What is the most effective treatment for depression in older adults quizlet?
Selective serotonin reuptake inhibitors (SSRIs) are antidepressants commonly prescribed to older adults. A psychiatrist, mental health nurse practitioner, or primary care physician can prescribe and help monitor medications and potential side effects.
What are the most effective ways of managing depression in older adults?
Antidepressant medication may take longer to work in older people, so trials of at least six to eight weeks may be required. Electroconvulsive therapy (ECT) is a useful treatment in melancholic and psychotic depression when individuals have failed to respond to medication, or when the depression is very severe.
What therapy would a professional recommend for elderly depression?
Group-CBT is recommended for the treatment of depression in older adults.
What is the most important treatment for depression?
People with severe major depression usually need to be seen by a psychiatrist and sometimes need to be hospitalized. Choosing an antidepressant — For the initial treatment of severe depression, we use serotonin-norepinephrine reuptake inhibitors (SNRIs) or selective serotonin reuptake inhibitors (SSRIs).
How can elderly improve mental health?
6 Ways to Improve Mental Health in SeniorsPlay Mind Games. Just as the body needs physical activity and stimulation to stay healthy, the brain needs stimulation to stay sharp and avoid cognitive decline as we age. ... Get Physical. ... Stay Connected with Friends. ... Pick up a New Hobby. ... Volunteering. ... Caring for a Pet.
How can older adults prevent depression?
Here are some tips to keep active and feel better – physically, mentally and socially.Exercise. Stay active. ... Stay in touch with others. ... Get enough sleep. ... Eat healthy meals, making it a point to avoid too much sugar and junk food.Volunteer, care for a pet, or find a good movie or book that makes you laugh.
Is geriatric depression treatable?
Although older adults are less likely to access and receive adequate mental health care services than their younger counterparts, late life depression is treatable with appropriate psychosocial and pharmacological interventions.
What is the most common cause of depression in the elderly?
The death of friends, family members, and pets, or the loss of a spouse or partner are common causes of depression in older adults.
What are the priority nursing interventions when caring for a patient with depression?
Nursing care plan goals for patients with major depression includes determining a degree of impairment, assessing the client's coping abilities, assisting the client to deal with the current situation, providing for meeting psychological needs, and promote health and wellness.
What are the two most common treatments for depression?
There are many types of therapy available. Three of the more common methods used in depression treatment include cognitive behavioral therapy, interpersonal therapy, and psychodynamic therapy. Often, a blended approach is used.
What is the first line treatment for depression?
Consider sertraline and escitalopram as first-line agents for initial treatment of major depression in adults. The least tolerated antidepressants in this study were bupropion, fluoxetine, paroxetine, and duloxetine.
What type of therapy is used for depression?
Cognitive Behavioral Therapy (CBT) Cognitive behavioral therapy, or CBT, helps an individual identify and change negative thoughts and associated behaviors. People who suffer from depression often struggle with negative thought patterns. These thought patterns can influence our behavior.
Why is it so hard to recognize depression in older people?
Depression in older adults may be difficult to recognize because older people may have different symptoms than younger people. For some older adults with depression, sadness is not their main symptom. They could instead be feeling more of a numbness or a lack of interest in activities.
What is a medical condition that causes depression?
Depressive Disorder Due to A Medical Condition – depression related to a separate illness, like heart disease or multiple sclerosis. Other forms of depression include psychotic depression, postmenopausal depression, and seasonal affective disorder.
How does depression look?
Signs and symptoms of depression can look different depending on the person and their cultural background. People from different cultures may express emotions, moods, and mood disorders — including depression — in different ways. In some cultures, depression may be displayed as physical symptoms, such as aches or pains, headaches, cramps, or digestive problems.
What are the symptoms of depression?
Still, because people experience depression differently, there may be symptoms that are not on this list. Persistent sad, anxious, or "empty" mood. Feelings of hopelessness, guilt, worthlessness, or helplessness. Irritability, restlessness, or having trouble sitting still.
