geriatric depression n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
GERIATRIC DEPRESSION PowerPoint Presentation
Download Presentation
GERIATRIC DEPRESSION

Loading in 2 Seconds...

play fullscreen
1 / 19

GERIATRIC DEPRESSION - PowerPoint PPT Presentation


  • 108 Views
  • Uploaded on

GERIATRIC DEPRESSION. July 11, 2000 Pat Borman, M.D. Swedish Family Medicine. Case 1. JT is an 80 y.o. white male Complaints - bad taste in mouth, sore muscles, dizziness, constipation. Repeated visit to doctor with vague symptoms.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'GERIATRIC DEPRESSION' - cree


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
geriatric depression

GERIATRIC DEPRESSION

July 11, 2000

Pat Borman, M.D.

Swedish Family Medicine

case 1
Case 1
  • JT is an 80 y.o. white male
    • Complaints - bad taste in mouth, sore muscles, dizziness, constipation. Repeated visit to doctor with vague symptoms.
    • Daughter reports impossibly uncooperative with angry outbursts.
    • Widowed 3 years ago, moved in with daughter 3 months ago
case 2
CASE 2
  • MG is a 78 y.o. asian female
    • Complains bitterly of a left facial pain or fullness to you, her family and her friends
    • On her own saw a neurologist, rheumatologist, ENT specialist, accupuncturist, massage therapist
    • Trails of NSAIDS, narcs, neurontin, capsaicin, ice, heat, steroids have failed
case 3
CASE 3
  • AR is an 85 y.o. black female
    • Large CVA last year, required nursing home placement
    • Withdrawn, makes no friends, no interest in activities
    • Poor sleep, loosing weight
    • Anxious, fretful, afraid her son will not come to visit
incidence of depression
INCIDENCE OF DEPRESSION
  • GERIATRIC
    • 3% community dwelling
    • 14% two years after spouse dies
    • 15% medically ill
    • 25% chronic care facilities
    • 25-35% have depressive symptoms
dsm iv diagnostic criteria
DSM-IV DIAGNOSTIC CRITERIA
  • 5 or more symptoms lasting >2 wk, change from previous functioning:
    • Depressed mood and/or loss of interest
    • Altered sleep, loss of energy, wt loss, feelings of worthlessness/guilt, loss of concentration and focus, recurrent thoughts of death
how is depression different in the elderly
How is Depression Different in the Elderly?
  • Less verbalization of emotions or guilt
  • Minimize or deny depressed mood
  • Preoccupied with somatic symptoms
  • Cognitive impairment can be huge
  • More anxiety, agitation and psychosis
  • Medical Conditions can mask OR cause depression
medical conditions mask or cause depression
Metabolic

Endocrine

Autoimmune

Disorders

Infections

Neoplasms

Cerebrovascular

Disease

Degenerative Neurological Disease

DRUGS

Propranolol

Cimetidine

Clonidine

Benzodiazepines

Steroids

MANY,MANY MORE

Medical Conditions Mask or Cause Depression
signs and symptoms in geriatric depression
SYMPTOMS

MOOD

COGNITIVE

VEGETATIVE

VOLITIONAL

SIGNS

APPEARANCE

BEHAVIORS

PSYCHOMOTOR RETARDATION

PHYSCHOMOTOR AGITATION

SIGNS AND SYMPTOMS IN GERIATRIC DEPRESSION
interventions
INTERVENTIONS
  • Seek out medical illness
  • Recognize medical side effects
  • Rehab services to maximize remaining function
  • Involve Family/care taker
  • Counseling role transitions, grief, family
  • Medications
  • ECT
suicide is the real risk
SUICIDE IS THE REAL RISK
  • 25% of all completed suicides are >65
  • Suicide rate for depressed men over 65 is 5 times higher than for younger men
  • Men:60% complete guns or hanging
  • Women:70% attempt with drugs
  • Increased risk: financial problems, physical illness, recent loss, ETOH, abuse, isolation
geriatric prescribing principles
GERIATRIC PRESCRIBING PRINCIPLES
  • C Caution, Compliance
  • A Adjust dose for Age
  • R Review, Remove, Reduce
  • E Educate

START LOW & GO SLOW

medical therapy in geriatric depression
MEDICAL THERAPY IN GERIATRIC DEPRESSION
  • Select based on symptoms, prior response, concurrent illness, side effect profile
  • Reassess after 4-6 weeks:
    • Increase dose, augment with second agent, add psychotherapy
    • Consider psychiatric consult/referral
preferred antidepressants
Least side effects

good safety record

cost can be a problem

Least expensive

activation, tremor

anxiolytic

PREFERRED ANTIDEPRESSANTS
  • SSRIs
    • Celexa, Paxil
    • Zoloft, Prozac
  • TCA
    • Nortriptyline
  • HCA
    • Wellbutrin
    • Serzone
acceptable antidepressants
TCA

Despiramine

HCA

Trazodone

Remeron

SNRI

Effexor

Sedation, hypotension

cognitive slowing

appetite, wt gain

constipation

Dizzy, anorexia, nausea, BP increase

ACCEPTABLE ANTIDEPRESSANTS
antidepressants to aviod in the elderly
ANTIDEPRESSANTS TO AVIOD IN THE ELDERLY
  • Too many side effects:
  • TCA
    • Amitriptyline, doxipine, protriptyline, Amozapine, trimipramine
  • MAOI
    • Phenalizine, trancypromine
case 1 treatment options
CASE 1 Treatment Options
  • Consider Serzone for anxiolytic properties
    • Much too expensive for him
  • Start Nortriptyline 10 mg q d
  • Family Counseling for role transitions, and grief counseling
  • Excellent response, household happier
case 2 treatment options
CASE 2 Treatment Options
  • After 14 months of exhausting all the specialists and unhappy with the side effects off all the drugs
  • Start PAXIL 10 mg q d
    • Pain and facial pressure completely resolved in 14 days
case 3 treatment options
CASE 3 Treatment Options
  • Given wt loss, inability to sleep
  • Select Remron 15 mg q hs
    • In 8 weeks she is up 7 pounds, starting to make friends, went on her first nursing home outing, such a good response to rehab the family is considering taking her home.