Depression

Question 1

Which illnesses are particularly associated with suicide in the elderly? Other factors

Answer 1

Epilepsy
MS
Huntington's chorea
Head injury
Peptic ulcer
RA

Particularly older men
Bereaved
Social isolation
Chronic pain/illness
Alcohol abuse
Depressive episode

Question 2

Clinical features of depression in the elderly

Answer 2

Lowering of mood (most days for most of the day, for 2 weeks)
Reduction in energy
Decrease in activity

Reduced capacity for enjoyment, interest and concentration

Sleep disturbed, tiredness

Appetite reduced

Self-esteem and confidence reduced

Ideas of Guilt and worthlessness

Early morning wakening
Psychomotor retardation

Thoughts of death/suicide

Impaired cognition

Question 3

Biological management of depression in old age

Answer 3

SDRI for moderate/severe
-inform about withdrawal effects

If treatment-resistant:
augment with lithium/antipsychotic
Addition of 2nd antidepressant

ECT in severe and treatment resistant

Question 4

Psychosocial management of depression in old age

Answer 4

Monitor risk of self-harm

Educate patient (and care givers) about depression and involve in decisions

Treat whole person:
co-existing physical disorder
attention to sensory deficits and other handicaps
sign-post to appropriate social care agencies
Review medication

1st line in mild is psychological:
Individual/guided self-help
CBT