How does age affect medicine?
As you get older, body changes can affect the way medicines are absorbed and used. Because of these changes, there can be a larger risk of drug interactions among older adults. Share information about all medications and supplements you’re taking with your doctor or pharmacist.
How to boost mood?
Ask if the person wants to go for a walk or a bike ride. Physical activity can be great for boosting mood.
Do older people have depression?
However, if you’ve experienced depression as a younger person, you may be more likely to have depression as an older adult.
What are the best treatments for depression?
The primary treatment options for depression include medication and psychotherapy . It is important to remember that as doctors and therapists develop a personalized treatment plan for each individual, different treatments or treatment combinations sometimes might be tried until you find one that works for you.
What to do if you think you have depression?
If you think you have depression, the first step is to talk to your doctor or health care provider. Your doctor will review your medical history and do a physical exam to rule out other conditions that may be causing or contributing to your depression symptoms.
What kind of doctor treats depression?
If other factors can be ruled out, the doctor may refer you to a mental health professional, such as a psychologist, counselor , social worker, or psychiatrist. Some providers are specially trained to treat depression and other emotional problems in older adults.
How long does it take for depression to go away?
The good news is that, in most cases, depression is treatable in older adults. The right treatment may help improve your overall health and quality of life. With the right treatment, you may begin to see improvements as early as two weeks from the start of your therapy. Some symptoms may start to improve within a week or two, but it may be several weeks before you feel the full effect.
How do you know if you have depression?
If you have been experiencing several of the following symptoms for at least two weeks, you may be suffering from depression: Persistent sad, anxious, or “empty” mood. Loss of interest or pleasure in hobbies and activities. Feelings of hopelessness, pessimism. Feelings of guilt, worthlessness, helplessness.
What are the risks of being an older adult?
If you are an older adult, you may be at a higher risk if you: are female. have a chronic medical illness, such as cancer, diabetes or heart disease. have a disability. sleep poorly. are lonely or socially isolated. You may also be at a higher risk if you: have a personal or family history of depression.
How long does a person with persistent depression last?
Persistent Depressive Disorder (Dysthymia) —depression symptoms that are less severe than those of major depression, but last a long time (at least two years ). Minor Depression —depression symptoms that are less severe than those of major depression and dysthymia, and symptoms do not last long.
How does behavioral therapy help with depression?
Treatment usually begins with the therapist providing an overview of the behavioral theory of depression and explaining how actively engaging in pleasant activities and reducing avoidance/withdrawal in difficult situations can improve one’ s mood over time.
How does Socratic therapy help with depressive symptoms?
The patient learns to identify and record the unhelpful thoughts that trigger negative emotions and then utilizes the Socratic method to analyze and refute those thoughts. These thought records are used in sessions to work together to identify and address root beliefs. By addressing the underlying negative beliefs about the self, the world, others and the future, depressive symptoms are then presumed to subside.
What is cognitive therapy?
The cognitive therapy model proposes that holding negative views (also known as “schemas”) of the self, the world, others and the future are likely to lead to the development of unhelpful thinking patterns that play a role in the biological and emotional symptoms of depression.
What is a mood diary?
The patient might be encouraged to complete a “mood diary” outside of sessions, noting the situations that triggered the thoughts that then influenced feelings and behaviors in the moment. The patient and therapist then work together to identify common themes that influence the unhelpful thinking and behavior patterns in a particular situation.
How many sessions of cognitive therapy are there?
Cognitive therapy for depression emphasizes modifying these unhelpful thinking patterns. On average, adults receive eight to 28 weekly sessions of cognitive therapy. Cognitive therapy is recommended for the treatment of depression in adults. How cognitive therapy can help treat depression in adults.
How does behavioral therapy work?
