Depression is a common problem among older adults, affecting 15-27% of community-dwelling older people and up to 37% of those in primary care. Untreated depression can negatively impact physical health and recovery. Diagnosis involves assessing symptoms like depressed mood, loss of interest, changes in appetite, and fatigue. Effective treatment includes both pharmacological options like SSRIs and non-pharmacological therapies such as cognitive behavioral therapy. Regular screening is important to identify depression early in older patients.

1. GERIATRIC DEPRESSION
By-Dr.Swati

2. INTRODUCTION
• Depression is under-recognized and
undertreated in the older people.
• 15% - 27% older adults in community & up to
37% in primary care setting experience
depressive symptoms.
• Untreated depression can delay recovery or
worsen the outcome of other medical illnesses
via increased morbidity or mortality
• Depression is NOT a part of normal aging

3. WHAT IS DEPRESSION?
 DSM-5 Definition
 Five or more of the following must have
been present during the same 2-week
interval and represent a change from
baseline functioning
 One of the symptoms must be depressed
mood or loss of interest or pleasure

4.  Depressed mood
 Loss of interest in all or almost all
activities or pleasure
 Appetite change or weight loss
 Insomnia or hypersomnia
 Psychomotor agitation or
retardation

5.  Loss of energy or fatigue
 Feelings of worthlessness or excessive
guilt
 Difficulty with thinking, concentration, or
decision making
 Recurrent thoughts of death or suicide
 Preoccupation with somatic symptoms,
health status, or physical limitations

6.  For Major Depression, these
symptoms
 Produce social impairment
 Are not related to substance
abuse
 Are not related to bereavement
[the loss of a loved one by death]

7.  Types of Depressive Disorders
 Mild episode of major depression
 Moderate episode of major depression
 Severe episode of major depression
 Severe episode of major depression with
psychotic features

8.  Minor depression is common
 15% of older persons
 Causes ↑ use of health services, excess disability, poor
health outcomes, including ↑ mortality
 Major depression is not common
 1%–2% of physically healthy community dwellers
 Elders less likely to recognize or endorse depressed mood

9. RISK FACTORS
 Alcohol or substance abuse
 Current use of a medication associated with a high risk of
depression
 Hearing or vision impairment severe enough to affect
function
 History of attempted suicide
 History of psychiatric hospitalization
 Female gender
 Bereavement

10. COGNITIVE DEFICITS IN
GERIATRIC DEPRESSION
 Cognitive symptoms of severe depression can be misdiagnosed as
an early stage dementing disorder.
 The neuropsychological impairment seen frequently in geriatric
depression span across multiple cognitive domains. These include
impairments in episodic memory, recognition memory,verbal
fluency ,psychomotor speed.
 The specific structural abnormalities that contribute to symptoms
of depression have been identified in the orbitofrontal cortex, ant
cingulate,putamen, caudate head, hippocampus, amygdala

11. CAUSES
 As you grow older, you face significant life changes that
can put you at risk for depression.
 Health problems – Illness and disability; chronic or severe
pain; cognitive decline; damage to body image due to
disease.
 Loneliness and isolation – Living alone; a dwindling social
circle due to deaths or relocation;
 Reduced sense of purpose – Feelings of purposelessness
or loss of identity due to retirement or physical limitations
on activities.
 Fears – Fear of death or dying; anxiety over financial
problems or health issues.
 Recent bereavement – The death of friends, family
members, and pets; the loss of a spouse or partner.

