Late-life depression refers to depression occurring in older adults and has diverse presentations, including as a recurrence of early-onset depression, a new diagnosis of late-onset depression, and a mood disorder resulting from a separate medical condition, substance use, or medication regimen. Research regarding late-life depression often focuses on late-onset depression, which is defined as a major depressive episode occurring for the first time in an older person (various sources define this threshold differently, typically within the range of 60–65 years old). 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. 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. 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. Even when diagnosed, late-life depression is frequently undertreated as well. Primary care is most often where diagnosis and treatment of late-life depression occurs. Notably, the DSM-5 does not specifically define diagnostic criteria for late-life depression and concludes that the characteristics of major depressive disorder do not vary by age, although research suggests that late life depression can present differently, as described above. Broadly speaking, however, diagnosis is made in the same way as other age groups, using DSM-5 criteria for major depressive disorder. The American Psychological Association and other clinical recommendations also recognize the spectrum of depressive symptoms that extend beyond the formal criteria for major depressive disorder, including subthreshold/minor depression and dysthymic disorder; these diagnoses that fall under the umbrella of late-life depression can also present with debilitating and disruptive symptoms. Treatments for late-life depression include medicine and psychotherapy, along with lifestyle changes such as exercise, bright light therapy, and family support. In patients who do not respond to initial treatments, neurostimulation techniques such as electroconvulsive therapy (ECT) can be used. ECT has demonstrated effectiveness in treating the elderly.
Symptoms and diagnosis Diagnosis of depression in late life is made using the same criteria for Major Depressive Disorder found in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) To meet criteria for a major depressive episode, a patient must have five of the nine symptoms listed below nearly every day for at least two weeks and must have at least either a depressed mood or anhedonia. The symptoms they are facing must also harm their ability to function in daily life and must not be better explained by a medical illness or a substance. To further meet criteria for Major Depressive Disorder, the depressive episode must not be attributable to another psychiatric disorder such as psychosis or a bipolar disorder.
Depressed or sad mood Anhedonia (loss of interest in pleasurable activities) Sleep disturbance (increased or decreased sleep) Appetite disturbance (increased or decreased appetite) typically with weight change Energy disturbance (increased or decreased energy/activity level), usually fatigue Poor memory or concentration Feelings of guilt or worthlessness Psychomotor retardation or agitation (a change in mental and physical speed perceived by other people) Thoughts of wishing they were dead; suicidal ideation or suicide attempts
Causes and risk factors The exact changes in brain chemistry and function that cause either late-life or earlier-onset depression are unknown. Certain theories claim that late-life depression may result from dopamine and norepinephrine misregulation. Additionally, pituitary and adrenal imbalances accompany typical cases of late-life depression. The exact changes in brain chemistry and function that cause either late-life or earlier onset depression are unclear. It is known, however, that brain changes can be triggered by the stresses of certain life events such as illness, childbirth, death of a loved one, life transitions (such as retirement), interpersonal conflicts, or social isolation. 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. These complications most notably include hypertension, diabetes mellitus, smoking tendencies, and hypercholesterolemia. Research suggests that individuals with late life depression are more likely to develop Alzheimer's Disease, vascular dementia, and all-cause dementia. Dementia, however, can present early in its disease course with depressive symptoms, meaning that this association could actually be reflecting that dementia causes late life depression. 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.
… excerpt ends here. Continue reading the full article.
