* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Geriatric Depression
Survey
Document related concepts
Emergency psychiatry wikipedia , lookup
Conversion disorder wikipedia , lookup
Separation anxiety disorder wikipedia , lookup
Bipolar II disorder wikipedia , lookup
Death of Dan Markingson wikipedia , lookup
Controversy surrounding psychiatry wikipedia , lookup
Generalized anxiety disorder wikipedia , lookup
Postpartum depression wikipedia , lookup
Behavioral theories of depression wikipedia , lookup
Major depressive disorder wikipedia , lookup
Evolutionary approaches to depression wikipedia , lookup
Transcript
Kimothi Cain, MD, MPH Psychiatry Psychosomatic Fellow Persons 65 years or older 39.6 million in 2009 (the latest year for which data is available) or 12.9% of the U.S. population 72.1 million or 19% of the population estimated in 2030 Department of Health and Human Services, 2012 Of 39.6 million US seniors: 3 million have a depressive disorder 5 million have subsyndromal depression Less than 10% are treated 19% of all suicides are by patients over 65 The second highest U.S. suicide rates are white men over age 65 More somatic complaints: Persistent, vague, unexplained physical complaints such as pain, GI disturbances, weakness, insomnia, anergy Less likely to present with depressed mood Agitation, anxiety Memory problems, difficulty concentrating Social withdrawal In primary care, depressed geriatric patients frequently present with somatic complaints Chief complaints of 1043 geriatric patients in a primary care setting who were subsequently diagnosed with Major Depressive Disorder Simon GE, et al. N Engl J Med. 2012;341(18):1329-1335 Hypothyroidism Calcium B12 deficiency Vitamin D deficiency Heart disease Neurological illnesses Cancer COPD Autoimmune diseases CVA Trauma Alzheimer disease Other neurodegenerative diseases etc. etc. Evidence for Drug-Induced Depression associated with drug groups DRUG CLASS/DRUG Calcium channel blockers LEVEL OF EVIDENCE +/- AVAILABLE LITERATURE COMMENTS Prescription symmetry analysis, Results are conflicting—newer have cohort study examining suicide fewer reports. rates ACE inhibitors +/- Prescription symmetry analysis No comment ARBs +/- Case reports No comment Alpha interferons ++ Uncontrolled and controlled No comment studies Beta interferons +/- Corticosteroids + 4 RCTs and 1 naturalistic study No comment Case control study, cross-sectional Results of trials are suggestive of DID, analysis especially over >65 **Reflects authors’ global assessment of evidence; --- little or no convincing evidence; +/- limited evidence; + moderately strong evidence; ++ strong evidence; +++ very strong/unequivocal evidence Rogers et al, Psychiatry, 2008; 5(12): 28–41 Geriatric Depression Scale DSM-V criteria for MDD At least 5 of 9 symptoms, present nearly every day for 2 or more weeks: 1. Depressed mood or irritable most of the day** 2. Decreased interest or pleasure in most activities (anhedonia)** 3. Significant weight change (5%) or change in appetite 4. Change in sleep: Insomnia or hypersomnia 5. Change in activity: Psychomotor agitation or retardation 6. Fatigue or loss of energy 7. Guilt/worthlessness 8. Concentration: diminished ability to think, concentrate, or indecisiveness 9. Suicidality: Thoughts of death or suicide, or has suicide plan ** Depressed/irritable or anhedonia required for diagnosis Geriatric depression can be challenging to diagnose and treat Consider psychotherapy, group therapy Healthy lifestyle Behavior activation Consider an antidressant antidepressant Increases use of primary care medical resources Depressive symptoms significantly reduce survival of medical illness Increases risk of suicide Decrease in lean body mass and total body water Increase in body fat, prolongs half life Hepatic metabolism decreases, as well as production of albumin Decrease in renal function Antidepressant Target sx Starting dose Incremental increase Target dose (Not the same for seniors) Sertraline Depression 25mg qday Anxiety Cardioprotective 25mg q3-6 weeks Usually requires less than 200mg. Max 200mg Escitalopram Depression Anxiety 5mg qday 5mg q3-6 weeks Max 20mg Mirtazapine Insomnia Poor appetite Depression Anxiety 7.5mg qhs 7.5mg q3-6 weeks Max 45mg 1. Fluoxetine -Long half-life metabolites -Drug-drug interactions 2. Paroxetine -Anticholinergic -Short-half life with marked withdrawal sx