Behavioral therapy focuses on having the person re-engage more frequently in activities he/she once found pleasurable. The person and therapist work together to identify short-term and long-term goals specific to the individual. During the course of behavioral therapy, the person identifies his/her behaviors and reactions to difficult situations that might be unhelpful in moving forward in life. Instead, the person learns to engage in behaviors that are more likely to reverse the negative patterns. As the individual increases participation in pleasurable activities and changes those behavioral patterns, his/her mood is expected to improve. On average, adults receive 20-24 weekly sessions of behavioral therapy.
What is cognitive behavioral therapy?
Cognitive-behavioral therapy targets current problems and symptoms and focuses on recognizing the relationship between behaviors, thoughts, and feelings and changing patterns that reduce pleasure and interfere with a person’s ability to function at his/her best.
What is the best treatment for depression in older people?
Depression occurring in older patients is often undetected or inadequately treated. Antidepressants are the best-studied treatment option, but psychotherapy, exercise therapy, and electroconvulsive therapy may also be effective. Psychotherapy is recommended for patients with mild to moderate severity depression.
How to treat depression in older adults?
Major depression in older adults is common and can be effectively treated with antidepressants and electroconvulsive therapy. Psychological therapies and exercise may also be effective for mild-moderate depression, for patients who prefer nonpharmacological treatment, or for patients who are too fra ….
How many people have major depression?
Major depression occurs in 2% of adults aged 55 years or older, and its prevalence rises with increasing age. In addition, 10% to 15% of older adults have clinically significant depressive symptoms, even in the absence of major depression.
Why are antidepressants dangerous?
Although antidepressants may effectively treat depression in older adults, they tend to pose greater risk for adverse events because of multiple medical comorbidities and drug-drug interactions in case of polypharmacy.
How does depression affect older people?
Depression in older adults may present somewhat differently than in younger adults. For example, older adults are less likely to endorse cognitive-affective symptoms of depression, including dysphoria and worthlessness/guilt, than are younger adults ( Gallo et al., 1994 ). Sleep disturbance, fatigue, psychomotor retardation, loss of interest in living, and hopelessness about the future may be more prevalent in late-life depression than in depression in younger or middle-aged adults ( Christensen et al., 1999 ). Subjective complaints of poor memory and concentration are also common among depressed older adults. Slower cognitive processing speed and executive dysfunction are frequent findings from objective testing ( Butters et al., 2004 ). Overall there do not appear to be substantial differences by gender or ethnicity. Some evidence suggests that older African Americans are even less likely to report dysphoria than European-Americans and more likely to report thoughts of death ( Gallo, Cooper-Patrick, & Lesikar, 1998 ). With respect to somatic symptoms, depressed older women report more appetite disturbance than men, whereas older men report more agitation ( Kockler & Heun, 2002 ).
Why do older people get depressed?
Why might a person become depressed, especially for the first time, in old age? Figure 1 provides a lifespan view of risk factors that may help to explain the occurrence of depression in an older person. Biological factors loom large in late life. Both cardiovascular and neurological changes that occur with normal aging or with age-associated diseases appear to increase vulnerability to depression. But these explanations are not sufficient in light of the fact that neurobiological changes are ubiquitous with aging and physical disease is not uncommon, yet only a small fraction of older adults become depressed. It would also be easy to point to all of the losses that characterize later life; yet, most older adults experience stressful life events and only a small proportion become depressed. For these reasons, we suggest that the onset and maintenance of depression in late life can be understood as an interaction between certain vulnerabilities, including genetic factors, cognitive diathesis and age-associated neurobiological changes, and the types of stressful events that occur with greater frequency in late life than earlier in the lifespan.
How does socioeconomic disadvantage affect depression?
