Depression and Other Affective Disorders

  • Harold G. Koenig
  • Dan G. BlazerII


Depression, the prototype affective disorder, is a common and pervasive syndrome that includes some of the most painful emotional experiences that humans can endure. The intense suffering during a depressive episode can drain life of meaning, desire, excitement, and pleasure. Depressed elders may perceive their past to have been wasted, their present without meaning, and their future without hope. Some prefer and may choose death as an alternative. Poets and clinicians, since ancient times, have noted symptoms of depression to be common among older persons. Age is accompanied by loss and challenges adaptive capacity; yet, most older adults do not suffer from depression and report higher life satisfaction than younger adults.1 Nevertheless, many elders do suffer from loneliness, discouragement, and feelings of worthlessness and uselessness, having lost hope in the future and believing that they are destined to endure this painful existence for the rest of their lives. Because older adults often see their personal physician for relief from such symptoms, a solid understanding by clinicians of the principles of diagnosis and management of affective disorders is essential.


Depressive Symptom Bipolar Disorder Major Depression Affective Disorder Medical Illness 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Koenig HG. Depression and dysphoria among the elderly: dispelling a myth. J Fam Pract 1986; 23: 383–385.PubMedGoogle Scholar
  2. 2.
    Blazer DG. Depression in Late Life. St Louis, Mo: VC Mosby Co; 1982: 113.Google Scholar
  3. 3.
    Cavanaugh S. The prevalence of emotional and cognitive dysfunction in a general medical population: using the MMSE, GHQ, and BDI. Gen Hosp Psychiatry 1983; 5: 15–24.CrossRefGoogle Scholar
  4. 4.
    Magni G, Diego DL, Schifano F. Depression in geriatric and adult medical inpatients. J Clin Psychol 1985; 41: 337–344.PubMedCrossRefGoogle Scholar
  5. 5.
    Myers JK, Weissman MM, Tischler GL, et al. Six-month prevalence of psychiatric disorders in three communities. Arch Gen Psychiatry 1984; 41: 959–967.PubMedCrossRefGoogle Scholar
  6. 6.
    Weissman MM, Leaf PF, Tischler GL, et al. Affective disorders in five United States communities. Psychol Med 1988; 18: 141–153.PubMedCrossRefGoogle Scholar
  7. 7.
    Blazer DG, Hughes DC, George LK. The epidemiology of depression in an elderly community population. Gerontologist 1987; 27: 281–287.PubMedCrossRefGoogle Scholar
  8. 8.
    Koenig HG, Meador KG, Cohen HJ, et al. Depression in elderly men hospitalized with medical illness. Arch Intern Med 1988; 148: 1929–1936.PubMedCrossRefGoogle Scholar
  9. 9.
    Kitchell MA, Barnes RF, Veith RC, et al. Screening for depression in hospitalized geriatric medical patients. J Am Geriatr Soc 1982; 30: 174–144.PubMedGoogle Scholar
  10. 10.
    Borson S, Barnes RA, Kukull WA, et al. Symptomatic depression in elderly medical outpatients, I: prevalence, demography, and health services utilization. J Am Geriatr Soc 1986; 34: 341–347.PubMedGoogle Scholar
  11. 11.
    Schulberg HC, McClelland M, Gooding W. Six-month outcomes for medical patients with major depressive disorders. J Gen Intern Med 1987; 2: 312–317.PubMedCrossRefGoogle Scholar
  12. 12.
    Parmalee PA, Katz IR, Lawton MP. Depression among institutionalized aged: Assessment and prevalence estimation. Presented at the Gerontological Society of America annual meeting, 1987; Washington, DC.Google Scholar
  13. 13.
    Kafonek S, Ettinger W, Roca R, et al. Dementia, depression, and functional status in a long-term care facility. In: Proceedings of the AGS/AFAR Annual Meeting; May 1987; Kafonek S, Ettinger WH, Roca R, Kittner S, Taylor N, Kittner S, 1989; 37: 29–34.Google Scholar
  14. 14.
    Hopkinson G. A genetic study of affective illness in patients over 50. Br J Psychiatry 1964; 110: 244–254.PubMedCrossRefGoogle Scholar
  15. 15.
