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Late life depression

From Wikipedia, the free encyclopedia

Late-life depression refers to depression occurring in older adults and has diverse presentations, including as a recurrence of early-onset depression, a new diagnosis of late-onset depression, and a mood disorder resulting from a separate medical condition, substance use, or medication regimen.[1] Research regarding late-life depression often focuses on late-onset depression, which is defined as a major depressive episode occurring for the first time in an older person (various sources define this threshold differently, typically within the range of 60–65 years old).[1][2]

Late-life depression is often underdiagnosed, which is due to numerous reasons, including that depressed mood is commonly not as prominent as other somatic and psychotic symptoms such as loss of appetite, disruptions in sleep, lack of energy or anergia, fatigue, and loss of interest and enjoyment in normal life activities.[3][4] Concurrent medical problems and lower functional expectations of elderly patients also often obscure the degree of impairment caused by late-life depression. Elderly persons sometimes dismiss less severe depression as an acceptable response to life stress or a normal part of aging.[5][6][7][8] Additional reasons for the difficulty in diagnosis include: medical illnesses and medication side effects that present similarly to depression, difficulty communicating with providers, lack of time in an appointment, and beliefs about mental illness and treatment from the patient, friends, family members, and society.[9][10][11][12] Even when diagnosed, late-life depression is frequently undertreated as well.[4]

Primary care is most often where diagnosis and treatment of late-life depression occurs.[9][2] Notably, the DSM-5 does not specifically define diagnostic criteria for late-life depression and concludes that the characteristics of major depressive disorder do not vary by age, although research suggests that late life depression can present differently, as described above.[4] Broadly speaking, however, diagnosis is made in the same way as other age groups, using DSM-5 criteria for major depressive disorder.[13][9]

The American Psychological Association and other clinical recommendations also recognize the spectrum of depressive symptoms that extend beyond the formal criteria for major depressive disorder, including subthreshold/minor depression and dysthymic disorder; these diagnoses that fall under the umbrella of late-life depression can also present with debilitating and disruptive symptoms.[1][14][4] Treatments for late-life depression include medicine and psychotherapy, along with lifestyle changes such as exercise, bright light therapy, and family support.[9][14] In patients who do not respond to initial treatments, neurostimulation techniques such as electroconvulsive therapy (ECT) can be used.[13] ECT has demonstrated effectiveness in treating the elderly.[15]

Symptoms and diagnosis

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Diagnosis of depression in late life is made using the same criteria for Major Depressive Disorder found in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)

To meet criteria for a major depressive episode, a patient must have five of the nine symptoms listed below nearly every day for at least two weeks and must have at least either a depressed mood or anhedonia.[16][17] The symptoms they are facing must also harm their ability to function in daily life and must not be better explained by a medical illness or a substance.[17] To further meet criteria for Major Depressive Disorder, the depressive episode must not be attributable to another psychiatric disorder such as psychosis or a bipolar disorder.[17]

  1. Depressed or sad mood
  2. Anhedonia (loss of interest in pleasurable activities)
  3. Sleep disturbance (increased or decreased sleep)
  4. Appetite disturbance (increased or decreased appetite) typically with weight change
  5. Energy disturbance (increased or decreased energy/activity level), usually fatigue
  6. Poor memory or concentration
  7. Feelings of guilt or worthlessness
  8. Psychomotor retardation or agitation (a change in mental and physical speed perceived by other people)
  9. Thoughts of wishing they were dead; suicidal ideation or suicide attempts

Causes and risk factors

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The exact changes in brain chemistry and function that cause either late-life or earlier-onset depression are unknown. Certain theories claim that late-life depression may result from dopamine and norepinephrine misregulation. Additionally, pituitary and adrenal imbalances accompany typical cases of late-life depression. The exact changes in brain chemistry and function that cause either late-life or earlier onset depression are unclear. It is known, however, that brain changes can be triggered by the stresses of certain life events such as illness, childbirth, death of a loved one, life transitions (such as retirement), interpersonal conflicts, or social isolation. Risk factors for depression in older persons include a history of depression, social isolation, lower socioeconomic status, uncontrolled pain, co-morbid chronic medical illness, insomnia, female sex, being single or divorced, cognitive or functional impairment, brain disease, alcohol use disorder, use of certain medications, stressful life events, and specific cardiovascular complications. These complications most notably include hypertension, diabetes mellitus, smoking tendencies, and hypercholesterolemia.[18][19][20][21][22]

