Mooddisorders.ppt slides/ Affective disorders

MOOD DISORDERS
PRESENTED BY: MS RITIKA SONI

INTRODUCTION
EMOTIONS
AFFECT:
Short-lived, emotional
Response to an event
MOOD:
Sustained and pervasive

 Mood disorders are characterized by a
disturbance of mood, accompanied by a full or
partial manic or depressive syndrome, which is
not due to any other physical or mental disorder .
 Mood disorders are a group of clinical
conditions(syndrome) which are characterized by
a sense of loss of control over one’s mood
and subjective sense of distress, impaired
interpersonal, social and occupational
functioning.
 The prevalence rate of mood disorder is 1.5 %,
and it is uniform throughout the world.

HISTORY
 Hippocrates (400 B.C.) used the terms
mania and melancholia to describe mental
disturbances, it was Aretaeus who first
described mania and depression.
 Roman physician (30 A.D.) described
melancholia as depression caused by black
bile

 In 1854, Jules Farlet described a
condition called folie circulaire:
alternating moods of depression and
mania
 In 1899, Emil Kraepelin described
manic-depressive psychosis using most of
the criteria that psychiatrists use now.

CLASSIFICATION( F30-F39)
 F30: Manic Episode
 F31: Bipolar (Affective) Disorder
 F32: Depressive Episode
 F33: major depressive disorder, single episode
 F34: Persistent Mood (affective) Disorder (cyclothymia
and dysthymia)
 F39: Unspecified mood disorder

MANIC EPISODE
Introduction:
 Life time risk – 0.8-1%
 Occurs in episodes- lasting usually 3-4 months, followed by clinical recovery.
 Future episodes can be manic, depressive or mixed.
 The manic episode is characterized by the following features( which should last for at least 1 week and
cause disruption in occupational and social functioning)
Definition:
 Mania refers to a syndrome in which the central features are over-activity, mood change( which may be
towards elation or irritability)and self- important ideas.
 Mania : an alteration in mood that is expressed by feelings of elation, inflated self- esteem, grandiosity,
hyperactivity, agitation, and accelerated thinking and speaking.

CLASSIFICATION: F30- MANIC
EPISODE
 F30.0- HYPOMANIA
 F30.1- MANIA WITHOUT PSYCHOTIC
FEATURES
 F30.2- MANIA WITH PSYCHOTIC FEATURES
 F30.8- OTHER MANIC EPISODES
 F30.9- MANIC EPISODES UNSPECIFIED

MANIA: CLINICAL
FEATURES
 Core features
 Elevated, expansive or irritable mood
 Increased speech
 Decreased need for sleep
 Increased psychomotor activity
 Psychotic features
 Delusions
 Hallucinations
(Mood incongruent psychotic features)
 Others
11

1. Core features:
2. 1. Elevated, Expansive or Irritable mood
3. Stages/Degrees :
o Euphoria/ Grade 1 (mild elevation of mood): increased
sense of psychological well being and happiness, not in keeping
with ongoing events. Usually seen in hypomania.
o Elation/ Grade 2(moderate elevation of mood): feeling of
confidence and enjoyment, along with increased psychomotor
activity. Classically seen in mania.
o Exaltation/ Grade 3 (severe elevation of mood):intense
elation with delusions of grandiosity. Seen in severe mania
o Ecstasy/ Grade 4 (very severe elevation of mood): intense
sense of rapture or blissfulness. Typically seen in delirious or
stuporous mania. 12

2. Increased speech and thought
o Volubility
o Acceleration
o Pressured speech- difficult to interrupt
o Flight of ideas- shift from topic to topic with cues
o Clang association
o Delusion of grandeur
o Delusion of persecution
o Distractibility
3. Increased psychomotor activity
Increased psychomotor activity ranging from
over activeness and restlessness to manic
excitement. The activities are goal oriented.
o Over activity/ restlessness
o Excitement
o Stupor ( rarely) 14

4. PSYCHOTIC SYMPTOMS
 Delusions: grandiose, love( Erotomania), persecutory.
 Hallucinations.
5. GOAL-DRECTED ACTIVITY:
- The person is unusually alert, trying to do many
things at one time.
- In hypomania, the ability to function becomes much
better and there is marked increase in productivity
and creativity.
-In mania, there is marked increase in activity with
excessive planning and, at times, execution of
multiple activities.

