Treatment Of Depression In Elderly Patients Research Articles

Differences in gut microbiota correlate with symptoms and regional brain volumes in patients with late-life depression.

Depression is associated with gut dysbiosis that disrupts a gut-brain bidirectional axis. Gray matter volume changes in cortical and subcortical structures, including prefrontal regions and the hippocampus, have also been noted in depressive disorders. However, the link between gut microbiota and brain structures in depressed patients remains elusive. Neuropsychiatric measures, stool samples, and structural brain images were collected from 36 patients with late-life depression (LLD) and 17 healthy controls. 16S ribosomal RNA (rRNA) gene sequencing was used to profile stool microbial communities for quantitation of microbial composition, abundance, and diversity. T1-weighted brain images were assessed with voxel-based morphometry to detect alterations in gray matter volume between groups. Correlation analysis was performed to identify the possible association between depressive symptoms, brain structures and gut microbiota. We found a significant difference in the gut microbial composition between patients with late-life depression (LLD) and healthy controls. The genera Enterobacter and Burkholderia were positively correlated with depressive symptoms and negatively correlated with brain structural signatures in regions associated with memory, somatosensory integration, and emotional processing/cognition/regulation. Our study purports the microbiota-gut-brain axis as a potential mechanism mediating the symptomatology of LLD patients, which may facilitate the development of therapeutic strategies targeting gut microbes in the treatment of elderly depressed patients.

New approaches to the typology and prediction of the effectiveness of therapy for late-life depression

To analyze clinical parameters and effectiveness of therapy in depressed patients of late age with different activity of enzymes of energy, glutamate metabolism and antioxidant glutathione system in platelets and red blood cells. The study included 53 hospitalized patients (41 women and 12 men), aged 60 to 86 years (median - 66 years), with a depressive episode of mild to marked severity within the framework of recurrent depressive disorder, bipolar affective disorder or a single depressive episode according to ICD-10. The patients were examined using clinical, psychometric, biochemical and statistical methods. Psychometric assessment of patients' condition was performed before the start of therapy and on the 28th day of treatment using HAMD-17 and HARS. Blood sampling was carried out to determine the activity of cytochrome c-oxidase (COX), glutathione reductase (GR), glutathione S-transferase (GST) and glutamate dehydrogenase (GDH). Cluster analysis revealed 3 clusters (Cl.1, Cl.2, Cl.3), which differed in biochemical indicators. In Cl.1 (n=24, 45.2%), there was a decrease in the activity of COX (p<0.05) and a decrease of GR activity in red blood cells and GST activity in platelets (p<0.001). Patients of Cl.2 (n=11, 20.8%) had increased COX activity (p<0.001) and decreased GDH activity (p<0.001). In patients of Cl.3 (n=18, 34%) the enzyme activity was similar to that in the controls. Later age at disease onset was observed in Cl.1 compared to Cl.2 (51 years [40; 60.5] and 32 years [19; 59], p=0.052). Compared with Cl.2 and Cl.3, patients of Cl.1 significantly more often (p<0.05) had apathetic depressions (41.7%), while complex depressions were observed almost 2 times less often than in Cl.2 (50% and 91.9%, p<0.05). The effectiveness and tolerability of psychopharmacotherapy was higher in Cl.3. There is a relationship between the nature of changes in metabolic parameters and differences in the phenomenology and course of late-age depression. The results of the study open up new directions in the field of predicting the effectiveness of therapy and the development of personalized therapeutic approaches to improve the effectiveness and safety of treatment of depressed elderly patients.