Research suggests that individuals with late life depression are more likely to develop Alzheimer's Disease, vascular dementia, and all-cause dementia. Dementia, however, can present early in its disease course with depressive symptoms, meaning that this association could actually be reflecting that dementia causes late life depression.[23] Studies that have directly tried to determine whether depression is an independent risk factor for dementia have led to inconclusive results. Guidelines exist to help clinicians distinguish dementia versus a primary psychiatric disorder as the cause of a late-life depression diagnosis.[24]

Treatments

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Treatment is effective in about 80% of identified cases, when treatment is provided. Effective management requires a biopsychosocial approach, combining pharmacotherapy, art therapy, and psychotherapy. Therapy generally results in improved quality of life, enhanced functional capacity, possible improvement in medical health status, increased longevity, and lower health care costs. Improvement should be evident as early as two weeks after the start of therapy, but full therapeutic effects may require several months of treatment. Therapy for older patients should be continued for longer periods than are typically used in younger patients.[25][26]

Psychotherapy

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Psychologic therapies are recommended for elderly patients with depression because of this group's vulnerability to adverse effects and high rates of medical problems and medication use. Psychotherapeutic approaches include cognitive behavioral therapy, supportive psychotherapy, problem-solving therapy, and interpersonal therapy.[27] Life review therapy is another type of therapy with evidence supporting its usefulness in older adults with moderate depression.[28] The potential benefit of psychotherapy is not diminished by increasing age. Older adults often have better treatment compliance, lower dropout rates, and more positive responses to psychotherapy than younger patients.[27] While therapy can be beneficial, it is not always provided due to factors such as lack of trained therapists or lack of coverage by health insurance.[29]

Art therapy

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Art therapy can be suggested to those with depression, Alzheimer's, dementia, anxiety, and other mental health issues. Up to 27% of older adults have been diagnosed with depression in the U.S. Thus art therapy and its several uses, whether physical(dancing), auditory (music), or visual (painting), can be used differently to additionally help those on top of mental health issues but cognitive, physical, and behavioral/emotional disabilities as well.[30] Art therapy has been seen to help those in their late life, engage, and support healthy habits.[31] Specifically, those with depression have been seen to relax, hit physical and emotional distress, and overall increase well-being over time, the longer the participation.[32] Patients are able to express themselves in ways where it may be hard to communicate.[30]

It has also been found that patients do not even need to partake in the use of art, as "studies have found that a landscape picture in a hospital room had reduced need for narcotic pain killers and less time in recovery at the hospital."[33] The use of art as a form of therapy helps patients who are engaged with it physically or visually. Those within their late life, diagnosed with depression can participate regardless of age, gender, or physical/mental disability.[34][35]

Pharmacotherapy

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Pharmacotherapy for acute episodes of depression usually is effective and free of complications. Antidepressant medications are often the first treatment choice for adults with moderate or severe depression, sometimes along with psychotherapy. The most promising therapeutic effect is achieved when the treatment continues for at least six weeks.[36] Underuse or misuse of antidepressants and prescribing inadequate dosages are the most common mistakes physicians make when treating elderly patients for depression. Only 10% to 40% of depressed elderly patients are given medication.

Selective serotonin reuptake inhibitors, commonly referred to as SSRIs, are considered first line pharmacotherapy for depression in late life as they are more tolerable and safer than other antidepressants.[37] Serotonin-norepinephrine reuptake inhibitors (SNRIs) are considered second-line but also can be useful for patients with chronic pain.[38][39] Atypical antidepressants such as bupropion and mirtazapine have not been studied extensively in older adults but appear to offer some benefit.[40][41] Monoamine oxidase inhibitors (MAOIs) similarly have been shown to offer some benefit, but have not been studied extensively[42] MAOIs must be used with caution to prevent side effects such as serotonin syndrome and adrenergic crisis.[43]

