Depression and Older Adults.ppt

Depression and Older Adults
Mark Snowden, ., .
Associate Professor
University of Washington
Medical Director Geriatric Psychiatry Services
Harborview Medical Center
OVERVIEW
Prevalence and heterogeneity
Major Depression Treatment
Minor Depression Treatment
Bereavement
Depression in Dementia
Response to Drug Failure
1 YR PREVALENCE AFFECTIVE DISORDER
Age (yrs) Odds Ratio
15-24
25-34
35-44
45-54
*



* p<.05
(Kessler,RC et al. Arch Gen Psych Jan. ‘94)
COHORT DEPRESSION RATES
.14
Cumulative
Depression
Rate .07
Age (yrs)
14 24 34 44 54 64 74
0
1955-64
1945-54
1935-44
1925-34
1915-24
1905-14
PREVALENCE OF DEPRESSION IN GERIATRIC POPULATIONS
Setting Maj. Depr.
Community
Med. Clinics
Nursing Homes
1 - 4%
5 - 10%
12 - 20%
PREVALENCE OF DEPRESSION IN GERIATRIC POPULATIONS
Setting Maj. Depr. Depr. Sxs.
Community
Med. Clinics
Nursing Homes
1 - 4%
5 - 10%
12 - 20%
8 - 16%
17 - 35%
30 - 45%
Differential Diagnosis
Maj. Depression (Partial Remission)
Dysthymia
Minor Depression
Adj. Disorder w/ depressed mood
Mood Disorder due to Medical Condition
Depression of Alzheimer’s Dementia
Bereavement
DSM IV MAJOR DEPRESSION CRITERIA
1) Depressed Mood

and/or
2) Anhedonia
DSM IV MAJOR DEPRESSION CRITERIA
3) Anorexia/wt loss
4) Insomnia or Hypersomnia
5) Psychomotor Agitation or Retardation
6) Fatigue
7) Feelings of Worthlessness/Guilt
8) Indecisiveness/Trouble Concentrating
9) Recurrent Thoughts of Death/Suicide
Late Onset vs Early Onset Depression
Symptom Odds Ratio
Loss of Interest *
Motor Retardation
Guilt Feelings
Pessimism
Psychotic Sxs.
Gen. Anxiety
* P<.05
(Krishnan et al. Am J Psychiatry, 5/95)
N=246