PERCEPTIONS, ATTITUDE AND PRACTICES TOWARD ELDERLY DEPRESSION AMONG PRIMARY HEALTH CARE PHYSICIANS, RIYADH, SAUDI ARABIA 2021

Background: Elderly people need care services in particular to maintain a high quality of life and health status. Managing the health needs of geriatric patients is part of the continuity of care family physicians provide to their patients. Aims: to assess physicians attitude, perception and practice toward depression in elderly in primary care sitting. Methodology: A cross- sectional study to assess primary health care physicians attitude and perceptions and practices toward depression in elderly patients in primary health care centers of King Saud medical city in Riyadh, kingdom of Saudi Arabia using self-administrated questionnaire Results: We received 210 responses to our questionnaire with response rate of 100 % where 51 % of them were females. Furthermore, 37 % of them have experience in PHC less than 5 years while 32 % have experience for more than 10 years. PHC physicians routinely screen for sleep disturbance (79 %), loss of interest or pleasure (79 %), sad mood (72 %), and decreased energy (63 %) in order to diagnosis of depression. Moreover, we found that 56 % of physicians would use clinical guidelines for diagnosis and treatment of geriatric depression where PHQ-9 was the most reported used tool (28 %) followed by geriatric depression scales (24%). Moreover, 71 % of physicians would refer patients with depression to psychiatry and 65 % to CBT instead to prescribe medications including SNRI (29 %), TCA (17 %) and SSRI (2 %). Moreover, the main barriers to adequate diagnosis and treatment of elderly depressed patients were rejection of patients to treatment (22 % of them indicated it as major problem) and difficulty for access to mental health care in our community (19 % of them indicated it as major problem). Conclusion: we found that most of physicians in Riyadh show high positive attitude toward depression of elderly however, there is some limitations in knowledge about symptoms of depression and restriction to guideline. Main barriers to adequate diagnosis and treatment of elderly depressed patients were rejection of patients to treatment and difficulty for access to mental health care in our community.

Perceptions, attitude and practices toward elderly depression among primary health care physicians, Riyadh, Saudi Arabia, 2021.

Background: Elderly people need to care services in particular to maintain a high quality of life and health status. Managing the health needs of geriatric patients is part of the continuity of care family physicians provide to their patients. Aims: to assess physicians' attitude, perception and practice toward depression in elderly in primary care sitting.Methodology: A cross- sectional study to assess primary health care physicians' attitude and perceptions and practices toward depression in elderly patients in primary health care centers of King Saud medical city in Riyadh, kingdom of Saudi Arabia using self-administrated questionnaire Results: We received 210 responses to our questionnaire with response rate of 100% where 51% of them were females. PHC physicians routinely screen for sleep disturbance (79%), loss of interest or pleasure (79%), sad mood (72%), and decreased energy (63%) in order to diagnosis of depression. Moreover, we found that 56% of physicians would use clinical guidelines for diagnosis and treatment of geriatric depression. Furthermore, the main barriers to adequate diagnosis and treatment of elderly depressed patients were rejection of patients to treatment (22% of them indicated it as major problem) and difficulty for access to mental health care in our community (19% of them indicated it as major problem).Conclusion: we found that most of the physicians in Riyadh show high positive attitude toward depression of elderly however, there are some limitations in knowledge about symptoms of depression and restriction to guideline.

Clinical efficacy and safety of escitalopram in the treatment of depressed elderly patients with insomnia

Objective To investigate the clinical efficacy and safety of escitalopram in the treatment of depressed elderly patients with insomnia. Methods According to the digital table, 60 depressed elderly patients with insomnia were selected and randomly divided into the control group and the observation group, 30 cases in each group.The control group was treated by citalopram, the observation group was treated by escitalopram, the two groups were treated for 8 weeks.The depression and sleep quality were tested by HAMD and PSQI before and after treatment, and the incidence of adverse reactions and the total clinical efficacy were compared between the two groups in the same time. Results Compared with pre-treatment, the HAMD scores in the control group and observation group were decreased from (26.76±3.47)points and (26.53±3.44)points to (13.48±1.36)points and (18.25±2.15)points respectively; the PSQI scores were decreased from (26.76±3.47)points and (26.53±3.44)points to (13.48±1.36)points and (18.25±2.15)points respectively, and the differences were statistically significant(all P<0.05). After treatment, compared with the control group, the HAMD score(t=10.270, P=0.000) and PSQI score(t=-7.712, P=0.000) in the observation group were significantly lower.The incidence rate of adverse effects was lower(χ2=0.425, P=0.935) and the total effective rate was higher, but without statistically significant differences(χ2=2.785, P=0.426). Conclusion Escitalopram can improve the depression of elderly depression patients with insomnia, improve sleep quality with high safety. Key words: Depressive disorder; Sleep initiation and maintenance disorders; Escitalopram; Middle aged; Aged

