patient's existence and a pathological condition. Clinical pictures of depression, the pathological nature of which is obvious, are frequent in the elderly; however, the line between normal and pathological becomes less clear above a certain symptomatic threshold, in the presence of chronic evolutions and in situations of comorbidity. The nosographical tool, in spite of its limits, is precious. Epidemiological studies that include the comorbidities of the depressive episode with cognitive and/or somatic affections permit better estimations of the prevalence of the symptoms and the depressive problems among elderly populations. The formula "depression is depression at whatever age" harbours a certain truth if one takes into account the multiple factors that modify the symptomatic expression of depression in later life. The most documented factor is the comorbidity of depression with somatic affections that is present in the majority of those aged over 80. Other psychological or sociocultural factors are also apparent, but their influence has been studied less. The decline in cognitive performance observed during depression is not exclusive to the elderly but is undeniably more marked in this population. Making an early diagnosis of Alzheimer's disease or, conversely, eliminating this diagnosis in a depressed patient complaining of diminished cognition is an essential step in the subsequent management. Together with the neuropsychological assessment and brain imaging, required for diagnosis, a neuropsychogeriatric pluridisciplinary assessment is obviously required. The management of geriatric depression is based on various approaches that include somatic care, psychotropic drugs, brain stimulation techniques and psychotherapy, but also requires medicosocial care. The coordination of care is incumbent on the general practitioner in the heart of the plan. However, this theoretical mission may appear impossible for the management of complex cases. Based on this, reflections on were initiated on the modalities of adapting the Anglo-Saxon "collaborative care" to France: coordination of the various therapeutic interventions by a care manager would offer greater efficacy than that of the usual care modalities.
Gallarda
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Inserm, U 894-7, physiopathologie des maladies psychiatriques, Paris, France. t.gallarda@ch-sainte-anne.fr
Lôo
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D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D002908:Chronic Disease; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D003937:Diagnosis, Differential; D005196:Family Therapy; D006304:Health Status; D006801:Humans; D010348:Patient Care Team; D011613:Psychotherapy
D000928:Antidepressive Agents