چکیده:
Depression is a common symptom and a major public health problem in the elderly. Despite its prevalence and seriousness, depressive disorder in older people remains under-treated. The optimal treatment of depression in later life is crucial, and requires appreciation of several age-related factors such as comorbidity, polypharmacy, altered drug kinetics, variable treatment response and increased predisposition to side effects. Although sometimes difficult to diagnose because of concurrent stressors medical illness, or dementia, depression in elderly patients responds readily to appropriate therapy. When untreated, this disorder may result in increased morbidity and mortality or suicide. Effective therapeutic options for late-life depression, as in younger patients, include psychotherapy and pharmacotherapy. Because of their favorable adverse effect profiles and safety in cases of overdose, the selective serotonin reuptake inhibitors have, in most cases, replaced tricyclic antidepressants as first-line therapy when antidepressants are indicated. SSRIs considered to have the best safety profile in the elderly are citalopram, escitalopram, and sertraline. Finally, electroconvulsive therapy offers a safe and effective alternative for patients refractory to or unable to tolerate antidepressant medication
خلاصه ماشینی:
The optimal treatment of depression in later life is crucial, and requires appreciation of several age-related factors such as comorbidity, polypharmacy, altered drug kinetics, variable treatment responses and increased predisposition to side effects.
g. alcohol use), drug prescription, impoverishment and low socioeconomic status (that confines the accessibility to health care), mourning, social isolation, hypochondriasis, hiding the effects of concomitant medical problems, misdiagnosis of dementia instead of depression, somatization, expense matters, time limitations, and the stigma of mental illness (1,2,4).
Treatment Modalities As in younger patients, the goals of treating depression in elderly patients include alleviating depressive symptoms, reducing risk of recurrence and relapse, decreasing morbidity and mortality, and improving quality of life.
When selecting an antidepressant it is important to consider the elderly patient’s previous response to treatment, the type of depression, the other medical problems of the patient and medications and the potential risk of overdose (41,42).
Of the clinical variables reviewed, the presence of a comorbid psychiatric or general medical disorder, older age, greater severity of illness, and chronicity of course show the strongest evidence as risk factors for treatment-resistant depression.
On the contrary, factors improving compliance to treatment include a complete physical and cognitive assessment of the patient, involvement of relatives in the therapeutic program, maintenance of frequent contacts and supply of clear and comprehensible information on diagnosis and therapeutic management, these being generally, the cardinal points of the so-called good medical practice.