Methods of augmentation of antidepressant therapy (on the model of complex therapy with the inclusion of actovegin) in gerontopsychiatric hospital

Increasing the effectiveness of treatment of elderly depressed patients in the conditions of the gerontopsychiatric hospital by augmentation of actovegin to antidepressants of new generations (fluvoxamine, venlafaxine or agomelatine). The efficacy of the therapy was compared in two groups of 21 patients aged 60 to 79 years with mild to moderate depression in ICD-10 receiving 8-week antidepressant mono- or combined therapy with actovegin. The effectiveness criteria were changes in the mean total scores on the HAMD-17, HARS, CGI scales, as well as the proportion of respondents and the quality of getting out of depression. Cognitive activity was assessed using MMSE, 10 word memory tests and drawing of clock. It has been established that the use of complex antidepressants therapy with the inclusion of actovegin allows for a more rapid and pronounced therapeutic effect compared to monotherapy with antidepressants. This is confirmed earlier (by the 4th week) and significant reduction of depressive and anxious symptoms (p<0.01), a greater number of responders and better quality of depressive outcomes by the end of treatment. In patients with complex therapy, there was also a faster improvement in cognitive functioning. Obtained results allow us to recommend the inclusion of actovegin in the antidepressant therapy regimen of elderly in-patients with the aim of achieving a faster and fuller therapeutic response and shortening hospitalization.

Fysioterapeuters erfaringer med bruk av fysisk aktivitet til eldre deprimerte

This article is based upon a study of the experiences of physiotherapists working with elderly depressed patients and the use of physical activity. Depression in the elderly is a common condition, and it is estimated to be the second most common cause of failing health towards 2020. Physical activity has a positive effect on depression in the elderly. The aim of this study was to investigate the experiences of physiotherapist`s in the treatment of elderly depressed patients over 65 years of age. Data was collected by qualitative reasearch interviews of 5 physiotherapists. Important findings of this study were that the physiotherapists experienced that they did not get any referrals to treatment solely due to depression, and that they needed a different approach to physical activity compared to other patient groups.

Subkutan siyanür enjeksiyonu ile özkıyım girişimi: Bir olgu sunumu

Cyanide is a powerful poison which cause inhibition of mitochondrial cytochrome oxidase system. Cyanide poisining can present in a wide variety of forms such as inhalation, ingestion or injection. Dermal exposure is rare, very few case reports have been reported about cyanide. In this paper, we present an uncommon case of a suicide attempt with cyanide injection. A 91 year old man with a history of depression admitted to the emergency department after injected cyanide to himself subcutaneously. He was diagnosed with depressive disorder and hospitalized after psychiatric assessment. The psychiatric history of this patient suggests that depression in elderly can give way to serious suicides attempts. Psychiatrists interested in treatment of elderly depressed patients should do careful monitoring about suicide.

P.2.c.015 A randomised, double-blind, placebo-controlled, active-referenced study of the multimodal antidepressant Lu AA21004 in the treatment of elderly depressed patients

P.2.c.015 A randomised, double-blind, placebo-controlled, active-referenced study of the multimodal antidepressant Lu AA21004 in the treatment of elderly depressed patients

