Depression in old age - Causes, symptoms and treatment. MF.

Unfortunately, at present, the majority of elderly people with depressive disorders do not get into the field of view of psychiatrists, including gerontopsychiatrists, do not get specialized care, which leads to prolongation, aggravation of the disease, up to suicide. I hope this article will help to understand what is happening to your relatives or with you, to orient yourself in the situation and to solve it in the best way.

At the beginning of the disease patients are disturbed by a depressed mood, they are gloomy, insomnia is noted. Further, the phenomena of anxiety with motor anxiety and ideator excitement are growing, various forms of depressive delirium are developing - conviction, punishment, death, hypochondriacal and suicidal ideation.

Distinctive features of depressive disorder in the elderly:

1. Anxious motor anxiety at the height of the development of the disease reaches the degree of pronounced motor excitement, it can alternate with a state of inhibition in the form of a motorized stupor reflecting the patient's fear and despair. Gestures of such patients are expressive, the behavior is demonstrative-artsy.
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2. Delusional experiences cover almost all the variety of themes of "guilt" and "punishment".Characteristic also hypochondriac delirium, the content of which is usually concentrated on violations of the intestinal function and associated with them "destructive" for the organism consequences( decay, poisoning, atrophy of organs).
3. At the distant stages of the disease, the clinical picture stabilizes, it becomes more monotonous, a state of monotonous anxiety with monotonous motor anxiety, a decrease in mental activity, a constant depression of mood and a decrease in emotional resonance.

After the end of the depressive episode, the patient displays residual mood disturbances either in the form of a persistent background decrease, or in the form of periodic recessions. These disorders are combined with individual somatovegetative manifestations of depression( sleep disorders, appetite).

For late depressions, the development of a phenomenon called "double depression" is characteristic when, against a background of persistent depression of mood, there are repeated outlined depressive phases.

Symptoms of depression in old age

In patients' complaints, general depression, gloomy reflections, anxiety, physical decay, sleep disorders, vegetative disorders in the form of diffuse pathological sensations or painful disorders of the functions of individual organs usually dominate. When observing the patient, there is a small expressiveness of mimicry, a lack of liveliness, a look that reflects impotence and fatigue, a monotonously muffled voice and anxious anxiety.

Depression in the elderly can be "blinded" by somatic complaints. Such patients fix attention on somatic manifestations of the depressive syndrome - loss of appetite, constipation, loss of body weight, fatigue, headaches, back pain and other parts of the body, etc. At the same time, they can deny or sharply minimize the degree of severity of affective disorders proper.

Causes of depression in old age

When describing a psychological situation, it is usually emphasized the importance of emerging issues in old age such as "confrontation with the approaching death," "loss of prospects," "tension and friction with a new generation."With the loss of a loved one, the habitual way of life, the settled order in the relationship is sharply disrupted. Widowhood without a subsequent marriage in old age is associated with a high risk of loneliness and as a consequence of this depressive disorder. The increase in stress due to unfavorable socio-economic conditions of the "reform era", which affected primarily the elderly, as well as the violation of their outlook lead to social maladjustment. Depressive conditions also develop and as a result of the dismissal of the elderly from work( "pension depression").They are accompanied by painful experiences of uselessness, unclaimedness while maintaining the need for further professional and social self-actualization. Attempts to belittle and belittle the role of veterans of the Great Patriotic War and the workers of the rear, the significance of their combat and labor feats and efforts cause them moral trauma. There is also information about the pathogenic effect of housing change. This situation causes a special type of depression - "depressed moving".In addition, depressed states in the elderly are often provoked by events such as intra-family conflicts.