    Robinson DS, Davies JM, Nies A, et al. Relation of sex and aging to monoamine oxidase activity of human plasma and platelets. Arch Gen Psychiatry 1971; 24: 536541.Google Scholar
  16. 16.
    Vogel GW, Vogel F, McAbee RS, et al. Improvement of depression by REM sleep deprivation: new findings and a theory. Arch Gen Psychiatry 1980; 37: 247–253.PubMedCrossRefGoogle Scholar
  17. 17.
    Pfifer JF, Murrell SA. Etiologic factors in the onset of depressive symptoms in older adults. J Abnorm Psychol 1986; 95: 282–291.CrossRefGoogle Scholar
  18. 18.
    Blazer DG. Impact of late-life depression on the social network. Am J Psychiatry 1983; 140: 162–166.PubMedGoogle Scholar
  19. 19.
    Fredman L, Schoenbach VJ, Kaplan BH, et al. The association between depressive symptoms and mortality among older participants in the Epidemiologic Catchment Area-Piedmont Health Survey, 1986.Google Scholar
  20. 20.
    Murphy E, Smith R, Lundesay J, et al. Increased mortality rates in late-life depression. Br J Psychiatry 1988; 152: 347–353.PubMedCrossRefGoogle Scholar
  21. 21.
    Schweitzer I, Maguire KP, Gee AH, et al. Prediction of outcome in depressed patients by weekly monitoring with the dexamethasone suppression text. Br J Psychiatry 1987; 151: 780–783.PubMedCrossRefGoogle Scholar
  22. 22.
    Post F. The management and nature of depressive illness in late life: a follow-through study. Br J Psychiatry 1972; 121: 393–404.PubMedCrossRefGoogle Scholar
  23. 23.
    Murphy E. The prognosis of depression in old age. Br J Psychiatry 1983; 142: 111–119.PubMedCrossRefGoogle Scholar
  24. 24.
    Blazer D, Fowler N, Hughes D. Follow-up of hospitalized depressed patients: an age comparison.Google Scholar
  25. 25.
    George LK, Blazer DG, Hughes DC, et al. Social support and the outcome of major depression. 1989; 154: 478–485.Google Scholar
  26. 26.
    Shulman K, Post F. Bipolar affective disorder in old age. Br J Psychiatry 1980; 136: 26–32.PubMedCrossRefGoogle Scholar
  27. 27.
    Blazer DG, Bachar JR, Manton KG. Suicide in late life: review and commentary. J Am Geriatr Soc 1986; 34: 519525.Google Scholar
  28. 28.
    Parkin D, Stengal E. Incidence of suicide attempts in an urban community. Br Med J Clin Res 1965; 2: 133–134.CrossRefGoogle Scholar
  29. 29.
    Gianturco DT, Busse EW. Psychiatric problems encounGoogle Scholar
  30. tered during a long-term study of normal ageing volunteers. In: Issacs AD, Post F, eds. Studies in Geriatric Psychiatry New York, NY: John Wiley and Sons Inc; 1978: 1–16.Google Scholar
  31. 30.
    German PS, Shapiro S, Skinner EA. Mental health of the elderly: use of health and mental health services. J Am Geriatr Soc 1985; 33: 246–252.PubMedGoogle Scholar
  32. 31.
    German PS, Shapiro S, Skinner EA, et al. Detection and management of mental health problems of older patients by primary care providers. JAMA 1987; 257: 489–493.PubMedCrossRefGoogle Scholar
  33. 32.
    Koenig HG, Meador KG, Cohen HJ, et al. Detection and treatment of major depression in older medically ill hospitalized patients. Intl J Psychiatry Med 1988; 18: 17–31.CrossRefGoogle Scholar
  34. 33.
    Norris JT, Gallagher D, Wilson A, et al. Assessment of depression in geriatric medical outpatients: the validity of two screening measures. J Am Geriatr Soc 1987; 35: 989–995.PubMedGoogle Scholar
  35. 34.
    Koenig HG, Meador KG, Cohen HJ, et al. Self-rated depression scales and screening for major depression in the older hospitalized patient with medical illness. J Am Geriatr Soc 1988; 36: 699–706.PubMedGoogle Scholar
  36. 35.
    Carroll BJ, Feinberg M, Greden JF, et al. A specific laboratory test for the diagnosis of melancholia: standardization, validity, and clinical utility. Arch Gen Psychiatry 1981; 38: 15–22.PubMedCrossRefGoogle Scholar
  37. 36.
    Rosenbaum AH, Schatzberg AF, MacLaughlin MS, et al. The DST in normal control subjects: a comparison of two assays and the effects of age. Am J Psychiatry 1984; 141: 1550–1555.PubMedGoogle Scholar