The inflammation hypothesis in geriatric depression

A large body of research has focused on "mediating mechanisms" and predisposing brain abnormalities to geriatric depression, but little is known about its etiology. This paper examines whether age-related and comorbid disease-related immune deregulation is an etiologic contributor to geriatric depression. This article reviews findings on neuroinflammation during the aging process and depression as well as studies of anti-inflammatory actions of classical antidepressants and antidepressant actions of anti-inflammatory agents. Aging results in increased peripheral immune responses, impaired peripheral-CNS immune communication, and a shift of the CNS into a pro-inflammatory state. These exaggerated and prolonged immune responses may lead to changes in the function of emotional and cognitive networks pertinent to geriatric depression and to behavioral changes reminiscent of the depressive and cognitive symptoms of geriatric depression. Some antidepressants may reduce the expression of inflammation markers. Limited data suggest that some anti-inflammatory agents may have antidepressant properties. A synthesis of available findings suggests that aging-related and comorbid disease-related inflammatory processes may promote changes in the neural systems predisposing to geriatric depression or facilitating metabolic changes that mediate depressive syndromes. The "inflammation hypothesis" in geriatric depression cannot be tested in its entirety, but it can lead to testable hypotheses and data on mechanisms by which inflammatory processes promote geriatric depression. The significance of such an effort is that it may lead to a novel treatment development model bringing to bear recent advances of anti-inflammatory pharmacology to the treatment of depressed elderly patients.

Early response as predictor of final remission in elderly depressed patients

Several studies have attempted to predict the final response or remission based on improvement during the early course of treatment of major depression. There is however a great variation in cut offs used to define early response and in the optimal week to predict final results. To compare different cut offs at different time points early in the treatment of elderly depressed patients. A 12 week randomised, controlled trial in 81 elderly inpatients with DSM-IV major depression comparing venlafaxine with nortriptyline. At least 20, 25, 30 or 50% improvement was analysed after 1, 3 and 5 weeks using the Hamilton Depression Rating Scale and the Montgomery Asberg Depression Rating Scale. We plotted sensitivity against 1-specificity and calculated areas under the curve (AUCs). The highest percentage of correctly classified patients is found using at least 50% decrease as cut off in week 5, with acceptable sensitivity (81.8%) and specificity (87.4%). In week 5, the AUCs were 0.891 (95% CI 0.798-0.984) and 0.866 (95% CI 0.789-0.983) for the HAM-D and MADRS, respectively. Combining the results from our study and the other studies addressing this issue, we suggest that the treatment should be changed in the elderly if after 3-4 weeks less than 30% improvement in depression score has been achieved.

Gerontopsychiatrie versus Allgemeinpsychiatrie bei stationärer Behandlung von Depressionen im höheren Lebensalter

Is the integrated treatment of depressed elderly patients on a geriatric psychiatry unit superior to the treatment on a general psychiatry unit? Retrospective comparison of treatment outcomes of depression in elderly patients on geriatric and general psychiatry units. The clinical outcome showed comparable results. Somatic examinations turned out to be more comprehensive on a geriatric psychiatry unit, which also showed better results in pharmacotherapeutic safety. Regarding risk management, geriatric psychiatry units proved superior to general psychiatry units.

Sertraline Versus Fluvoxamine in the Treatment of Elderly Patients With Major Depression

Major depression is a common psychiatric disorder in the elderly population. The efficacy of tricyclic antidepressants is well established, and selective serotonin reuptake inhibitors appear to have a similar effectiveness along with advantages in terms of tolerability and safety. Given the lack of literature data regarding fluvoxamine in the treatment of depressed elderly patients, the aim of the present study was to compare its efficacy and tolerability with those of sertraline in a sample of elderly patients. Under double-blind conditions, 93 hospitalized patients older than 59 years, who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for a major depressive episode, were randomly assigned to receive sertraline (150 mg daily) or fluvoxamine (200 mg daily) for 7 weeks. The clinical response was defined as a reduction on the Hamilton Rating Scale for Depression score to 8 or below. At study completion, the response rates were 55.6% (25/45) and 71.8% (28/39) for sertraline and fluvoxamine, respectively. No significant difference in final response rates was found between the 2 treatment groups (P = 0.12). A repeated-measures analysis of variance on Hamilton Rating Scale for Depression scores revealed a significantly different decrease of depressive symptoms between the 2 treatment groups, favoring fluvoxamine (P = 0.007). The overall safety profile of sertraline and fluvoxamine was favorable with no differences between the 2 drugs. The results of this double-blind trial show that sertraline and fluvoxamine may be effective compounds in the treatment of elderly depression with the latter showing some advantage in terms of speed of response. These findings warrant further replication in placebo-controlled studies.