6. OTHER SYMPTOMS
o Over religiosity
o Over spending/ expansive ideas
o Over familiarity/ disinhibition
o Dressed up in gaudy and flamboyant cloths but poor
self care.
o Appetite may be increased, but decreased food intake
due to over-activity
o Decreased need for sleep
o Impulsive behavior
o Increased sociability
o Poor judgement
o Absent insight

 TRIAD SYMPTOMS OF MANIA
HYPERACTIVITY
INCREASED SPEECH ELEVATED , IRRITABLE, EXPANSIVE,
LABILE MOOD , FLIGHT OF IDEAS
PRODUCTION

ETIOLOGY
 Neurotransmitter and structural hypothesis:
Manic episodes are related to excessive levels of nor-
epinephrine and dopamine(an imbalance between
cholinergic and noradrenergic systems).
(Serotonin is decreased).
- structural hypothesis:
Biological findings suggest that lesions are more
common in this population in areas of the brain such
as the right hemisphere or bilateral sub cortical and
periventricular grey matter heterotopia.
- Sleep studies:
Sleep abnormalities are common in mood disorders(eg:
Decreased need for sleep in mania)

 Genetic consideration:
 Twin studies:
Monozygotic twins have a higher rate of incidence
than normal siblings and other close relatives.
- Siblings and close relatives have a higher incidence
of manic-depressive illness than a general
population.
- First degree relative – 5-10% chance
- Identical twin with bipolar disorder about 40-70%
chance.
- Family studies:
o Psychodynamic theories:
Developmental theorists have hypothesized that faulty
family dynamics during early life are responsible for
manic behaviors in later life.
o Neuroendocrine theory: hyperthyroidism

 Lifestyle triggers include irregular sleep-wake
schedules and sleep deprivation, as well as
extremely emotional or stressful stimuli.
 Substance use, such as recreational drugs or
alcohol.
 A side effect of a medication (such as some
antidepressants)
 A high level of stress and an inability to manage
it.
 Mania may be associated with strokes, especially
cerebral lesions in the right hemisphere
 Mania can also be caused by physical trauma or
illness. When the causes are physical, it is called
secondary mania

 THE DYNAMICS OF MANIA, USING THE
TRANSACTIONAL MODEL OF
STRESS/ADAPTATION

Precipitating factors
(A loss- real or perceived, an environment stressor)
Predisposing factor-
Genetic influences: Family H/O Manic disorder
possible biochemical alterations
Past experiences: Past episode of mania triggered
by steroid use
Existing conditions: Possible electrolyte imbalance
Possible cerebral lesion
Possible medication side effects

cognitive appraisal
Primary appraisal( perceived threat or loss of, self concept)
secondary appraisal(because of weak ego
strength, patient is unable to use coping mechanisms
effectively. Defense mechanisms utilized: denial,
regression, projection)
Quality of response
Adaptive Maladaptive
Manic symptoms

DIAGNOSIS OF MANIA
 Psychological tests such as Young Mania Rating Scale
 ICD-10 Diagnostic criteria
 Based on sign and symptoms

28
TREATMENT MODALITIES
PHARMACOTHERAPY
Lithium- 900-2100 mg/dl
Carbamazepine : 600-1800 mg/dl
Sodium valproate- 600-2600 mg/dl
Other drug- clonazepam

ECT
 It can be used for acute cases of mania if not
responding to mood stabilizer and antipsychotic.
PSYCHOSOCIAL TREATMENT
Family therapy and Marital therapy is used to
decrease interfamilial and interpersonal
difficulties and reduce or modify stressor.
Talk therapy
CBT

NURSING MANAGEMENT OF
MANIA
Nursing assessment
Assessing the severity of the disorder
Forming an opinion about the causes
Assessing the patients resources and judging the
effects of patient’s behavior on other people.

 Assess for mood and affect
 Thinking and perceptual ability
 Sleep disturbance
 Changes in energy level
 Speech pattern
 Motor activity
 Speech production

NURSING DIAGNOSIS-1
 High risk for injury R/T hyperactivity and impulsive
behavior as evidence by lack of control over purposeful
and injurious movements.
Nursing intervention
 Keep environmental stimuli to minimum; assign single
room, limit interaction, keep lighting and noise level low
 Remove hazardous objects
 Engage patient in activities such as drawing, writing and
physical exercise
 Stay with patient as hyperactivity increases
 Administer medication as prescribed by physician

