Download ECHO Geriatric Series Depression: An Extremely Complex Disease

GERIATRIC EDUCATION SERIES
Presented in partnership by
Funded in part by a grant from the EJC
Foundation
ECHO Geriatric Series
Depression: An Extremely Complex Disease
Steven L. Phillips, MD
Medical Director
Sanford Center for Aging
dhs.unr.edu/aging
Depression is an extremely complex disease. It occurs
for a variety of reasons. Some people experience
depression during a serious illness. Others may have
depression with life changes such as a move or the
death of a loved one. Still others have a family history
of depression. Those who do may experience
depression and feel overwhelmed with sadness and
loneliness for no known reason.
Course Objectives
• Objective 1: Define main cause of depression.
• Objective 2: Describe the impact of depression on
commonly treated medical conditions.
• Objective 3: Review options for the treatment of
depression.
Main Causes of Depression
•
•
•
•
•
Past Abuse
Conflict
Death or a Loss
Genetics
Substance Abuse
•
•
•
•
•
Major Events
Social Isolation
Rejection
Medications
Chronic Illness
Chronic illness is an illness that lasts for a very long
time (> 6 months) and usually cannot be cured
completely. However, chronic illnesses can often be
controlled through diet, exercise, lifestyle habits and
certain medications.
Chronic Illnesses That May Cause
Depression
•
•
•
•
•
Diabetes Mellitus
COPD/Emphysema
HIV/AIDS
Multiple Sclerosis
Cancer
•
•
•
•
•
Heart Disease
Arthritis
Systemic Lupus
Hypothyroidism
CVA/Stroke
Impact of Depression
•
•
•
•
•
Social Isolation
Functional Decline
Loss of Productivity
Self Neglect
Danger to Self or Others
•
•
•
•
•
Increase Office Visits
Increase ER Visits
Increase Hospitalizations
Increase Readmissions
Increase Mortality
Symptoms of Depression
•
•
•
•
•
•
Sadness or Depressed Mood
Physical Restlessness
Worthlessness
Impaired Decision Making
Major Weight Change
Excessive Sleep
•
•
•
•
•
•
Loss of Enjoyment
Insomnia
Fatigue
Hopelessness
Excessive Guilt
Thoughts of Death
Patient Health Questionnaire (PHQ-9)
Over the last 2 weeks, how often have you been bothered by any of the following problems (circle your answer):
Not at all Several More than Nearly
days
half days every day
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
Little interest in doing things
Feeling down, depressed or hopeless
Trouble falling or staying asleep or sleeping too much
Feeling tired or having little energy
Poor appetite or overeating
Feeling bad about yourself-or that you
are a failure or have let yourself or your family down
Trouble concentrating on things, such as reading the
newspaper or watching television
Moving or speaking so slowly that other people could have noticed?
Or the opposite-being so fidgety or restless that you have been
moving around a lot more than usual
Thoughts that you would be better off dead or hurting yourself in
some way
If you checked off any problems, how difficult have these problems made it for you to do your work, take care of
things at home, or get along with other people?
 Not difficult at all
 Somewhat difficult
 Very difficult
 Extremely difficult
Treatment Options for Depression
• Routine Exercise
• Antidepressant
• Social Engagement
• Medication
Discontinuation
• Psychotherapy
• Brain Stimulation (ECT)
Sanford Center for Aging Geriatric
Specialty Clinic
Steven L. Phillips, MD
[email protected]
(775) 784-1808