Discrepancy between opinion and attitude on the practice of ECT by psychiatrists specializing in old age in the Netherlands.

Current guidelines consider electroconvulsive therapy (ECT) in the Netherlands a treatment of choice for a depressive disorder with psychotic features, severe suicidal behavior, severe physical exhaustion, or resistance to treatment with antidepressants (consecutively SSRIs, TCAs, lithium, MAO inhibitors). It is advised to use ECT early on in the treatment of depressed elderly patients. In practice, ECT is applied to only a minority of depressed elderly patients in the Netherlands. This situation dates back to the 1970s, in which strong aversive opinions toward ECT grew in the Netherlands, largely as a reaction to the malpractice of ECT in that time and influenced by social-cultural opinions toward psychiatry. Negative attitudes among professionals and lack of knowledge may contribute to the under use in depressed elderly patients. A postal questionnaire was sent to 152 psychiatrists who specialize in old age to assess their opinions and attitudes toward ECT. Only a small minority thought ECT was a treatment of choice in a depressive disorder with psychotic features (4%), severe suicidal risk (2%), or physical exhaustion (5%). The majority of the psychiatrists had strongly reserved opinions in considering ECT as a treatment of first, second or third choice in depressed elderly patients, even in treatment-resistant depressive disorders. Many psychiatrists who specialize in old age in the Netherlands divert from the current guidelines and are reluctant toward using ECT as a treatment of choice in a number of specific, clinical situations. This might be a major contributing factor to the present and past underuse of ECT in depressed elderly patients in the Netherlands.

Milnacipran in the treatment of elderly depressed patients including a case of interferon-induced depression

Elderly patients represent a particularly fragile patient group that requires highly effective but extremely well tolerated antidepressants. Two cases are reported showing that the serotonin and noradrenaline reuptake inhibitor, milnacipran, is both effective and well tolerated. One case is the first reported in which milnacipran is shown to effectively reduce interferon-induced depressive symptoms.

Depression in Late Life, 3rd ed.

Back to table of contents Previous article Next article Book Forum: TextbooksFull AccessDepression in Late Life, 3rd ed.GEORGE S. ALEXOPOULOS, M.D., GEORGE S. ALEXOPOULOSSearch for more papers by this author, M.D., White Plains, N.Y.Published Online:1 Jan 2003https://doi.org/10.1176/appi.ajp.160.1.200AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This book serves many purposes but is, above all, about clinical values and intellectual principles. Its explicit intention is to provide a broad biopsychosocial account of late-life depression that explicates the development of late-life depression; most importantly, however, it provides a meaningful guide to treatment.Central to the book is Blazer’s own clinical thinking and his way of integrating new findings in the care of the individual patient. Late-life depression is a disease that tries the clinician’s skills to their limit. Psychiatry now believes that late-life depression is a disease with rather specific brain abnormalities, but seemingly less specific factors often play a devastating role in late life. Many depressed patients are medically ill, have lost cognitive abilities necessary for negotiating their environment, are unable to care for themselves, experience unanticipated indignities, and lose the sense of meaning in their lives. In some cases, the biological mechanisms of what was originally thought to be a nonspecific factor are clarified. For example, subcortical white matter abnormalities and executive dysfunction, one of its clinical expressions (1), may lead to depression by inducing disability (2), but a concomitant path to both depression and disability may be dysfunction of frontostriatal systems (3) resulting from white matter abnormalities. Blazer’s book serves as a guide to the role of each path in the depression of the individual patient by placing biological and psychosocial findings in the clinical and personal context of the individual patient.The book uses skillfully presented case reports to initiate discussion of scientific findings. Building the exposition of new findings on the foundation of clinical issues and questions arising from treatment of the individual patient lets the reader know how Blazer thinks when he works with depressed old people. One may agree or disagree with the author’s views, but it is impossible not to think critically.Blazer takes the position that adherence to the biopsychosocial model is necessary for planning the treatment of depressed elderly patients. “If we deviate from that model we will defeat our intentions to provide the best possible care to depressed older adults.” Whether he summarizes biological and psychosocial findings or presents steps of differential diagnosis and treatment, Blazer remains faithful to this goal throughout the book.The biopsychosocial model has been inadequately tested in late-life depression and in most other psychiatric disorders. In fact, a complex model such as the biopsychosocial model cannot be adequately tested with the available, rather reductionistic experimental methodology. Although it defies some of the epistemological requirements for experimental support, the biopsychosocial model still has merit. Most theoretical generalizations about observable phenomena are rejected before they are subjected to experimental testing (4). The criteria for selecting a theoretical model are pragmatic and include its aesthetic value (simple meaningful concepts) and its usefulness (5). The biopsychosocial model passes this formal test with flying colors. Every thoughtful clinician knows that the biopsychosocial model is the best way to understand and integrate new findings in late-life depression. Blazer’s book simply explains, in the most elegant way, how to do so and better the care of depressed older people.By Dan Blazer, M.D., Ph.D. New York, Springer, 2002, 485 pp., $56.95.

