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Management of acute episodes of depression

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Antidepressants for Elderly People

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Abstract

Depression is a common condition in the elderly. However, reports of its incidence and prevalence have varied, because research workers have different criteria for defining depression. Gurland (1976) pointed out that milder affective disorders have their greatest incidence between the ages of 35 and 45, while psychotic depression presents for the first time most commonly between the ages of 55 and 65. Post (1982) has reported that first episodes of depression become increasingly rare after this age, particularly after the age of 75. Gurland (1976) has suggested that a worldwide prevalence rate for depression of greater than 10% in individuals aged 65 and over is likely. Community survey of an elderly population in Edinburgh (Williamson, 1978) and Newcastle (Kay et al., 1964) reported a prevalence of depressive illness in 5.4% and 2.4% respectively. The prevalence of depression in medically ill elderly patients has been reported as rising to 20–35% in this group (Lancet, 1979; Moffic and Paykel, 1975). Post (1972) in a series of follow-up studies of hospital-treated depressives aged over 60 showed that only 25% of patients failed to have further breakdowns within the next three years. Between 25 and 30% of all suicides occur in those over the age of 65, although this group comprises about 12% of the population (Post, 1982).

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References

  • Abou-Saleh, M.T. and Coppen, A. (1983) The prognosis of depression in old age — The case for lithium therapy. British Journal of Psychiatry, 143, 527–8.

    Article  PubMed  CAS  Google Scholar 

  • Akiskal, H.S. (1983) Dysthymic disorder. Psychopathology of proposed chronic depressive symptoms. American Journal of Psychiatry, 140, 11–20.

    PubMed  CAS  Google Scholar 

  • Angst, J., Baastrup, P., Grof, P. et al. (1973) The cause of monopolar depression and bipolar psychoses. Psychiatria Neurologia Neurochinurgia, 76, 489–500.

    CAS  Google Scholar 

  • Ashford, J.W. and Ford, C. (1979) Use of MAO inhibitors in elderly patients. Am. J. Psych., 136(11), 1466–7.

    CAS  Google Scholar 

  • Avery, D. and Winokur, G. (1976) Mortality in depressed patients treated with electro-convulsive therapy and anti-depressants. Archives of General Psychiatry, 33, 1029.

    Article  PubMed  CAS  Google Scholar 

  • Ayd, F.J. (1974) Single daily dose of anti-depressants. Journal of the American Medical Association, 230, 263–4.

    Article  PubMed  Google Scholar 

  • Baldessarini, R.J. (1984) Treatment of depression by altering monoamine metabolism: Precursors and metabolic inhibitors. Psychopharmacology Bulletin, 20, 224.

    PubMed  CAS  Google Scholar 

  • Blazer, D.G. and Williams, C.A. (1980) The epidemiology of dysphoria and depression in an elderly population. American Journal of Psychiatry, 137, 439–44.

    PubMed  CAS  Google Scholar 

  • Branconnier, R.J., Cole, J.O., Ghajunian, S. and Rosenthal, S. (1981) Treating the depressed elderly patient — the comparative behavioural pharmacology of mianserin and amitriptyline. In Typical and atypical anti-depressants advances in Biochemical Psychopharmacology, 32, 195–212. Raven Press, New York.

    Google Scholar 

  • Caine, E.D. (1981) Pseudo dementia: Current concepts and future directions. Archives of General Psychiatry, 38, 1359–64.

    Article  PubMed  CAS  Google Scholar 

  • Coppen, A., Noguera, R., Bailey, J. et al. (1971) Prophylactic lithium in affective disorders: Controlled trial. Lancet, ii, 275–9.

    Article  Google Scholar 

  • Coppen, A., Ghose, K., Montgomery, S., Rao, V. and Bailey, J. (1978) Continuation therapy with amitriptyline in depression. British Journal of Psychiatry, 133, 28–33.

    Article  PubMed  CAS  Google Scholar 

  • de Alarcon, R. (1964) Hypochondriasis and depression in the aged. Gerontology Clinics, 6, 266.

    Article  Google Scholar 

  • de Montigny, C., Cournoyer, G., Morissette, R. et al. (1983) Lithium carbonate addition in tricyclic anti-depressant resistance unipolar depression. Archives of General Psychiatry, 40, 1327.

    Article  PubMed  Google Scholar 

  • Eisderfer, C. and Raskin, M.A. (1975) Endocrinologic bases of behaviour in aging. In Hormonal Correlates of Behaviour (eds R.L. Sprott and B.E. Eleftherias), Jackson Laboratory, Maine.

    Google Scholar 

  • Georgotas, A. (1981) Phenelzine in treatment resistive geriatric depression. World Psychiatric Association Regional Meeting. New York.