Older adults who are economically disadvantaged are more likely to experience persistent depressive symptoms ( Mojtabai & Olfson, 2004 ), consistent with the chronic nature of the stressors associated with low income, including financial strain and exposure to unsafe and unstable environments. Practical issues such as these may also complicate treatment for those low income older adults who are depressed ( Areán et al., 2005 ). In addition, socioeconomic disadvantage early in life may increase vulnerability to depression throughout the lifespan through the effects of poor nutrition, reduced opportunities for education, less access to health care, or other mechanisms. The effects of early disadvantage may become even more consequential with age, as economic and health disparities are compounded.
How prevalent is depression in the cardiovascular system?
Depression is particularly prevalent in cardiovascular disease. Approximately 20-25% of heart disease patients experience major depression, and another 20-25% report symptoms of depression that do not meet criteria for major depressive disorder (Carney & Freedland, 2003).
How much depression is associated with Type II diabetes?
DIABETES . Prevalence estimates for depression in patients with Type II diabetes are as high as 15% for major depression and approximately 20% for elevated depressive symptoms (Li, Ford, Strine, & Mokdad, 2008).
What are the causes of depression?
Much attention has been paid to neuroanatomical and chemical changes in the central nervous system as risk factors for depression and as predictors of poor response to treatment. Frontal, basal ganglia, and subcortical white matter lesions may be responsible for the phenomenon of depression-executive dysfunction syndrome ( Alexopoulos, 2005; Krishnan, 2002 ). Structural abnormalities in various brain regions have been observed in depressed older adults ( Alexopoulos, 2005; Blazer 2003 ). Functionally, depression is associated with hypoactivity in cortical structures and hyperactivity in limbic structures, and hypometabolism of the anterior cingulate is associated with treatment resistance ( Alexopoulos, 2005 ). Reduced connectivity between the amygdala and structures in the thalamus and frontal cortex that regulate emotional processing may contribute to the maintenance of late-life depression ( Alexopoulos, 2005 ). Studies have found a reduction in glial cells and neuronal abnormalities associated with late life depression, suggesting possible mechanisms for this decreased connectivity.
What genes are associated with depression in older adults?
The search for specific genes associated with depression in older adults has encompassed both genes studied in the non-geriatric population and genes that might relate to distinctive aspects of late life depression. Genetic studies in the non-geriatric population have for the most part focused on the short variant of an insertion/deletion polymorphism located in the promoter region of the serotonin transporter gene (5-HTTLPR). In one of the few extensions of this work to older adults, Jansson and colleagues (2003) found a significant effect for the A/A genotype of the 5-HTR2A gene promoter polymorphism and depressed mood for older males but not for older females. In this study, the 5-HTT serotonin transporter gene was not associated with depressed mood.
How to treat depression in older adults?
When treating depression in older adults, it is essential to identify co-occurring medical conditions that may be contributing to mood symptoms or complicate its treatment . Psychiatric treatment guidelines recommend psychotherapy and/or pharmacotherapy for initial treatment of individuals with MDD(7). However, treatment with antidepressant medication may be problematic, as nonadherence is common among older adults for myriad reasons including polypharmacy, cost, and beliefs about medication(8). A recent meta-analysis found that cognitive impairment (particularly executive dysfunction) is associated with poor antidepressant treatment response in LLD(9). Furthermore, mounting evidence suggests a greater patient preference for psychological treatment compared to medication(10).
How does cognitive behavior therapy help with depression?
Cognitive behavior therapy (CBT) is one of the most rigorously tested psychosocial treatments for depression across the lifespan, with consistent evidence as efficacious for late-life depression. This treatment approach, as pioneered by Beck(12) and Ellis(13), posits that maladaptive cognitions precipitate and maintain depression and other forms of emotional distress. Specifically, depression results from a triad of negative views about oneself, one’s future, and the world. Thus, this structured treatment actively engages older adults to identify and modify, or “restructure,” their maladaptive cognitions while also incorporating behavioral components; namely behavioral activation, relaxation training, and skill rehearsal. Treatment may be relatively brief in duration, ranging from 12–16 sessions. CBT for older adults may be modified to include gerontologically-relevant elements such as physical and cognitive changes, cohort beliefs, losses and role transitions, and there are multiple resources to inform CBT practice with older adults(14, 15).
