[1][2] Late-life depression is often underdiagnosed, which is due to numerous reasons, including that depressed mood is commonly not as prominent as other somatic and psychotic symptoms such as loss of appetite, disruptions in sleep, lack of energy or anergia, fatigue, and loss of interest and enjoyment in normal life activities.
[3][4] Concurrent medical problems and lower functional expectations of elderly patients also often obscure the degree of impairment caused by late-life depression.
Elderly persons sometimes dismiss less severe depression as an acceptable response to life stress or a normal part of aging.
[5][6][7][8] Additional reasons for the difficulty in diagnosis include: medical illnesses and medication side effects that present similarly to depression, difficulty communicating with providers, lack of time in an appointment, and beliefs about mental illness and treatment from the patient, friends, family members, and society.
[4] Broadly speaking, however, diagnosis is made in the same way as other age groups, using DSM-5 criteria for major depressive disorder.
[1][14][4] Treatments for late-life depression include medicine and psychotherapy, along with lifestyle changes such as exercise, bright light therapy, and family support.
Risk factors for depression in older persons include a history of depression, social isolation, lower socioeconomic status, uncontrolled pain, co-morbid chronic medical illness, insomnia, female sex, being single or divorced, cognitive or functional impairment, brain disease, alcohol use disorder, use of certain medications, stressful life events, and specific cardiovascular complications.
[23] Studies that have directly tried to determine whether depression is an independent risk factor for dementia have led to inconclusive results.
Guidelines exist to help clinicians distinguish dementia versus a primary psychiatric disorder as the cause of a late-life depression diagnosis.
Improvement should be evident as early as two weeks after the start of therapy, but full therapeutic effects may require several months of treatment.
Older adults often have better treatment compliance, lower dropout rates, and more positive responses to psychotherapy than younger patients.
[31] Specifically, those with depression have been seen to relax, hit physical and emotional distress, and overall increase well-being over time, the longer the participation.
[36] Underuse or misuse of antidepressants and prescribing inadequate dosages are the most common mistakes physicians make when treating elderly patients for depression.
Selective serotonin reuptake inhibitors, commonly referred to as SSRIs, are considered first line pharmacotherapy for depression in late life as they are more tolerable and safer than other antidepressants.
[44][45][46] TCAs are typically not used initially due to their side effects and risk from overdose compared to SSRIs.
It's thought that antidepressants may increase the effects of brain receptors that help nerve cells keep sensitivity to glutamate which is an organic compound of a nonessential amino acid.
[53] In the geriatric population specifically, including patients over the age of 85, ECT provides a safe and effective treatment option.
[62][63] Transcranial magnetic stimulation (TMS) is another example of neurostimulation used to treat depression, but ECT is considered to be the more effective modality.
Regions of the brain that have been associated with these genes are hippocampal remodeling and the endocrine pathway of the Hypothalamus-Pituitary-Adrenal axis when managing stress.