Tricyclic antidepressants are no longer the first line therapy for depression, but can still benefit patients who do not respond to initial therapies.[39] TCAs have also demonstrated a unique ability to prevent re-occurrence of depression following electroconvulsive therapy.[44][45][46] TCAs are typically not used initially due to their side effects and risk from overdose compared to SSRIs.[47][48] A TCA overdose can be fatal at a much lower dose than SSRIs.[48]

Antidepressants, in general, may also work by playing a neuroprotective role in how they relieve anxiety and depression. It's thought that antidepressants may increase the effects of brain receptors that help nerve cells keep sensitivity to glutamate which is an organic compound of a nonessential amino acid. This increased support of nerve cells lowers glutamate sensitivity, providing protection against the glutamate overwhelming and exciting key brain areas related to depression. Although antidepressants may not cure depression, they can lead to remission, which is the disappearance or nearly complete reduction of depression symptoms.[49][50][51]

Continuation and maintenance treatments for depression in older people

A 2016 Cochrane review provided limited evidence that continuing antidepressant medication for one year seems to reduce the risk of depression recurrence with no additional harm.[52] However, a robust recommendation can not be drawn about psychological treatments or combination treatments in preventing recurrence.  

Neurostimulation

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Neurostimulation, specifically electroconvulsive therapy (ECT) is an effective treatment for depression in the elderly. It is particularly useful in treating severe major depression that does not respond well to the above treatments.[53] In the geriatric population specifically, including patients over the age of 85, ECT provides a safe and effective treatment option.[54][55] Compared to treatment with younger patients, ECT appears to work more effectively in the older patients.[56] A typical course of ECT treatment ranges from 6 to 12 treatments, with some requiring more or less.[57] A normal treatment schedule in the United States might include three treatments a week on Monday, Wednesday, and Friday. Two treatments a week compares favorably with three and can also be used.[58] Maintenance ECT, which is ECT given longitudinally after the initial set of acute treatments, also helps depression in late life and helps prevent reoccurring depression.[59]

If an older person requires hospitalization for their depression, ECT has been shown in multiple studies to work faster than medicine and reduce mortality associated with depression.[60][61] Even in cases such as depression following a stroke, ECT can be efficacious; however, the evidence is not as strong on its ability to treat vascular depression caused by long-term disease, versus an acute event like a stroke.[62][63]

Transcranial magnetic stimulation (TMS) is another example of neurostimulation used to treat depression, but ECT is considered to be the more effective modality.[64][65][66]

Epidemiology

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Major depression is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Nearly five million of the 31 million Americans who are 65 years or older are clinically depressed, and one million have major depression. Approximately 3% of healthy elderly persons living in the community have major depression. Recurrence may be as high as 40%. Suicide rates are nearly twice as high in depressed patients as in the general population. Major depression is more common in medically ill patients who are older than 70 years and hospitalized or institutionalized. Severe or chronic diseases associated with high rates of depression include stroke (30–60%), coronary heart disease (8–44%), cancer (1–40%), Parkinson's disease (40%), Alzheimer's disease (20–40%), and dementia (17–31%).[67]

Minor depression is a clinically significant depressive disorder that does not fulfill the duration criterion or the number of symptoms necessary for the diagnosis of major depression. Minor depression, which is more common than major depression in elderly patients, may follow a major depressive episode. It also can be a reaction to routine stressors in older populations. 15–50% of patients with minor depression develop major depression within two years.[68]

Research

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Brain imaging (functional/structural MRI) may help direct the search for microscopic abnormalities in brain structure and function responsible for late life depression. Ultimately, imaging technologies may serve as tools for early diagnosis and subtyping of depression.[69]

Genetics research studying late life depression is focused on identifying associated genetic markers linked to the development of late life depression. It is understood that genetic variants of APOE, BDNF, and SLC6A4 may be attributed to an increased risk. Regions of the brain that have been associated with these genes are hippocampal remodeling and the endocrine pathway of the Hypothalamus-Pituitary-Adrenal axis when managing stress.[70]

