Understanding and Addressing Depression in the Elderly: A Comprehensive Overview

High co-morbidity

Depression affects the elderly differently from young patients, depression in the elderly is often accompanied by other medical diseases or disabilities, and the symptoms are more serious and last longer, and the co-morbidity rate of depression in some somatic diseases is extremely high, such as the prevalence of major depression: 22-50% in stroke, 18-39% in tumor, 15-19% in myocardial ischemia, 10-37% in Parkinson's disease, etc., and the depression and the somatic diseases are causally related to each other. For example, long-term chronic pain can cause depressive symptoms, while depression aggravates the feeling of pain, major depression is a risk factor for type 2 diabetes mellitus and myocardial ischemia, about 20% of patients with stroke have secondary depression, and in addition to the direct correlation between physical diseases and depression in the physiology, the risk of depression is greatly increased when these chronic diseases lead to a decline in the ability of the elderly to take care of their own lives, or impaired functioning.

Treatment modalities

The goals of treatment for geriatric depression are to effectively improve symptoms, reduce the suicide rate, prevent recurrence, promote functional recovery, and improve quality of life. Because it is different from ordinary patients, it is necessary to take into account the physical disease, cognitive impairment and external stress factors, and the most reasonable and effective method is the all-round comprehensive and individualized treatment mode. Drugs and electroconvulsive therapy can effectively reduce the symptoms, but the recurrence rate is high, and it is also necessary to combine with psychological and social interventions in order to consolidate the efficacy of the treatment and reduce the recurrence.

Drug treatment 

The development of drug treatment programs for elderly patients with depression should take into full consideration the impact of age factors and history of chronic diseases on pharmacogenetics and pharmacodynamics. The acceptability of pharmacotherapy in the elderly is low; therefore, monotherapy is preferred, with an initial dose of 1/2 the recommended adult dose, and treatment for 8-12 weeks or longer is required to achieve full efficacy. Pharmacotherapy is more appropriate for patients with severe geriatric depression and is not recommended for routine use. In terms of drug selection, selective 5-hydroxytryptamine reuptake inhibitors, such as sertraline and escitalopram, are preferred, which have a rapid onset of action, less impact on the cardiovascular system, and a higher overall safety profile, which improves long-term efficacy.

Electroconvulsive therapy (ECT)

With high safety and high symptom relief rate, it is a commonly used physical means of treating geriatric depression, and can be used for geriatric patients with depression who are intolerant to medications or who do not respond to adequate attempts at medications. Repetitive Transcranial Magnetic Stimulation (TMS), Deep Brain Stimulation Therapy (DBST) and Vagus Nerve Stimulation Therapy (VNST) have been proven to be effective for geriatric depression, especially refractory depression.

Psychotherapy 

Cognitive-behavioral therapy and interpersonal therapy can effectively alleviate the symptoms of geriatric depression. A recent placebo-controlled trial proved that the combination of medication is better than medication alone in preventing the recurrence of geriatric depression, and it can also improve the adherence to medication of the patients. Psychological therapy also includes educating the patients and their family members about the knowledge related to depression as well as providing support and help to them, and in addition to explaining the diagnosis and treatment of depression, the doctor himself should also do the following In addition to explaining the diagnosis and treatment of depression, the doctor himself should also do regular follow-up visits, " intervene in the patient's bad habits " to warn the patient's suicidal ideation.