How does PST help with depression?
PST is based on the premise that depression is maintained by ineffective problem-solving and the resultant poor coping, low self-efficacy, and negative emotions. The PST therapist teaches effective ways of addressing problems while maximizing well-being by utilizing a 7-step approach, encompassing (1) selecting a specific problem and defining it in concrete terms; (2) selecting a goal that is feasible to reach between sessions, (3) identifying different ways to reach that goal, (4) evaluating each solution based on the likelihoods the patient can actually implement it, (5) choosing the best solution, (6) creating a plan to implement the solution, and (7) circling back around to ascertain the effectiveness of the solution. While PST shares some similarities with CBT and BT, it focuses on ineffective problem solving rather than maladaptive cognitions or lack of activity. To date, PST is the only psychotherapy for late-life depression that has demonstrated efficacy relative to a supportive therapy control(32) as well as CBT among medically ill older adults(33).
What is reminiscence therapy?
Reminiscence therapy is a term encompassing a variety of approaches that entail review of one’s past experiences. While reminisce may include unstructured storytelling, life-review therapy is more structured and typically focuses on a therapeutic process of promoting a positive view of one’s past among older adults with depression(49). Such treatment tends to be brief (e.g., 6–8 sessions) and in addition to LLD may be used more broadly for end-of-life, life satisfaction, and social integration. Meta-analytic findings suggest that reminiscence produces small to moderate effects on depressive symptoms and may be appropriate to LLD in the context of chronic physical illness(49). Evidence from a recent systematic review synthesized three trials of life review therapy among frail older adults; all trials demonstrated large clinical effects of treatment on depressive symptoms in international samples (Spain(50), Switzerland(51), and Taiwan(52)). However, the trials to date have not used confirmed diagnoses of depression (rather, symptoms of depression), and entailed comparison of a nonactive control condition that did not receive an active psychological treatment; thus, it is not clear how this type of treatment compares to other psychological approaches for LLD, and results may be explained by regression to the mean.
What are the factors that contribute to late life depression?
Changing life circumstances and aging-related processes place older adults at unique risk of encountering factors that contribute to late-life depression (LLD), including chronic disease, disability and frailty, caregiving demands, experiences related to grief and loss, and cognitive impairment. In addition to the personal impact of depression, this condition also confers an economic burden, as it is associated with increased overall health service utilization and healthcare expenditure among older adults(1). Although depression is not a normal aspect of aging, LLD is relatively common. Prevalence data range depending on diagnostic severity (e.g., diagnosis of major depressive disorder [MDD] versus depressive symptomatology); US nationally representative estimates of the 12-month prevalence of MDD for adults aged 55 and older are between 4(2) – 5.63%(3), and that for any mood disorder at 4.9(2) – 6.77(3). These estimates may be conservative due in part to methodological and diagnostic issues(2, 4). While the DSM-5 criteria are the same for MDD in older and younger patients, the clinical presentation may differ, with older adults endorsing more somatic symptoms and less mood complaints(5). LLD may be more chronic than presentation in younger adults, and is often associated with or exacerbated by chronic physical health conditions, cognitive impairment, and dementia(6). As such, LLD often goes unrecognized and undertreated.
What are the barriers to accessing psychological services?