    Google Scholar 

  • Georgotas, A., Cooper, T., Kim, M. et al. (1984) The treatment of affective disorders in the elderly. Psycho-pharmacology Bulletin, 19, 226.

    Google Scholar 

  • Gerner, R.H., Estabrook, W., Steiner, J. and Jarvik, L.F. (1980) Treatment of geriatric depression with trazodone, imipramine and placebo — a double blind study. Journal of Clinical Psychiatry, 41(6), 216–20.

    PubMed  CAS  Google Scholar 

  • Gerner, R.H. and Jarvik, L.F. (1980) Anti-depressant treatment in the elderly. In Depression and anti-depressants — Implications for cause and treatment (eds E. Friedman, J. Mann and S. Gershon), Plenum Press, New York.

    Google Scholar 

  • Gerner, R.H. (1985) Present status of drug therapy of depression in late life. Journal of Affective Disorders Suppl., 1, 23–32.

    Article  Google Scholar 

  • Gillis, L.S. and Zabao, A. (1982) Dysphoria in the elderly. South African Medical Journal, 62, 410–13.

    PubMed  CAS  Google Scholar 

  • Glassman, A.H., Giardina, E.U., Perez, J.M. et al. (1979) Clinical characteristics of imipramine induced orthostatic hypotension. Lancet, i, 468–72.

    Article  Google Scholar 

  • Goff, D.C. and Jenike, M.A. (1986) Treatment Resistant Depression in the Elderly. Journal of the American Geriatrics Society, 34, 63–79.

    PubMed  CAS  Google Scholar 

  • Goodwin, F.K., Prange, A.J., Post, R.M. et al. (1982) Potentiation of antidepressant effects by L tri-iodothyronine in tricyclic nonresponders. American Journal of Psychiatry.

    Google Scholar 

  • Greenblatt, D.J., Sellers, E.M. and Shader, R.T. (1982) Drug disposition in old age. New England Journal of Medicine, 306, 1081–8.

    Article  PubMed  CAS  Google Scholar 

  • Gurland, B.J. (1976) The comparative frequency of depression in various adult age groups. Journal of Gerontology, 31, 283–92.

    Article  PubMed  CAS  Google Scholar 

  • Heiman, E.M. (1977) Cardiac toxicity with thioridazine tricyclic anti-depressant combination. Journal of Nervous and Mental Disorders, 165, 139–43.

    Article  CAS  Google Scholar 

  • Heminger, G.R., Charney, D.J. and Sternberg, D.E. (1983) Lithium carbonate augmentation of anti-depressant treatment. Archives of General Psychiatry, 40, 1335.

    Article  Google Scholar 

  • Himmelbeck, J.M., Detre, T., Kupfer, J.D. et al. (1972) Treatment of previously intractable depressions with tranylcypramine and lithium. Journal of Nervous and Mental Disorders, 155–216.

    Google Scholar 

  • Jacoby, R.J., Levy, R. and Davison, J.M. (1980) Computed tomography in the elderly — affective disorders. British Journal of Psychiatry, 136, 270–5.

    Article  PubMed  CAS  Google Scholar 

  • Jacoby, R.J. (1981) Depression in the elderly. British Journal of Hospital Medicine, 25, 40–7.

    PubMed  CAS  Google Scholar 

  • Jacoby, R.J., Dolan, R.J., Levy, R. and Baldy, R. (1983) Quantitative computed tomography in elderly depressed patients. British Journal of Psychiatry, 143, 124–7.

    Article  PubMed  CAS  Google Scholar 

  • Jarvik, L.F. and Perl, M. (1981) Overview of physiologic dysfunctions related to psychiatric problems in the elderly, in Psychiatric management of physical disease in the elderly (eds A. Levenson and R. C. W. Hall) Raven Press, New York.

    Google Scholar 

  • Jarvik, L.F., Minty, J., Stener, J. and Gerner, R.H. (1982) Treating geriatric depression — a 26 weeks interim analysis. Journal of the American Geriatric Society, 30, 713–17.

    CAS  Google Scholar 

  • Jefferson, J.W. and Ayd, F.J. (1983) Combining lithium and anti-depressants. Journal of Clinical Psychopharmacology, 3, 303.

    Article  PubMed  CAS  Google Scholar 

  • Kane, J.M., Quitkin, F.M., Rifkin, A. et al. (1982) Lithium Carbonate and Imipramine in the prophylaxis of unipolar and bipolar II illness. Archives of General Psychiatry, 39, 1065–9.

    Article  PubMed  CAS  Google Scholar 

  • Kantor, S.J., Bigger, J., Glassman, A.H., Macken, D.L. and Perez, J.M. (1975) Imipramine induced heart block — a longitudinal case study. Journal of the American Medical Association, 231, 1364–6.