The systematic assessment of depressed elderly primary care patients.

Studies of the primary care treatment of depressed elderly patients are constrained by limited time and space and by subject burden. Research assessments must balance these constraints with the need for obtaining clinically meaningful information. Due to the wide-ranging impact of depression, assessments should also focus on suicidality, hopelessness, substance abuse, anxiety, cognitive functioning, medical comorbidity, functional disability, social support, personality, service use and satisfaction with services. This paper describes considerations concerning the assessment selection process for primary care studies, using the PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial) study as an example. Strategies are discussed for ensuring that data are complete, valid and reliable.

Sertraline versus fluvoxamine in the treatment of elderly depressed patients: A double-blind randomized trial

Sertraline versus fluvoxamine in the treatment of elderly depressed patients: A double-blind randomized trial

Treatment of elderly depression with personality disorder comorbidity using dialectical behavior therapy

Depression among older adults is a particularly distressing problem, not only because of high rates but also because of higher risks for suicide among this population. In addition, personality disordered depressed elderly have been shown to be less responsive to depression-specific therapies. This article reviews the rationale and treatment modifications under development for treatment of elderly depressed patients with comorbid personality disorders using Dialectical Behavior Therapy.

Efficacy and tolerability of moclobemide in comparison with placebo, tricyclic antidepressants, and selective serotonin reuptake inhibitors in elderly depressed patients: a clinical overview.

To review the efficacy and safety of moclobemide in comparison with TCAs (for our purposes, "TCAs" will represent tricyclic and tetracyclic antidepressants, including maprotilin and mianserin) and selective serotonin reuptake inhibitors (SSRIs) in elderly depressed patients. The efficacy data reviewed were obtained from the following sources: 1) results of published studies in the elderly; 2) data on patients aged > or = 60 years extracted from all available controlled trials in adults (> or = 18 years) in which moclobemide was compared with TCAs or SSRIs; and 3) the adverse events were extracted for patients aged > or = 60 years from the safety data base of all available comparative short-term studies with moclobemide versus TCAs, SSRIs, or placebo and of long-term studies with moclobemide. The data show that moclobemide is an effective antidepressant in depressed patients aged > or = 60 years. The response rate to moclobemide was 50% to 55% in this population. Moclobemide was more effective than placebo and was of similar efficacy to the TCAs and the more recently introduced SSRIs. The tolerability of moclobemide was rated as "very good" or "good" in almost 90% of these patients, which was better than the tolerability of TCAs and similar to that of SSRIs. Patients without any adverse events were more frequently found in the moclobemide group than in those treated with TCAs (P < 0.01) or SSRIs (P < 0.01). Adverse events of the anticholinergic type were more frequent with TCAs than with moclobemide (P < 0.001), and nausea was found 3 times more frequently with SSRIs than with moclobemide (P < 0.01). Moclobemide is an effective and well-tolerated antidepressant for the treatment of elderly depressed patients.