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Depressive Disorders in Elderly - Coggle Diagram
Depressive Disorders in Elderly
DSM 5 Criteria
Depressed mood, diminished activities, change in appetite, insomnia, psychomotor agitation, fatigue or loss of energy
Melancholic Depression
Loss of pleasure, lack of reactivity, profound despondency, worse in morning, early morning awakening, marked psychomotor agitation
DDx
Manic episodes with irritable mood, Persistent depressive disorder, mood disroder, neurocognitive disorder, substance/medication-induced depressive, adjustment disorder bereavement
Grief
More feelings of emptiness, dysphoria in waves, preoccupation of thoguhts of deceased, preserved self-esteem, thoguhts of joining deceased
Risk Factors
Recently bereaved, socially isolated, persistent complains, chronic disabling illness, recent physical illness, persistent sleep difficulties, significant somatic concerns, refusal, recurrent hospitalization
Certain personality traits, traumatic life events, FHx of depression, bipolar disorder, history of other mental helath disorders, substance use
Onset/Course/Prognosis
First-onset episodes occur after 60, lasts 9 months, frequency of episodes increases with age and can merge into chronic
Screening Tools
Without Cognitive impairment
Geriatric Depresion Scale, PHQ-9
Significant cognitive impairment
Cornell Scale for depression
Compared to Younger Adults
Less sadness, more somatic symptoms, more anxiety/agitation, more delusional symptoms, weight loss, melancholic and cognitive features
Investigations
CBC, Electrolytes, LFT, Vitamin V12, TSH, Folate
Treatments
CBT, PST, Brief dynamic therapy, reminscence therapy, support behaviour, IPT
Exercise, mind-body interventions
Pharmacotherapy
SSRI, SNRI, NDRI, TCA, MAOI
Clinical features and dimnesions, past response, family history of respionse, adverse effects, comorbid conditions, drug interactions, tolerability
Guidelines
Duloxetine/Sertraline (1st line), Mirtazapine, Venlafaxine, buproprion (2nd), TCA and MAOis (3rd line)
Treat for 1-2 years minimum following first episode
medications should be recommended for depression with dementia
Medications with low anticholinergic properties
Citalopram and Escitalopram
Warning of QTc prolongation
Side Effects
Overall Common
GI, Headache, HTN, sexual dysfunction
Rare
SIADH, Serotonin syndorme, SRI discontinuation, GI bleed, Seizures
TCA
Sedation, weight gain, anticholinergic effects
MAOI
Swelling, weight gain, orthostatic hypotension
Post-Stroke
Cosnider SSRi as first, SNRI and Mirtazapine as second line
Parkinson's Disease