12. DRUGS THAT MAY CAUSE
DEPRESSION SYMPTOMS

13. DRUG CLASS EXAMPLES
Angiotension-converting enzyme
inhibitors
Captopril,enalapril
Antibiotics Ciprofloxacin,dapsone,metronidazole
Anticholinergic Dicyclomine
Antivirals Acyclovir, nevirapine
Benzodiazepines Alprazolam, clonazepam, lorazepam
Calcium-channel blockers Verapamil, diltiazem
Opioids Codeine,morphine
NSAIDs Ibuprofen , indomethacin , naproxen
Parkinson drugs Levodopa ,pramipexole

14. DIFFERENTIAL DIAGNOSIS
 Thyroid disorders (hypo- and hyper-thyroidism)
 Dementia (or mild cognitive impairment)
 Bereavement
 Anxiety Disorder
 Substance Abuse Disorder
 Personality Disorder
 Diabetes mellitus
 Underlying malignancy
 Anemia
 Medication side effects

15. Most commonly used and
validated screening tool for
diagnosis of Depression in the
geriatrics patient:
 The Geriatric Depression Scale

16. • It can either be self administered or administered by a
clinician & takes approx. 5-7 minutes to complete. .
• The presence of 5 or more depression symptoms
responses suggests a positive screen for depression.
• The original instrument consist of 30 questions,although
shorter 15-item and ultrashort 4-item versions have been
developed.

17. Geriatric Depression Scale: Short Form
Choose the best answer for how you have felt over the past week:
1. Are you basically satisfied with your life? YES / NO
2. Have you dropped many of your activities and interests? YES / NO
3. Do you feel that your life is empty? YES / NO
4. Do you often get bored? YES / NO
5. Are you in good spirits most of the time? YES / NO
6. Are you afraid that something bad is going to happen to you? YES / NO
7. Do you feel happy most of the time? YES / NO
8. Do you often feel helpless? YES / NO
9. Do you prefer to stay at home, rather than going out and doing new things? YES / NO
10. Do you feel you have more problems with memory than most? YES / NO
11. Do you think it is wonderful to be alive now? YES / NO
12. Do you feel pretty worthless the way you are now? YES / NO
13. Do you feel full of energy? YES / NO
14. Do you feel that your situation is hopeless? YES / NO
15. Do you think that most people are better off than you are? YES / NO
Answers in bold indicate depression. Score 1 point for each bolded answer.
A score > 5 points is suggestive of depression.

18. TREATMENT
 Effective management requires a biopsychosocial
approach, combining pharmacotherapy and
psychotherapy.
 Therapy generally results in improved quality of life,
enhanced functional capacity, possible
improvement in medical health status, and lower
health care costs.

19. NON
PHARMACOLOGICAL T/T
1. CBT:
 teaches individuals to identify maladaptive or distorted cognition &
learn to challenge them
 Increasing pleasurable activities and use techniques, such as
activity monitoring & scheduling.
2. IPT:
 focus on current relationship in 1 or more of problematic area of life:
grief, interpersonal conflicts, interpersonal deficits.
2. Life review intervention:
 focus on evaluating positive & negative events with the goal of
reframing & integrating these events by changing overview of
themselves & the events of their life.

20. NATURAL REMEDIES
 Exercise
 Yoga
 Tai-chi
 Massage
 Music therapy
 Spiritual/religious based therapy

21. COMPLEMENTARY &
ALTERNATIVE MEDICINES
1. FISH OIL
2. SAM(S-ADENOSYL METHIONINE)
3. FOLIC ACID

22. PHARMACOTHERAPY
 ANTIDEPRESSANTS SHOULD BE CONSIDERED IN PATIENTS WITH
MOD TO SEVERE DEPRESSION & IN PATIENT WITH A MILD TO MOD
DEPRESSION WHO WERE NOT RESPOND WITH NON-
PHARMACOLOGICAL TREATMENT.
 Selective Serotonin Reuptake Inhibitors (first line of drug because
of better safety profile)
 : fluoxetine
 Tricyclic Antidepressants : imipramine and amitriptyline(the use of
TCA has been limited bcz of safety profile, the major safety issue
is their cardiovascular effect)
 Monoamine Oxidase Inhibitors
 Other Antidepressants: mirtazapine

24. CONSEQUENCES AND
COMPLICATIONS OF
INADEQUATELY TREATED
DEPRESSION
 Recurrence, partial recovery, and
chronicity . . .
 ↑ disability
 ↑ use of health care resources
 ↑ morbidity and mortality
 Suicide (one fourth of
all suicides occur in
persons ≥ 65)

25. THANK YOU