Depression in the elderly - Causes, Symptoms and Treatment .MF .
Unfortunately at present the vast majority of elderly people suffering from depressive disorders do not come to the attention of psychiatrists, including old age psychiatrists, do not receive specialized care, which leads to delays, exacerbate the disease, up to suicide.I hope this article will help you understand what is happening with your loved ones or you sort out the situation and solve it the best way.
At the beginning of the disease of patients worried about depressed mood, they are gloomy, marked insomnia.In the future, growing phenomenon of anxiety with restlessness and excitement ideatornoy develop various forms of depressive delusions - condemnation, punishment, death, hypochondriacal, and suicidal ideation.
Features depressive disorders in the elderly:
- Anxious restlessness at the height of the disease reaches the degree of severity of motor excitation, may alternate with the state of inhibition of motor stupor, reflecting the patients experienced fear and despair.Gestures such patients expressive behavior demonstratively artsy.
- delusional experiences cover almost all the diversity of the "guilt" and "punishment".Characterized as hypochondriacal delusions, the contents of which are usually focused on violations of bowel function and related "devastating" consequences for the organism (rotting, poisoning, organ atrophy).
- at remote stages of the development of the clinical picture of the disease is stabilized, becomes more and more monotonous, monotone alarm condition occurs with monotonous restlessness, decreased mental activity, a constant decrease in depressed mood and emotional resonance.
After depressive episodes in patients with mood disturbances detected residual as a reduction-resistant background, either as a periodic recessions.These disorders are combined with individual somatovegetativnymi symptoms of depression (sleep problems, appetite).
for late-life depression is characterized by the development of the phenomenon, known as "double depression" when the background of persistent low mood occur re-defined depressive phases.
Symptoms of depression in the elderly
The complaints of patients usually dominate the overall depressed, gloomy thoughts, anxiety, physical decay, sleep disorders, autonomic disorders in the form of a diffuse abnormal sensations or painful disorders of individual organs.When monitoring patients have a small expressive facial expressions, lack of alertness, appearance, reflecting the weakness and fatigue, muffled monotone voice and anxious concern.
Depression in the elderly can be "shuttered" somatic complaints.Such patients focus attention on the physical manifestations of a depressive syndrome - loss of appetite, constipation, weight loss, fatigue, headaches, back pain and other body parts, etc. However, they may be denied or severely underestimate the severity of the actual affective disorders...
Causes of depression in the elderly
In describing the psychological situation usually emphasizes the importance of appearing in old age problems such as "confrontation with the impending death," "loss of prospects," "tension and friction with the new generation."With the loss of a loved one is greatly disturbed the habitual way of life, the established order in the relationship.Widowhood without subsequent marriage in old age is associated with a high degree of risk and loneliness as a result of a depressive disorder.Increased stress load due to unfavorable socio-economic conditions "reform era", which were reflected primarily in the elderly, as well as due to the violation of their worldviews lead to social exclusion.Depressive states including developing and as a result the dismissal of older people from work ( "pension depression").They are accompanied by painful feelings of uselessness, lack of demand, while maintaining the need for further professional and social self-actualization.Attempts to diminish and belittle the role of the Great Patriotic War veterans and home front workers, the value of combat and labor feats and efforts to inflict moral injury.Also there is evidence of pathogenic effect housing change.This situation is a special type of depression - "moving depression."In addition, depression in the elderly is often triggered by events such as intra-family conflicts.
Prevention of depression in the elderly
Mental health of older people with varying degrees of efficiency improve the various types of interventions:
- Exercise, which bring both physical and psychological benefits, including greater rigor life satisfaction, a good mood and mental well-being,mitigate manifestations of psychological distress and depressive symptoms, lower blood pressure, ulichshenie of the heart).
- Improving social support through friendships.Older people need to promote their actions.It is advisable to frequently validate their actions and to encourage progress."Today you move confidently with a cane!", "How do you good today sat on the bed!", "You are this very jacket-to-face!"etc.Inquiries elderly people about their past is very beneficial effect on them.Ask the older person to tell his relatives, childhood, where he lived in his youth, about the past work, interests.Very well seen together old photos of places where he was born, lived, worked, especially those in which he is depicted in force in the performance of socially important work.It always helps to increase self-esteem of an old man.However, older people need to feel your real interest in the events told by, your desire to go through what he once experienced and felt.If he will not believe your interest, then most likely, it will close in yourself, and you will lose their trust for a long time.
- Educational work with elderly people with chronic diseases and takes care of their people, a meeting to discuss the events of life.
- Warning traumatic brain injury, the normalization of high systolic blood pressure and high cholesterol concentrations in serum also appears to be effective, because it reduces the risk of dementia.
diagnosis of depression in the elderly
Factors to be taken into account when diagnosing depression in the elderly:
Changed symptoms of late-life depression:
- practically no complaints about sadness and gloom.
- Hypochondriacal and somatic complaints, instead of complaints of sadness and gloom.
- Complaints poor memory or a clinical picture resembling dementia.
- Later occurrence of neurotic symptoms (severe anxiety, obsessive-compulsive or hysterical symptoms).
- Apathy and low motivation.
symptoms that are difficult to interpret because of medical comorbidity:
- The decrease in body weight.
- Energy Reduction.
reasons depressive episodes of organic origin:
Medications that can cause depression organic :
- Calcium channel blockers (eg, nifedipine).
- COX-2 inhibitors (e.g. celecoxib, rofecoxib).
Drugs shown in parkinsonism:
Psychotropic drugs (can cause a clinical picture that resembles depression ):
- antipsychotic drugs.
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 brain lesions:
- cerebrovascular disease / stroke.
- tumors of the central nervous system.
- Parkinson's disease.
- Alzheimer .
Treatment of depression in the elderly
Elderly patients suffering from depression , rarely offer psychological therapies.However, in major depressive disorder and antidepressant combination therapy is more effective than either of these methods alone, especially in the prevention of relapses.
Of drugs used in almost all modern arsenal of antidepressants, including the well-known tricyclic antidepressants and chetyrehtsiklicheskie, as well as antidepressants, "the new generation" - selective serotonin reuptake inhibitors, and reversible inhibitors of MAO-A.However, the appointment of various psychopharmacological agents in elderly patients should always have in mind the increased risk of side effects and complications, especially in older age complications are especially the severity of symptoms.In these cases, the correction is possible by altering therapy doses, substitutions and changes in the total drug treatment regimen.
From the psychotherapeutic techniques used cognitive-behavioral therapy and interpersonal psychotherapy.
electroconvulsive therapy remains the most effective and affordable treatment for severe depression, it is usually applied in cases when there is a threat to life due to malnutrition or suicidal behavior or antidepressants are ineffective.