The most common barriers to utilization of psychological services among older adults are affordability of care, difficulty traveling, and lack of transportation (53). Although the PEARLS program mentioned herein is designed to deliver in-home care, clinician travel to people’s home is not a reimbursable activity. Recently, researchers have been studying the use of technology to facilitate access to this care. Emerging work has demonstrated the feasibility of internet-delivered CBT among Australian older adults with elevated depressive symptoms(60) and shown that tele-PST was well-accepted and efficacious for depression among low-income homebound adults(61). However, the latter study focused on a “young old” population (50 to 64 years old). As reviewed herein, recent work by Egede and colleagues(27) has supported the noninferiority of telemedicine using BA for LLD. Related to the growing interest in internet-based treatment delivery, there is a growing interest in novel use of mobile technology for depression treatment, such as mental health apps for smartphones. Although no studies to date have demonstrated the efficacy of apps on LLD, trials are underway to change the current models of face-to-face psychotherapy. Apps have the potential to play an important role in the future of psychological service delivery. Similarly, therapeutic videogames are of interest, but neither technology has been investigated in clinical trials. Given the large proportion of older adults who use the internet and smartphone technology, there is a general paradigm shift toward tele-mental health as acceptable and efficacious, with the power to improve access.
Why do older people have poor response to antidepressants?
We speculate that the reason for poor response to medications is that these treatments do not address the drivers of depression in the context of poverty . When people are faced with a daily struggle to find food, shelter, safety from harm and medical care, we hypothesize that a stress reaction takes place that creates a syndrome similar to a major depression in presentation(59). Our group has taken the lead on two trials to ascertain the relative merit of clinical case management on depression in low-income older adults. Clinical case management is an advocacy-based intervention that addresses older adult distress by assisting with linkage to social and medical services, stable and safe housing, and other needs. We have found in two large scale RCTs that clinical case management is a highly successful intervention for late life depression in the context of poverty, and that the additional of CBT(77), or PST(78, 79) produced no added benefit.
What to consider when treating depression in elderly?
Factors to consider when treating depression in elderly patients. Before pursuing any antidepressant for an el derly individual, it is important to analyze the potential risks vs. benefits. It is also important to be aware of any interactions and side effects associated with the medication. Finally the elderly patient should estimate ...
What antidepressants are effective for elderly people?
Tricyclic antidepressants: If an elderly individual is using a tricyclic antidepressant, they need to be used with precaution due to their side effects. Various tricyclics that appear to be effective for old people include: nortriptyline, amitriptyline, clomipramine, and desipramine.
How long does antidepressant work?
Antidepressant medications may work well for a year or two , but come with significant side effects such as sexual dysfunction and weight gain. Additionally if you can’t find a medication that works, you may end up playing a little game called “antidepressant roulette” – where you’re cycled through drugs that are supposed to work, but don’t – and you feel way worse than before you even tried the drugs.
How to reduce depressive symptoms?
Keep in mind that these treatments are devised for those who are doing everything in their power: dietary, exercise, vitamins, sunlight, socialization, etc. to reduce depressive symptoms. Starting with TMS and psychotherapy has promise, and adding an antidepressant if the person doesn’t get benefit from those practices can make a difference. It’s just a matter of choosing whether you want immediate relief (e.g. Suboxone) or want to test the waters and hope that something works (e.g. traditional antidepressants).
How many sessions of TMS for refractory depression?
In fact, one study showed that elderly patients (60 years or older) with refractory depression (a form that won’t respond to medication) significantly improved from 10 sessions of high-frequency TMS that was delivered to the left dorsolateral prefrontal cortex.
What is the therapy for depression?
This is a form of therapy for depression that involves analyzing the relationship between thoughts, behaviors, and emotions. A therapist will work with a person to help them correct errors in their thinking as a result of feeling depressed and may suggest certain behavioral changes in attempt to improve their mood.
What to consider when considering an intervention for elderly?
memory), onset of action, sexual dysfunction, etc. Always look at the side effect profile of the intervention that you’re pursuing to determine whether you think it would be an ideal fit for the elderly person.
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How Do I Help Someone with Depression?
- If you know someone who has depression, first help him or her see a doctor or mental health professional. Several ways you can help an older adult with depression is to: 1. Offer support, understanding, patience, and encouragement. 2. Help keep track of his or her appointments and weekly “pillbox” if possible because many older adults with depressi...
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