Depression in the Elderly

Question 1

What are some strong risk factors for suicide

Answer 1

Major Depression
Older Male
Widower/Bereavement
Living Alone/Social Isolation
Chronic pain
Alcohol Abuse 
Seen GP in last month (>70%)
Previous attempts
Sleep Disorder
Planning

Question 2

Clinical Features of Depression

Answer 2

Anhedonia
Low Energy
Low activity
Low Mood
Low concentration
Sleep Disturbance
Low appetite
Low self-esteem
Guilt + Worthlessness
Little mood variation
Early morning waking, Psychomotor Retardation
Low libido

Question 3

what is the ICD-10 Criteria for diagnosis of depression

Answer 3

Set 1

1. abnormally depressed mood, unchanging day to day, present for most of the day and every day for 2+ weeks
2. Anhedonia for activities that are usually pleasurable
3. Low energy/increased fatiguability

Set 2

1. Low confidence/self esteem
2. Excessive/inappropriate guilt
3. Recurrent suicidal thoughts/behaviour
4. Low concentration
5. Appetite dysfunction (low/high)
6. Sleep Disturbance
7. Psychomotor Agitation/retardation

Mild = 2 from set 1, 4 total (min) 
Moderate = at least 2 from set 1, 6 total
Severe = all from set 1 and 8 total +/- psychotic symptoms

Question 4

What is the framework for depression treatment

Answer 4

Bio-Psycho-social approach

Question 5

What are the pharmacological interventions available + when should they be considered

Answer 5

Chronic Mild depression (>2 weeks + all moderate/severe should be offered antidepressants

SSRIs are 1st line
Other choices include TCAs, NARIs, SSNARIs, MAOIs

Treatment resistance = lithium/another antidepressant

Question 6

What is another intervention option for severe and treatment resistant depression

Answer 6

Electro-convulsive therapy

Question 7

What indicates another SSRI should be used after commencing an SSRI

Answer 7

3+ months failure to treat

Question 8

What Psychological and Social interventions are available for Depression

Answer 8

Specialist mental health services
Educate Patient + Carers
Monitor Self harm risk
CBT
Active monitoring
Exercise
Individual guided self-help 
Treat whole person (physical disorder, review meds) 
Mitigate social factors that may contribute to disease

Question 9

What length of treatment is indicated in a patient with a 2+ prior episodes of treatment and a functional impairment (inability to work)

Answer 9

2 years

Question 10

What treatment is indicated for < 2-week mild depression

Answer 10

watchful waiting + lifestyle advice