8 - Depression

Question 1

Why does depression increase in the elderly?

Answer 1

All my friends are dead.

I have all these medical issues.

My brain is going.

Question 2

What is the greatest risk factor for depression in the elderly?

Answer 2

Previous depression

Question 3

Slide 4

Answer 3

Geriatric Depression screening (a lot of yes/no questions)

1 point for each bolded answer

A score of 5 or more = (+) depression screen

Question 4

Two questions you can ask to quickly screen for depression?

Answer 4

During the last month, have you often been bothered by feeling down, depressed, or hopeless?

During the last month, have you often been bothered by having little interest or please in doing things?

Yes to either is a (+) screen

Question 5

SIG E CAPS

Answer 5

Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor slowing
Suicide

Question 6

Major difference in depression presentation in geri vs youngins?

Answer 6

MDD in the elderly presents more insidiously than in the younger population

Question 7

Dx’ing depression in geri?

Answer 7

Same as youngins - DSM-V

Question 8

DSM-V for MDD episode

Answer 8

5 of 9 sxs x2weeks

AND

Change from previous functioning

AND

At least one of the sxs is either 1) depressed mood or 2) loss of interest or pleasure

The 9 sxs: 
Depressed mood
Diminished interest
Weight loss or gain
Insomnia or hypersomnia
Psychomotor agitation or retardation 
Fatigue
Worthlessness / guilt
Concentration issues
SI

Question 9

Management of MDD in adults:

Answer 9

Therapy works, though it’s underutilized (alone, or in combination with drugs)

Drug monotherapy preferred in geri’s

F/U 2 weeks after initial visit

SSRI’s take 4-6 weeks to start working, up to 3 mos for full benefit

ECT is an option if severe

Question 10

First line rx for MDD:

Answer 10

SSRI

2nd line: SNRI, Atypicals, Tricyclics and MAOI’s

TCA’s and MAOI’s not really recommended anymore, but you may see it being used

Question 11

Mirtazapine - additional benefits:

Answer 11

Helps sleep and appetite at low dose

SE’s - constipation, dizziness, dry mouth, somnolence

Question 12

Secondary depression

Answer 12

Consequence of other dz (i.e. parkinson’s, huntington’s, alzheimers)

You’d be depressed, too, if you had these

Txt the same as MDD

Question 13

Strokes of anterior L hemisphere with secondary MDD - consider:

Answer 13

TCA’s

Question 14

Parkinson’s / Huntington’s / Alzheimer’s with secondary MDD - consider:

Answer 14

TCA’s and ECT

Question 15

Want to hear a joke about paper?

Answer 15

Never mind its tearable