See also

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References

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  1. ^ a b c Aziz, Rehan; Steffens, David C. (1 December 2013). "What Are the Causes of Late-Life Depression?". Psychiatric Clinics. 36 (4): 497–516. doi:10.1016/j.psc.2013.08.001. ISSN 0193-953X. PMC 4084923. PMID 24229653.
  2. ^ a b Taylor WD (September 2014). "Clinical practice. Depression in the elderly". The New England Journal of Medicine. 371 (13): 1228–36. doi:10.1056/NEJMcp1402180. PMID 25251617. S2CID 36201456.
  3. ^ Lebowitz, Barry D.; Pearson, Jane L.; Schneider, Lon S.; Reynolds, Charles F. III; Alexopoulos, George S.; Bruce, Martha Livingston; Conwell, Yeates; Katz, Ira R.; Meyers, Barnett S.; Morrison, Mary F.; Mossey, Jana; Niederehe, George; Parmelee, Patricia (8 October 1997). "Diagnosis and Treatment of Depression in Late Life: Consensus Statement Update". JAMA. 278 (14): 1186–1190. doi:10.1001/jama.1997.03550140078045. ISSN 0098-7484. PMID 9326481.
  4. ^ a b c d Husain-Krautter, Sehba; Ellison, James M. (1 July 2021). "Late Life Depression: The Essentials and the Essential Distinctions". FOCUS. 19 (3): 282–293. doi:10.1176/appi.focus.20210006. ISSN 1541-4094. PMC 8475940. PMID 34690594.
  5. ^ Alexopoulos GS, Kelly RE (October 2009). "Research advances in geriatric depression". World Psychiatry. 8 (3): 140–9. doi:10.1002/j.2051-5545.2009.tb00234.x. PMC 2755271. PMID 19812743.
  6. ^ Steffens DC, Potter GG (February 2008). "Geriatric depression and cognitive impairment". Psychological Medicine. 38 (2): 163–75. doi:10.1017/S003329170700102X. PMID 17588275. S2CID 36713188.
  7. ^ Mitchell AJ, Subramaniam H (September 2005). "Prognosis of depression in old age compared to middle age: a systematic review of comparative studies". The American Journal of Psychiatry. 162 (9): 1588–601. doi:10.1176/appi.ajp.162.9.1588. PMID 16135616.
  8. ^ Yohannes AM, Baldwin RC (2008). "Medical Comorbidities in Late-Life Depression". Psychiatric Times. 25 (14).
  9. ^ a b c d "UpToDate". uptodate.com. Retrieved 20 November 2019.
  10. ^ Sirey JA, Bruce ML, Alexopoulos GS, Perlick DA, Raue P, Friedman SJ, Meyers BS (March 2001). "Perceived stigma as a predictor of treatment discontinuation in young and older outpatients with depression". The American Journal of Psychiatry. 158 (3): 479–81. doi:10.1176/appi.ajp.158.3.479. PMID 11229992.
  11. ^ Krishnan KR (January 2007). "Concept of disease in geriatric psychiatry". The American Journal of Geriatric Psychiatry. 15 (1): 1–11. doi:10.1097/01.JGP.0000224600.37387.4b. PMID 17095750.
  12. ^ Alexopoulos GS (2005). "Depression in the elderly". Lancet. 365 (9475): 1961–70. doi:10.1016/S0140-6736(05)66665-2. PMID 15936426. S2CID 34666321.
  13. ^ a b "UpToDate". uptodate.com. Retrieved 20 November 2019.
  14. ^ a b American Psychological Association. "APA Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts" (PDF). Retrieved 12 September 2022.
  15. ^ van der Wurff FB, Stek ML, Hoogendijk WJ, Beekman AT (October 2003). "The efficacy and safety of ECT in depressed older adults: a literature review". International Journal of Geriatric Psychiatry. 18 (10): 894–904. doi:10.1002/gps.944. PMID 14533122. S2CID 20799377.
  16. ^ Birrer RB, Vemuri SP (May 2004). "Depression in later life: a diagnostic and therapeutic challenge". American Family Physician. 69 (10): 2375–82. PMID 15168957.