NURSING DIAGNOSIS- 2
 High risk for violence ; self directed or directed at others
R/T manic excitement, delusional thinking and
hallucinations
 Maintain low of stimuli
 Observe patient’s behavior every 15 minutes
 Ensure all sharps, glasses or mirrors, belts, ties have been
removed from patients environment
 Avoid arguing with patient
 Encourage verbal expression of feeling
 Maintain and convey a calm attitude to the patient
 Have sufficient staffs to control the patient
 Administer tranquilizers
 Follow application of restrain
 Remove restrain gradually once at a time

 Imbalanced nutritional pattern less than
body requirement R/T hyperactivity as evidenced
by weight loss , refusal or inability to sit still
enough to eat .
 Assess the nutritional pattern of patient
 Find out patient’s likes and dislikes
 Provide high protein, calorie, nutritious foods and
drinks
 Provide 6-8 glasses of fluids per day
 Maintain accurate records of intake and output.
 Supplement with vitamins and minerals
 Walk or sit with patient while he eats
 Finger foods

NURSING DIAGNOSIS-4
 Impaired social interaction R/T egocentric and
narcissistic behavior as evidenced by inability to
develop satisfying relationship and manipulation
of others for own desires
 Recognize that manipulative behavior helps to
decrease feeling of insecurity by increasing the
feeling of power and control
 Set limits on manipulative behavior. Explain the
consequences if limits are violated.
 Ignore attempts by patient to argue or bargain his
way-out of setting limits.
 Give reinforcement for non- manipulative
behaviors.
 Helps patient identify positive aspects about self

OTHER DIAGNOSIS
 Disturbed sleep pattern related to hyperactivity
as evidenced by lack of sleep(hrs)
 Altered family process R/T euphoric mood,
manipulative behaviors

DEPRESSIVE EPISODE
 Life time risk in males is 8-12% and in
females is 20-26%.
 However, the life time risk- 8%
 Typical depressive episode is
characterized by the following features
(which would last for at least 2 weeks
for the diagnosis to be made)

DEFINITION
 An alteration in mood that is expressed by feelings of
sadness, despair, and pessimism. There is a loss of interest
in usual activities, and somatic symptoms may be evident.
Changes in appetite and sleep patterns are common.
Classification of Depression:
 F32: Depressive episode
 F32.0: Mild Depressive episode
 F32.1: Moderate Depressive episode
 F32.2: severe Depressive episode without psychotic
symptoms
 F32.3: severe Depressive episode with psychotic
symptoms
 F32.8: other depressive episode- Atypical depression
 F32.9: depressive episode, unspecified
 F33: recurrent Depressive episode.

TYPES OF DEPRESSIVE DISORDER
 Major depressive disorder(MDD):
MDD is characterized by depressed mood or loss of interest or
pleasure in usual activities.
Impaired social and occupational functioning that has been
existed for at least 2 weeks.
o Dysthymic Disorder/ chronic or long term
depression:
Chronically depressed mood (possibly an irritable mood) for
most of the day, more days than not, for at least 2 years.
o Others:
- Mood disorder (depression) due to a general medical
condition.
- Substance-induced mood disorder.

CLINICAL FEATURES
1. Depressed Mood:
 Pervasive and persistent sadness of mood
 Pervasive sadness: loss of interest / pleasure in almost all
activities leads to social withdrawal, decreased ability to
function in occupational and interpersonal functioning.
 Persistent sadness: sadness present throughout the day.
 This sadness of mood is Quantitatively as well as
qualitatively different from sadness encountered in
‘normal’ depression or grief
 Sadness of mood varies little from day to day and is
often unresponsive to environmental stimuli.
 In severe depression, there may be complete
Anhedonia.

2. Anhedonia:
 Loss of interest or pleasure in almost all
activities/ earlier pleasurable activities
 Results in social withdrawal
 Decreased ability to function in occupational
and interpersonal areas

3. Anergia:
 Easy fatigability
 Increased effort to perform simple tasks

4. Depressive ideation/ Cognition:
 Hopelessness (There is no hope in the future)
 Helplessness( no help is possible now) TRIAD
 Worthlessness( feeling of inadequacy and inferiority)
 Feelings of guilt
 Death wishes
 Suicidal ideas
 In severe cases, delusions of nihilism.(e.g.: ‘world is coming to an end, ‘there is
no brain in my head, my intestines have rotted away’) may occur.