Prevention of depression in old age

Mental health of elderly people with varying degrees of effectiveness improves various types of interventions:

• Physical exercises that bring both physical and psychological benefits, including greater satisfaction with life, good mood and mental well-being, mitigating the manifestations of psychological distressand the symptoms of depression, lowering blood pressure, clotting the work of the heart).
• Improve social support through a friendly attitude. Older people need to encourage their actions. It is desirable to confirm more often the correctness of their actions and to encourage success."Today you are more confident with the cane!", "How well you sat on the bed today!", "You have this jacket very much to face!"etc. The elderly people's inquiries about their past are very beneficial to them. Ask to tell the elderly person about his relatives, childhood, places where he lived in his youth, about past work, interests. It is very good to look at old photographs of the places where he was born, lived, worked, especially those on which he is depicted, while performing socially significant work. This always increases the self-esteem of an elderly person. However, older people should feel your real interest in the events being told, your desire to experience what he once experienced and experienced. If he does not believe your interest, then, most likely, he will close in himself, and you will lose his trust for a long time.
• Educating the elderly with chronic diseases and their caregivers, meetings to discuss life events.
• Prevention of craniocereberal trauma, normalization of high systolic pressure and high serum cholesterol concentration also seem to be effective, since they reduce the risk of developing dementia.

Diagnosis of depression in old age

Factors to be taken into consideration when diagnosing depression in the elderly:

Altered symptoms of advanced depression:

1. Virtually no complaints of sadness and despondency.
2. Hypochondriacal and somatic complaints instead of complaints of sadness and despondency.
3. Complaints of poor memory or a clinical picture resembling dementia.
4. Late appearance of neurotic symptoms( severe anxiety, obsessive-compulsive or hysterical symptoms).Apathy and low level of motivation.

Symptoms that are difficult to interpret due to concomitant somatic disease:

1. Anorexia.
2. Reduced body weight.
3. Decreased energy.

Causes of depressive episodes of organic origin:

Drugs that can cause organic depression :

Hypotensive:

• Beta-blockers.
• Methyl dopa. Calcium channel blockers( eg nifedipine).
• Digoxin.

Corticosteroids:

• Prednisolone.

Analgesics:

• Codeine.
• Opioids.
• COX-2 inhibitors( eg, celecoxib, rofecoxib).

Medicines shown in parkinsonism:

• Left-dopa.
• Amantadine.
• Tetrabenazine.

Psychotropic medications( may cause a clinical picture reminiscent of depression ):

• Antipsychotic drugs. Benzodiazepines

somatic disorders, which can serve as an organic cause depression in the elderly:

Endocrine and metabolic:

• hypo- and hyperthyroidism, Cushing's syndrome
• hypercalcemia( primary hyperparathyroidism, or carcinoma)
• Pernicious anemia folic acid deficiency

Organic defeatof the brain:

• Disease of cerebral vessels / stroke.
• Tumors of the central nervous system.
• Parkinson's disease.
• Alzheimer's disease .

Latent carcinoma:

• of the pancreas.
• lung.

Chronic infectious diseases:

• Neurosyphilis.
• Brucellosis.
• Shingles.

Treatment of depression in old age

Older patients suffering from depression rarely offer psychological treatments. However, with a large depressive disorder, the combination of antidepressants and psychotherapy is more effective than either of these methods alone, especially in preventing recurrence of the disease.

Almost all the modern arsenal of antidepressants, including well-known tricyclic and four-cycle antidepressants, as well as "new generation" antidepressants - selective serotonin reuptake inhibitors and reversible MAO-A inhibitors are used from drugs. However, when prescribing these or other psychopharmacologic agents, an elderly patient should always bear in mind the increased risk of side effects and complications, especially since late complications are characterized by a special severity of manifestations. In these cases, therapy can be adjusted by changing the dosage, substituting drugs and changing the general treatment regimen.

Psychotherapeutic methods use cognitive-behavioral therapy and interpersonal psychotherapy.

Electroconvulsive therapy remains the most effective and affordable treatment for severe depression, it is usually used in cases where there is a life threat due to malnutrition or suicidal behavior or antidepressants are ineffective.