  17. ^ a b c American Psychiatric Association (22 May 2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). American Psychiatric Association. CiteSeerX 10.1.1.988.5627. doi:10.1176/appi.books.9780890425596. ISBN 978-0-89042-555-8.
  18. ^ Lichtenberg, Pesach; Belmaker, R.H. (2010). "Subtyping Major Depressive Disorder". Psychotherapy and Psychosomatics. 79 (3): 132-133. doi:10.1159/000286957.
  19. ^ Aziz, Rehan; Steffens, David C. (December 2013). "What are the causes of late-life depression?". The Psychiatric Clinics of North America. 36 (4): 497–516. doi:10.1016/j.psc.2013.08.001. ISSN 1558-3147. PMC 4084923. PMID 24229653.
  20. ^ Büchtemann, Dorothea; Luppa, Melanie; Bramesfeld, Anke; Riedel-Heller, Steffi (15 December 2012). "Incidence of late-life depression: a systematic review". Journal of Affective Disorders. 142 (1–3): 172–179. doi:10.1016/j.jad.2012.05.010. ISSN 1573-2517. PMID 22940498.
  21. ^ Cole, Martin G.; Dendukuri, Nandini (June 2003). "Risk factors for depression among elderly community subjects: a systematic review and meta-analysis". The American Journal of Psychiatry. 160 (6): 1147–1156. doi:10.1176/appi.ajp.160.6.1147. ISSN 0002-953X. PMID 12777274.
  22. ^ Sekhon, Sandeep; Patel, Jason; Sapra, Amit. "Late-Life Depression". National Library of Medicine.
  23. ^ Diniz, Breno S.; Butters, Meryl A.; Albert, Steven M.; Dew, Mary Amanda; Reynolds, Charles F. (May 2013). "Late-life depression and risk of vascular dementia and Alzheimer's disease: systematic review and meta-analysis of community-based cohort studies". The British Journal of Psychiatry: The Journal of Mental Science. 202 (5): 329–335. doi:10.1192/bjp.bp.112.118307. ISSN 1472-1465. PMC 3640214. PMID 23637108.
  24. ^ Ducharme, Simon; Pearl-Dowler, Leora; Gossink, Flora; McCarthy, Jillian; Lai, Jimmy; Dickerson, Bradford C.; Chertkow, Howard; Rapin, Lucile; Vijverberg, Everard; Krudop, Welmoed; Dols, Annemieke; Pijnenburg, Yolande (1 January 2019). "The Frontotemporal Dementia versus Primary Psychiatric Disorder (FTD versus PPD) Checklist: A Bedside Clinical Tool to Identify Behavioral Variant FTD in Patients with Late-Onset Behavioral Changes". Journal of Alzheimer's Disease. 67 (1): 113–124. doi:10.3233/JAD-180839. ISSN 1387-2877. PMID 30584146. S2CID 58626686.
  25. ^ Frazer CJ, Christensen H, Griffiths KM (June 2005). "Effectiveness of treatments for depression in older people". The Medical Journal of Australia. 182 (12): 627–32. doi:10.5694/j.1326-5377.2005.tb06849.x. PMID 15963019. S2CID 18342952.
  26. ^ Smith GS, Alexopoulos GS (August 2009). "Neuroimaging in geriatric psychiatry". International Journal of Geriatric Psychiatry. 24 (8): 783–7. doi:10.1002/gps.2335. PMC 5675131. PMID 19593778.
  27. ^ a b Alexopoulos GS, Raue PJ, Kanellopoulos D, Mackin S, Arean PA (August 2008). "Problem solving therapy for the depression-executive dysfunction syndrome of late life". International Journal of Geriatric Psychiatry. 23 (8): 782–8. doi:10.1002/gps.1988. PMID 18213605. S2CID 35390619.
  28. ^ Korte J, Bohlmeijer ET, Cappeliez P, Smit F, Westerhof GJ (June 2012). "Life review therapy for older adults with moderate depressive symptomatology: a pragmatic randomized controlled trial" (PDF). Psychological Medicine. 42 (6): 1163–73. doi:10.1017/S0033291711002042. PMID 21995889. S2CID 38756731.