5. Psychomotor Activity:
 Younger patients (less than 40): slowed thinking and
activity, decreased energy, monotonous voice.
 Older patients (e.g. post- menopausal): agitation,
marked anxiety, restlessness, subjective feeling of
unease.
 Severe depression: stupor
 Anxiety, irritability, frustration in day to day activities-
unusual anger at the noise made by children at home.

6. PHYSICAL SYMPTOMS
 Multiple physical symptoms:
 Heaviness of head
 Vague multiple aches
 General aches and pains
 Hypochondriacal features.

7. Biological functions/ somatic syndrome:
 Insomnia
 Loss of appetite and weight
 Loss of sexual drive
 Early morning awakening (at least 2 hrs before usual
time of awakening)
 Loss of reactivity to pleasurable stimuli.

8. Psychotic Symptoms:
 Delusions of guilt, Nihilism
 Hallucinations
9. suicide:
suicidal ideas in depression should always be
taken very seriously.

SUICIDAL RISKS: SOME IMPORTANT
FACTORS
Suicidal risk is much more in the presence of following factors:
a)Presence of marked hopelessness
b)Males ; age > 40; unmarried, divorced/widowed
c)Written/verbal communication of suicidal intent/or plan
d)Early stages of depression
e)Recovering from depression
f)Period of 3 months of recovery

OTHER SYMPTOMS
 Difficulty in concentration
 Forgetfulness
 Low self-esteem
 Decreased self-confidence

50
ETIOLOGY
Biological theories
1.Genetic factors
- Twin studies
- Family studies
- Adoption studies
2. Neurotransmitter theories-
o Serotonin- decreased in depression and vice versa
3. Neuroendocrine theories:
Mood symptoms are prominently seen in disorder like,
hypothyroidism, Cushing’s disease and Addison’s disease.
 Hypothalamic-Pitutory- Adrenocortical Axis:
Endocrine function is often disturbed in depression, with cortisol
hypersecretion.

HYPOTHALAMIC-PITUTORY- THYROID
AXIS:
 Thyrotropin- releasing factor (TRF) from the hypothalamus
stimulates the release of thyroid –stimulating hormone
(TSH) from the anterior pituitary. Diminished TSH
response is observed in approximately 25 % of depressed
persons.
4. Physiological influences:
 Secondary depression: depressive symptoms that occur
as a consequence of a non-mood disorder or as an adverse
effect of certain medications are called secondary
depression.
 Secondary depression may be related to medication side
effects, neurological disorders, electrolyte or hormonal
disturbances, nutritional deficiencies and other
physiological or psychological conditions.

5. Neuroimaging and anatomy
Ventricular dilatation, white matter hyper- intensifies
and changes in blood flow & metabolism in several
parts of brain( prefrontal cortex).
6. Sleep studies:
Insomnia and frequent awakenings in depression).
7. Circadian Rhythm Theories:
Circadian rhythm are responsible for the daily
regulation of wake-sleep cycles, arousal and activity
patterns and hormonal secretions. Individual
experiencing circadian rhythm changes are at increased
risk for developing depressive symptoms and other
mood symptoms.
These changes might be caused by medications,
nutritional deficiencies, physical or psychological
illnesses, hormonal fluctuations.

53
CONTD-
Psychosocial theories:
1.Life events and stress
o Play a formative role in depression; precipitating in
mania
Psychoanalytical Theory:
In depression, loss of libidinal object, introjections of
the lost object, fixation in oral sadistic phase.

 THE DYNAMICS OF DEPRESSION, USING
THE TRANSACTIONAL MODEL OF
STRESS/ADAPTATION

Precipitating factors
(A loss- real or perceived, an environment stressor)
Predisposing factor-
Genetic influences: Family H/O Depression
possible biochemical alterations
Past experiences: -Anger turned inward on to the ego
-Learned helplessness – numerous
failures
-Object loss in infancy
-Defect in cognitive development
Existing conditions: Inadequate coping skills
Lack of adequate support system
Possible neuroendocrine disturbances
Possible medication side effects
Other physiological conditions

cognitive appraisal
Primary appraisal( perceived threat or loss of, self concept)
secondary appraisal(because of weak ego strength, patient
is unable to use coping mechanisms effectively. Defense
mechanisms utilized: denial, regression, repression,
suppression, displacement)
Quality of response
Adaptive Maladaptive
delayed grief exaggerated grief
denial of loss clinical depression
Depression

DIAGNOSIS FOR DEPRESSION
 Psychological tests- Beck depression inventory,
Hamilton rating depression scale to assess severity and
prognosis
 Dexamethasone suppression test showing failure to
suppress cortisol secretion in depressed patient.
 Based on ICD- 10
 Toxicology screening suggesting drug induced
depression(e.g anticonvulsive drugs, hormonal
agents, antipsychotics)

TREATMENT MODALITIES
1. Psychopharmacology
Selective serotonin reuptake inhibitor
(SSRIs)- Citalopram, Fluoxetine, Sertraline
Tricyclic antidepressant- clomipramine,
imipramine
Monoamine oxidase inhibitors- Isocaboxazid,
Phenelzine
Other newer antidepressants:
Bupropion,Maprotiline.

