3.5.3 Depression
Depression
Prevalence/incidence:
Depression is a common mental disorder among older adults, with an estimated prevalence of up to 15% in community settings and up to 25% in medical settings (Alexopoulos, 2019). The incidence of depression also increases with age and is higher among women than men.
Clinical features:
Depression in older adults can present differently than in younger adults and may be characterized by somatic complaints such as fatigue, insomnia, and decreased appetite rather than the typical mood symptoms (Alexopoulos, 2019). Other common symptoms of depression in older adults include persistent sadness, loss of interest in activities, feelings of worthlessness or guilt, and suicidal thoughts.
Differential diagnosis:
Depression in older adults can be difficult to distinguish from other medical conditions such as dementia, delirium, and Parkinson’s disease. It is important to conduct a thorough evaluation to rule out any underlying medical conditions that may be contributing to depressive symptoms (Razani et al., 2019).
Aetiology:
The causes of depression in older adults are multifactorial and may include biological, psychological, and social factors. Risk factors for depression in older adults include chronic medical illness, disability, social isolation, and bereavement (Alexopoulos, 2019).
Management:
Treatment for depression in older adults may include a combination of medication and psychotherapy. Antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat depression in older adults.
Psychotherapy, particularly cognitive-behavioural therapy (CBT), has also been found to be effective in treating depression in older adults (Razani et al., 2019).
Prognosis:
The prognosis for depression in older adults is generally good with appropriate treatment. However, older adults may be at increased risk for relapse and may require longer treatment periods than younger adults (Alexopoulos, 2019).
| Disorder | Prevalence/Incidence | Clinical Features | Differential Diagnosis |
| Depression | Up to 15% of the community | Somatic complaints such as fatigue | Other medical conditions such as dementia, delirium, Parkinson’s disease |
| Bipolar Affective Disorder | 1-2% | Less severe manic and depressive episodes | Other medical conditions such as dementia, delirium, stroke |
| Disorder | Aetiology | Management | Prognosis |
| Depression | Multifactorial, including biological, psychological, and social factors | Combination of medication and psychotherapy, such as antidepressant medications and cognitive-behavioural therapy (CBT) | Generally good with appropriate treatment, but older adults may be at increased risk for relapse and may require longer treatment periods than younger adults |
| Bipolar Affective Disorder | Not well understood, may involve genetic, neurobiological, and environmental factors | Combination of medication and psychotherapy, such as mood stabilizers and cognitive-behavioural therapy (CBT) | Generally good with appropriate treatment, but older adults may be at increased risk for medical complications associated with medication use and may require more frequent monitoring. |
Reference:
- Alexopoulos, G. S. (2019). Depression in the elderly. The Lancet Psychiatry, 6(4), 332-339.
- Razani, J., Kakos, L., Orieta-Barbalace, C., Wong, J. T., Casas, R., & Lu, P. (2019). Depression in the elderly: a review of diagnostic and treatment approaches. American Journal of Geriatric Psychiatry, 27(3), 290-303.