  29. ^ "UpToDate". uptodate.com. Retrieved 4 December 2019.
  30. ^ a b Dunphy, Kim; Baker, Felicity A.; Dumaresq, Ella; Carroll-Haskins, Katrina; Eickholt, Jasmin; Ercole, Maya; Kaimal, Girija; Meyer, Kirsten; Sajnani, Nisha; Shamir, Opher Y.; Wosch, Thomas (2019). "Creative Arts Interventions to Address Depression in Older Adults: A Systematic Review of Outcomes, Processes, and Mechanisms". Frontiers in Psychology. 9: 2655. doi:10.3389/fpsyg.2018.02655. ISSN 1664-1078. PMC 6331422. PMID 30671000.
  31. ^ "Aging: What's Art Got To Do With It?". todaysgeriatricmedicine.com. Retrieved 26 September 2022.
  32. ^ Stallings, J. W.; Thompson, S. K. (June 2012). "Use of Art Therapy in Geriatric Populations". Population Health Learning Network. Annals of Long Term Care. Retrieved 26 September 2022.
  33. ^ Stuckey, Heather L.; Nobel, Jeremy (February 2010). "The Connection Between Art, Healing, and Public Health: A Review of Current Literature". American Journal of Public Health. 100 (2): 254–263. doi:10.2105/AJPH.2008.156497. ISSN 0090-0036. PMC 2804629. PMID 20019311.
  34. ^ Flood, Matthew (1 August 2019). "Art Therapy for Seniors – How Art Can Help the Elderly". Complete Care. Retrieved 5 October 2022.
  35. ^ Ciasca, Eliana C.; Ferreira, Rita C.; Santana, Carmen L.A.; Forlenza, Orestes V.; dos Santos, Glenda D.; Brum, Paula S.; Nunes, Paula V. (1 February 2018). "Art therapy as an adjuvant treatment for depression in elderly women: a randomized controlled trial". Brazilian Journal of Psychiatry. 40 (3): 256–263. doi:10.1590/1516-4446-2017-2250. ISSN 1516-4446. PMC 6899401. PMID 29412335.
  36. ^ Wilson K, Mottram P, Sivanranthan A, Nightingale A (2001). "Antidepressant versus placebo for depressed elderly". The Cochrane Database of Systematic Reviews. 2001 (2): CD000561. doi:10.1002/14651858.CD000561. PMC 7066642. PMID 11405969.
  37. ^ Solai LK, Mulsant BH, Pollock BG (2001). "Selective serotonin reuptake inhibitors for late-life depression: a comparative review". Drugs & Aging. 18 (5): 355–68. doi:10.2165/00002512-200118050-00006. PMID 11392444. S2CID 23519411.
  38. ^ Nelson JC, Wohlreich MM, Mallinckrodt CH, Detke MJ, Watkin JG, Kennedy JS (March 2005). "Duloxetine for the treatment of major depressive disorder in older patients". The American Journal of Geriatric Psychiatry. 13 (3): 227–35. doi:10.1176/appi.ajgp.13.3.227. PMID 15728754.
  39. ^ a b "UpToDate". uptodate.com. Retrieved 4 December 2019.
  40. ^ Steffens DC, Doraiswamy PM, McQuoid DR (September 2001). "Bupropion SR in the naturalistic treatment of elderly patients with major depression". International Journal of Geriatric Psychiatry. 16 (9): 862–5. doi:10.1002/gps.424. PMID 11571765. S2CID 26398542.
  41. ^ Anttila SA, Leinonen EV (2001). "A review of the pharmacological and clinical profile of mirtazapine". CNS Drug Reviews. 7 (3): 249–64. doi:10.1111/j.1527-3458.2001.tb00198.x. PMC 6494141. PMID 11607047.
  42. ^ Georgotas A, McCue RE, Hapworth W, Friedman E, Kim OM, Welkowitz J, et al. (October 1986). "Comparative efficacy and safety of MAOIs versus TCAs in treating depression in the elderly". Biological Psychiatry. 21 (12): 1155–66. doi:10.1016/0006-3223(86)90222-2. PMID 3756264. S2CID 44627288.
  43. ^ "UpToDate". uptodate.com. Retrieved 4 December 2019.