2. Physical therapies/ Somatic therapies :
ECT- severe depression with suicidal thoughts
Light therapy: can be given in cases of seasonal
depression
Repetitive transcranial magnetic stimulation
(rTMS) ,Vagus nerve stimulation( VNS)

3. PSYCHOLOGICAL
TREATMENT
 PSYCHOTHERAPY
 COGNITIVE THERAPY
 SUPPORTIVE THERAPY
 GROUP THERAPY
 FAMILY THERAPY
 BEHAVIOURAL THERAPY

NURSING MANANAGEMENT OF MAJOR
DEPRESSIVE DISORDER
 Nursing assessment:
 Judging the severity of the disorder i.e.
1. Risk for suicide
2. Identifying the possible cause
3. Social resources available to the patient
4. Effect on other people
5. Assess the sign and symptoms like: hopelessness,
helplessness, worthlessness, decreased appetite,
sleep, decreased motor activity etc.

NURSING DIAGNOSIS-1
 High risk of self directed/other directed
violence related to depressed mood, feeling of
worthlessness and anger directed inwards

NURSING INTERVENTION
 Ask the patient directly ‘ have you thought of
harming yourself in any way’? If so, what do you
plan to do? Do you have the means to carry it out?
 Create safe environment for patient
 Formulate a short term verbal or written contract
that the patient will not harm himself.

 It may be desirable to place the patient near the
nursing station
 Close observation is specially required
 Do not allow the patient to bolt the room
 If the patient becomes unusually happy or gives
clues of suicide, immediately inform
 Encourage to express feelings including anger.

NURSING DIAGNOSIS-2
 Dysfunctional grieving R/T real or perceived
loss, as evidenced by denial of loss, inappropriate
expression of anger, inability to carry out
activities of daily living
 Assess the stage of fixation in grief process
 Be accepting to the patient and spend time with
him. Show sympathy, care and unconditional
love, positive regard
 Explore feelings of anger and help patient direct
them towards the intended object or person
 Provide simple activities.

 Powerlessness R/T dysfunctional grieving
process, life style of helplessness as evidenced by
feeling of lack of control over life situation and
decreased psychomotor activities.

 Allow patient to take decisions regarding own care.
 Ensure that the goals are realistic and the patient is
able to identify life situation.
 Encourage the patient to verbalize feelings about
areas that are not in his ability to control.
 Family therapy

NURSING DIAGNOSIS-N 4
 low Self esteem R/T learned helplessness,
impaired cognition, worthlessness as evidenced
by feeling of inferiority, negative view towards
self.

 Be accepting to the patient and spend time with him/her
 Focus on strengths and accomplishments and minimize failure.
 Provide him with simple and easily achievable activity.
 Encourage patients to recognize areas of change and provide
assistance towards effort.
 Teach assertiveness and coping skills

NURSING DIAGNOSIS-5
 Disturbed sleep and rest R/T depressed mood, early
morning awakening as evidenced by restlessness,
irritation .

 Plan daytime activities according to the patients interest, do not
allow him to sit idle
 Ensure a quiet and peaceful environment when patient is
preparing to sleep
 Provide comfort measures ( back rub, warm milk, tipid bath)
 Do not allow patient to sleep for long time during day
 Give medicine as prescribed

OTHER DIAGNOSIS
 Imbalanced nutritional status less than body
requirement R/T depressed mood, lack of interest
in food as evidenced by weight loss.
 Self care deficit R/T depressed mood, feeling of
worthlessness as evidenced by poor hygiene and
grooming.

73
BIPOLAR MOOD (AFFECTIVE)
DISORDER
 Earlier known as manic depressive psychosis
(MDP)
 Characterized by recurrent episodes of mania
and depression in same patient at different
times.