  38. 37.
    Jenike MA, Albert MS. The dexamethasone suppression test in patients with presenile and senile dementia of the Alzheimer’s type. J Am Geriatr Soc 1984; 32: 441–444.PubMedGoogle Scholar
  39. 38.
    Kupfer DJ, Foster FG, Coble P, et al. The application of EEG sleep for the differential diagnosis of affective disorders. Am J Psychiatry 1978; 135: 69–74.PubMedGoogle Scholar
  40. 39.
    Knight DL, Krishnan KRRR, Blazer DG, et al. Tritiated imipramine binding to platelets is markedly reduced in elderly depressed patients. Soc Neurosci Abstr 1986; 12: 1251.Google Scholar
  41. 40.
    Blazer DG, Bachar JR, Hughes DC. Major depression with melancholia: a comparison of middle-aged and elderly adults. J Am Geriatr Soc 1987; 35: 927–932.PubMedGoogle Scholar
  42. 41.
    Palmore E, Kivett V. Change in life satisfaction: a longitudinal study of persons age 46–70. J Gerontol 1977; 32: 311–316.PubMedCrossRefGoogle Scholar
  43. 42.
    de Alarcon R. Hypochondriasis and depression in the aged. Gerontology 1964; 6: 266–277.Google Scholar
  44. 43.
    Shoenborn CA, Cohen BH. Trends in Smoking, Alcohol Consumption, and Other Health Practices Among US Adults, 1977 and 1983. (1986.) US Dept of Health and Human Services publication (PHS) 86–1250.Google Scholar
  45. 44.
    Whitlock FA, Siskind M. Depression and cancer: a follow-up study. Psychol Med 1979; 9: 747–752.PubMedCrossRefGoogle Scholar
  46. 45.
    Robinson RG, Szetela B. Mood change following left hemisphere brain injury. Ann Neurol 1981; 9: 447–453.PubMedCrossRefGoogle Scholar
  47. 46.
    Beck AT, Rush AJ, Shaw BF, et al. Cognitive Therapy of Depression. New York, NY: Guilford Press; 1979.Google Scholar
  48. 47.
    Klerman GL, Weissman MM, Rounsaville BJ, et al. Interpersonal Psychotherapy of Depression. New York, NY: Basic Books Inc. Publishers; 1984.Google Scholar
  49. 48.
    Gallagher D, Thompson LW. Differential effectiveness of psychotherapies for the treatment of major depressive disorder in older adult patients. Psychother Theory Res Pract 1982; 19: 42–49.Google Scholar
  50. 49.
    Nies A, Robinson DS, Friedman MJ, et al. Relationship between age and tricyclic antidepressant pharmacokinetics and plasma levels. Am J Psychiatry 1977; 134: 790–793.PubMedGoogle Scholar
  51. 50.
    Reding MJ, Orto LA, Winter SW et al. Antidepressant therapy after stroke: a double-blind trial. Arch Neurol 1986; 43: 763–768.PubMedCrossRefGoogle Scholar
  52. 51.
    Lakshmanan M, Mion LC, Frengley JD. Effective low dose tricyclic antidepressant treatment for depressed geriatric rehabilitation patients. J Am Geriatr Soc 1986; 34: 421–426.PubMedGoogle Scholar
  53. 52.
    Lipsey JR, Robinson RG, Pearlson GD. Nortriptyline treatment of post-stroke depression: a double-blind study. Lancet 1984; 1: 297–300.PubMedCrossRefGoogle Scholar
  54. 53.
    Roose SP, Glassman AH, Giardina, EGV, et al. Nortriptyline in depressed patients with left ventricular impairment. JAMA 1986; 256: 3253–3257.PubMedCrossRefGoogle Scholar
  55. 54.
    Jarvik LF, Mintz J, Steuer J, et al. Treating geriatric depression: a 26-week interim analysis. J Am Geriatr Soc 1982; 30: 713–717.PubMedGoogle Scholar
  56. 55.
    Tyrer P, Murphy S. The place of benzodiazepines in psychiatric practice. Br J Psychiatry 1987; 151: 719–723.PubMedCrossRefGoogle Scholar
  57. 56.
    Greenblatt DJ, Shader RI, Abernathy DR. Current status of benzodiazepines: clinical use of benzodiazepines. N Engl J Med 1983; 309: 410–405.PubMedCrossRefGoogle Scholar
  58. 57.
    Katon W, Raskind M. Treatment of depression in the medically ill elderly with methylphenidate. Am J Psychiatry 1980; 137: 963–965.PubMedGoogle Scholar
  59. 58.
    Koenig HG. Shepherds’ Centers: elderly people helping themselves. J Am Geriatr Soc 1986; 34: 73–74.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1990

Authors and Affiliations

  • Harold G. Koenig
  • Dan G. BlazerII

There are no affiliations available

Personalised recommendations