  44. ^ Flint AJ, Rifat SL (January 1998). "The treatment of psychotic depression in later life: a comparison of pharmacotherapy and ECT". International Journal of Geriatric Psychiatry. 13 (1): 23–8. doi:10.1002/(SICI)1099-1166(199801)13:1<23::AID-GPS725>3.0.CO;2-J. PMID 9489577. S2CID 27593765.
  45. ^ Sackeim HA, Haskett RF, Mulsant BH, Thase ME, Mann JJ, Pettinati HM, et al. (March 2001). "Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial". JAMA. 285 (10): 1299–307. doi:10.1001/jama.285.10.1299. PMID 11255384.
  46. ^ Mittmann N, Herrmann N, Shulman KI, Silver IL, Busto UE, Borden EK, et al. (October 1999). "The effectiveness of antidepressants in elderly depressed outpatients: a prospective case series study". The Journal of Clinical Psychiatry. 60 (10): 690–7. doi:10.4088/jcp.v60n1008. PMID 10549686.
  47. ^ Anderson IM, Ferrier IN, Baldwin RC, Cowen PJ, Howard L, Lewis G, et al. (June 2008). "Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2000 British Association for Psychopharmacology guidelines". Journal of Psychopharmacology. 22 (4): 343–96. doi:10.1177/0269881107088441. PMID 18413657. S2CID 25658129.
  48. ^ a b Nelson J (May 2017). "Tricyclic and Tetracyclic Drugs". The American Psychiatric Association Publishing Textbook of Psychopharmacology. American Psychiatric Association Publishing. doi:10.1176/appi.books.9781615371624.as09. ISBN 978-1-58562-523-9.
  49. ^ Taylor WD, Kuchibhatla M, Payne ME, Macfall JR, Sheline YI, Krishnan KR, Doraiswamy PM (September 2008). "Frontal white matter anisotropy and antidepressant remission in late-life depression". PLOS ONE. 3 (9): e3267. Bibcode:2008PLoSO...3.3267T. doi:10.1371/journal.pone.0003267. PMC 2533397. PMID 18813343.
  50. ^ Murphy GM, Kremer C, Rodrigues HE, Schatzberg AF (October 2003). "Pharmacogenetics of antidepressant medication intolerance". The American Journal of Psychiatry. 160 (10): 1830–5. doi:10.1176/appi.ajp.160.10.1830. PMID 14514498.
  51. ^ Serafeim A, Holder MJ, Grafton G, Chamba A, Drayson MT, Luong QT, et al. (April 2003). "Selective serotonin reuptake inhibitors directly signal for apoptosis in biopsy-like Burkitt lymphoma cells". Blood. 101 (8): 3212–9. doi:10.1182/blood-2002-07-2044. PMID 12515726.
  52. ^ Wilkinson P, Izmeth Z (September 2016). "Continuation and maintenance treatments for depression in older people". The Cochrane Database of Systematic Reviews. 2016 (9): CD006727. doi:10.1002/14651858.cd006727.pub3. PMC 6457610. PMID 27609183.
  53. ^ Pagnin D, de Queiroz V, Pini S, Cassano GB (March 2004). "Efficacy of ECT in depression: a meta-analytic review". The Journal of ECT. 20 (1): 13–20. doi:10.1097/00124509-200403000-00004. PMID 15087991. S2CID 25843283.
  54. ^ Kerner N, Prudic J (February 2014). "Current electroconvulsive therapy practice and research in the geriatric population". Neuropsychiatry. 4 (1): 33–54. doi:10.2217/npy.14.3. PMC 4000084. PMID 24778709.
  55. ^ Geduldig ET, Kellner CH (April 2016). "Electroconvulsive Therapy in the Elderly: New Findings in Geriatric Depression". Current Psychiatry Reports. 18 (4): 40. doi:10.1007/s11920-016-0674-5. PMID 26909702. S2CID 44569093.
  56. ^ Rhebergen D, Huisman A, Bouckaert F, Kho K, Kok R, Sienaert P, et al. (March 2015). "Older age is associated with rapid remission of depression after electroconvulsive therapy: a latent class growth analysis". The American Journal of Geriatric Psychiatry. 23 (3): 274–82. doi:10.1016/j.jagp.2014.05.002. PMID 24951182.