CLASSIFICATION:
 F31.0:BAD, current episode
hypomania
mania, without psychotic
symptoms
mania, with psychotic symptoms
 F31.3:BAD, current episode mild
or moderate depression.
severe depression without
psychotic symptoms
 F31.5:BAD, current episode of
severe depression with psychotic
symptoms.

 The current episode in bipolar mood
disorder is specified as one of the following:
 Hypomania
 Mania without psychotic symptoms
 Mania with psychotic symptoms
 Mild or moderate depression
 Severe depression, without psychotic symptoms

 Severe depression with psychotic symptoms
 Mixed
 In remission

SUBTYPES OF BIPOLAR
DISORDER
 Bipolar I
Characterized by episodes of severe mania and
severe depression
 Bipolar II
Characterized by episodes of hypomania ( not
requiring hospitalization) and severe depression

Others :
Cyclothymia or cyclothymic disorder -- is a
relatively mild mood disorder. In cyclothymic
disorder, moods swing between short periods of mild
depression and hypomania, an elevated mood. It
involve numerous episodes of hypomania and
depressed mood of insufficient severity ( means no
full manic episodes or full major depressive episodes).
Bipolar disorder NOS : sometimes called "sub-
threshold" bipolar, indicates that the patient suffers
from some symptoms in the bipolar spectrum (e.g.,
manic and depressive symptoms) but does not fully
qualify for any of the formal bipolar

OTHER BIPOLAR DISORDER
 Bipolar disorder due to a general medical
condition
 Substance- induced bipolar disorder

ETIOLOGY
 Precise unknown cause
 Genetics, biochemical and psychological factors
 Stressful life events, antidepressant use chronically
 Sleep deprivation and hypothyroidism
DIAGNOSIS:
Based on sign and symptoms
ICD-10 classification
TREATMENT:
- Lithium
- Valporic acid
- Carbamazepines
- Antidepressants
- Antipsychotics

4. RECURRENT DEPRESSIVE
DISORDER
 Recurrent (at least 2 )depressive episodes
(unipolar depression)
 Episodes last between 3 to 12 months
 Recovery is usually complete
 Often precipitated by stressful life events

5. PERSISTENT MOOD DISORDERS
 Persistent mood symptoms lasting for more than
2 years
 Chronic/ long term depression: Dysthymia
 Persistent instability of mood between mild
depression and elation: Cyclothymia

COURSE AND PROGNOSIS
 Average manic episode lasts for 3-4
months
 Average depressive episode lasts for 4-6
months
 Unipolar depression is usually longer than
bipolar depression
 As age advances, intervals between 2
episodes shorten; duration and frequency
increases

86
EPIDEMIOLOGY
Prevalence
Unipolar depression- 6%
Bipolar disorder- 1%, milder forms often missed
Gender ratio
Equal prevalence among men and women
Manic episodes more common in men and depressive
episodes more common in women
Seasonality
Two prevalent period of seasonal involvement: one in
spring(march,april, may) and one in the fall (sep., oct,
nov). Large peak in the spring and a smaller one in
october.

87
Age of onset
Unipolar depression can occur from childhood
50% has age of onset 20-50
Bipolar begins a bit earlier, childhood to 50 years
Ranges from 5-50yrs; mean age 30yrs
Marital status
More common in divorced and single persons
Socioeconomic status
Higher than average incidence among upper
socioeconomic status

GERIATRIC CONSIDERATION
 Late onset bipolar disorder is rare
 Depression is common among elderly
 Have psychotic features particularly
delusions
 Suicide is doubles in older age people
above 65.
 Treated with ECT more frequently.

 Have increased tolerance to side effects of
antidepressants. However not able to tolerate
high doses.
 Accompanying stresses can put older adults at
risk for clinical depression

FACTORS RESPONSIBLE FOR
CLINICAL DEPRESSION AMONG
OLDER ADULTS:

MANAGEMENT OF DEPRESSION FOR
ELDERLY
 Psychotherapy
 Cognitive behavioural therapy (CBT)
 problem-solving therapy (PST)
 interpersonal therapy (IPT)
 reminiscence and life review therapy
 and brief psychodynamic therapy.
 newer forms of brain stimulation (such as repetitive
trans cranial magnetic stimulation, or rTMS)
o Pharmacotherapy
SSRIs (e.g., citalopram, escitalopram, paroxetine,
sertraline
TCAs are not recommended as first-line agents in older
patients. This is due to side effects such as postural
hypotension, cardiac conduction abnormalities, and
anticholinergic effects.

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