(3/22/13)- A presentation at the annual meeting of the American association for Geriatric Psychiatry, March 15, 2013 suggested that right unilateral ultrabrief pulses of electroconvulsive therapy (ECT) may be effective in elderly patients with major depression. This first phase of the Prolonging Remission in Depressed Elderly (PRIDE) study showed that of 141 depressed patients, nearly 63% remitted after 12 ECT treatments.
The researchers chose to use ultrabrief ECT — which lasts just a quarter of a millisecond vs standard pulse, which lasts 1 millisecond — because it preserves memory and has fewer side effects.
The lead researcher suggested that the 12 sessions of brief ECT may be a little short. He thinks 2 or 3 more sessions may bring the remission rate to 80%.
(undated )-In part I, we listed medications that may produce depression in the elderly and listed medical conditions that may be possible causes of depression. Listed below are various medical disorders that may produce depression. This does not mean that everyone who has these medical disorders will exhibit symptoms of depression. It does reflect the high correlation between various symptoms exhibited during the course of the medical illness and depression. This should alert treating medical personnel to think in terms of affect disorder secondary to the medical illness. At the same time, any medications prescribed may also prove to be associated with depression (see part I). As noted elsewhere, age-related alterations in the metabolism rates as well as medical conditions in elderly suggest lower doses of agents to treat depression. Remember that the susceptibility of the elderly to side effects of medications or synergistic effects may result from medications for the medical condition.
It is evident from studies that episodes of depression appear to become more frequent and severe, with a longer duration as an individual ages. One theory to explain this involves regulation of affect by the neurotransmitters norepinephrine and serotonin. Apparently, they become less efficient with age and according to Salzman may be responsible for the increase in severity and duration of depression in the elderly.
Depression in the elderly may not express itself in the typical fashion. Elderly persons suffering depression may be more anxious and agitated, complain about disorientation, memory loss, or difficulty concentrating. This may look like dementia, making a differential diagnosis important because depression and dementia have different treatment programs. Professional consultation should always be undertaken to make this differential diagnosis. The following areas will give the professional clues as to whether the disorder is dementia or depression: nature of complaints, mood and effect, onset, course and general behavior. Thus a depressed individual will express a strong sense of distress, while a demented individual will be relatively unconcerned; depression usually has a rapid progression after onset, while dementia is slow in progressing etc.
Endocrine disorders including hypo- or hyperthyroidism, hyperparathyroidism, diabetes mellitus, Cushing’s disease and Addison’s disease.
Collagen disorders including polymyalgia rheumatica, temporal arthritis, rheumatoid arthritis and systemic lupus erythematosus.
Miscellaneous disorders including cancer, chronic infection, metabolic abnormalities, malnutrition, chronic pain, pernicious anemia, loss of organs of great personal significance, and serious burns.
One study of 454 patients newly admitted to a nursing home and followed for one year showed that those patients with a diagnosis of depression were 59% more likely to die in the course of a year than were nondepressed patients. This same study found that approximately 13% of these newly admitted residents had a major depressive disorder, while another 18% had depressive symptoms but did not meet the criteria for major depression. Failure to relieve depressive symptoms in the elderly adds to the suffering of the individual and can have dire consequences.
Depression is treatable and the newer antidepressants should be considered as first-line therapies for elderly patients.