  57. ^ "UpToDate". uptodate.com. Retrieved 27 November 2019.
  58. ^ Kellner CH (2012). Brain Stimulation in Psychiatry. Cambridge: Cambridge University Press. doi:10.1017/cbo9780511736216. ISBN 978-0-511-73621-6.
  59. ^ van Schaik AM, Comijs HC, Sonnenberg CM, Beekman AT, Sienaert P, Stek ML (January 2012). "Efficacy and safety of continuation and maintenance electroconvulsive therapy in depressed elderly patients: a systematic review". The American Journal of Geriatric Psychiatry. 20 (1): 5–17. doi:10.1097/JGP.0b013e31820dcbf9. PMID 22183009.
  60. ^ Philibert RA, Richards L, Lynch CF, Winokur G (September 1995). "Effect of ECT on mortality and clinical outcome in geriatric unipolar depression". The Journal of Clinical Psychiatry. 56 (9): 390–4. PMID 7665536.
  61. ^ Spaans HP, Sienaert P, Bouckaert F, van den Berg JF, Verwijk E, Kho KH, Stek ML, Kok RM (January 2015). "Speed of remission in elderly patients with depression: electroconvulsive therapy v. medication". The British Journal of Psychiatry. 206 (1): 67–71. doi:10.1192/bjp.bp.114.148213. PMID 25323140.
  62. ^ Kales HC, Maixner DF, Mellow AM (February 2005). "Cerebrovascular disease and late-life depression". The American Journal of Geriatric Psychiatry. 13 (2): 88–98. doi:10.1176/appi.ajgp.13.2.88. PMID 15703317.
  63. ^ Currier MB, Murray GB, Welch CC (1992). "Electroconvulsive therapy for post-stroke depressed geriatric patients". The Journal of Neuropsychiatry and Clinical Neurosciences. 4 (2): 140–4. doi:10.1176/jnp.4.2.140. PMID 1627974.
  64. ^ Berlim MT, Van den Eynde F, Daskalakis ZJ (July 2013). "Efficacy and acceptability of high frequency repetitive transcranial magnetic stimulation (rTMS) versus electroconvulsive therapy (ECT) for major depression: a systematic review and meta-analysis of randomized trials". Depression and Anxiety. 30 (7): 614–23. doi:10.1002/da.22060. PMID 23349112. S2CID 2173645.
  65. ^ Slotema CW, Blom JD, Hoek HW, Sommer IE (July 2010). "Should we expand the toolbox of psychiatric treatment methods to include Repetitive Transcranial Magnetic Stimulation (rTMS)? A meta-analysis of the efficacy of rTMS in psychiatric disorders". The Journal of Clinical Psychiatry. 71 (7): 873–84. doi:10.4088/JCP.08m04872gre. PMID 20361902.
  66. ^ Health Quality, Ontario (2016). "Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials". Ontario Health Technology Assessment Series. 16 (5): 1–66. PMC 4808719. PMID 27099642.
  67. ^ American Psychiatric Association 2000a, p. 354
  68. ^ Rapaport MH, Judd LL, Schettler PJ, Yonkers KA, Thase ME, Kupfer DJ, et al. (April 2002). "A descriptive analysis of minor depression". The American Journal of Psychiatry. 159 (4): 637–43. doi:10.1176/appi.ajp.159.4.637. PMID 11925303.
  69. ^ Soares JC, Mann JJ (January 1997). "The anatomy of mood disorders--review of structural neuroimaging studies". Biological Psychiatry. 41 (1): 86–106. doi:10.1016/S0006-3223(96)00006-6. PMID 8988799. S2CID 32444863.
  70. ^ Tsang, Ruby S. M.; Mather, Karen A.; Sachdev, Perminder S.; Reppermund, Simone (April 2017). "Systematic review and meta-analysis of genetic studies of late-life depression". Neuroscience and Biobehavioral Reviews. 75: 129–139. doi:10.1016/j.neubiorev.2017.01.028. ISSN 1873-7528. PMID 28137459. S2CID 39796461.
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