    Article  PubMed  CAS  Google Scholar 

  • Kantor, S.J. and Glassman, A.H. (1980) The use of tricyclic anti-depressant drugs in geriatric patients. In Psycho-pharmacology of ageing (eds C. Eisderfer and W.E. Fann), 99–118. M.T.P. Press, Lancaster.

    Chapter  Google Scholar 

  • Kay, D.W.K., Beamish, P. and Roth, M. (1964) Old age mental disorders in Newcastle-upon-Tyne — a study of prevalence. British Journal of Psychiatry, 110, 46–66.

    Article  Google Scholar 

  • Kayton, W. (1984) Depression: Relationship to somatization and chronic medical illness. Journal of Clinical Psychiatry, 45, 4.

    Google Scholar 

  • Klerman, G.L. and Cole, J.O. (1965) Clerical Pharmacology of Imipramine and related anti-depressant compounds. Pharmacology Review, 17, 101–41.

    CAS  Google Scholar 

  • Kretschmar, J.H. (1980) Mianserin and amitriptyline in elderly hospitalized patients with depressive illness — a double blind trial. Current Medical Research Opinion, 6(7), 144–50.

    Article  Google Scholar 

  • Lader, M. (1982) The Psychopharmacology of old age. In The Psychiatry of Late Life (eds R. Levy and F. Post), 143–61. Blackwell Scientific Publications, Oxford.

    Chapter  Google Scholar 

  • Lancet, i, 479 (1979) Editorial: Psychiatric illness among medical patients.

    Google Scholar 

  • Linstedt, G., Nilsson, L., Walinder, J., Skott, A. and Ohman, R. (1977) On the prevalence, diagnosis and management of lithium induced hypothyroidism in psychiatric patients. British Journal of Psychiatry, 139, 452–8.

    Article  Google Scholar 

  • Lydiard, R.B., Golenberg, A.J. (1981) Amoxapine: An anti-depressant with some neuroleptic properties? Pharmacotherapy, 1, 163.

    PubMed  CAS  Google Scholar 

  • McAllister, T.W. and Price, T.P.R. (1982) Severe depressive pseudo-dementia with and without dementia. American Journal of Psychiatry, 138, 626–8.

    Google Scholar 

  • McGrath, P.S., Quitkin, F.M., Harrison, W. et al. (1984) Treatment of melancholia with tranylcypramine. American Journal of Psychiatry, 141, 288.

    PubMed  CAS  Google Scholar 

  • Medical Research Council (1981) Continuation therapy with lithium and amitriptyline in unipolar depressive illness: A controlled trial. Psychological Medicine, 2, 409–16.

    Google Scholar 

  • Mendiewicz, J., Dunbar, G.C. and Hoffman, G. (1985) Changes in sleep EEG architecture during the treatment of depressed patients with mianserin. Acta Psychiatrica Scandinavica, Suppl. 72, 320–6.

    Google Scholar 

  • Mindham, R.H.S., Howland, C. and Shephard, M. (1973) An evaluation of continuation therapy with tricyclic anti-depressants in depressive illness. Psychological Medicine, 3, 5–17.

    Article  PubMed  CAS  Google Scholar 

  • Minter, R.E. and Mandel, M.R. (1979) The treatment of psychotic major depressive disorders with drugs and electroconvulsive therapy. Journal of Nervous and Mental Disorders, 67, 726–33.

    Google Scholar 

  • Moffic, H.S. and Paykel, E.S. (1975) Depression in medical inpatients. British Journal of Psychiatry, 126, 346.

    Article  PubMed  CAS  Google Scholar 

  • Montgomery, I., Oswald, I., Morgan, R. and Adam, R. (1983) Trazodone enhances sleep in subjective quality but not in objective duration. British Journal of Clinical Pharmacology, 16, 139.

    Article  PubMed  CAS  Google Scholar 

  • Moore, J.T. (1985) Dysthymia in the elderly. Journal of Affective Disorders Suppl, 1, 15–21.

    Article  Google Scholar 

  • Murphy, E. (1982) Social origins of depression in old age. British Journal of Psychiatry, 141, 135–42.

    Article  PubMed  CAS  Google Scholar 

  • Murphy, E. (1983) The prognosis of depression in old age. British Journal of Psychiatry, 142, 111–19.

    Article  PubMed  CAS  Google Scholar 

  • Murphy, E. (1985) General Management of Depression in Late Life. Journal of Affective Disorders Suppl, 1, 7–10.

    Article  Google Scholar 

  • Neshkes, R., Gerner R. and Aldrich, J. (1982) A comparison trial of the cardiovascular effects of doxepin and imipramine in elderly depressed outpatients. Gerontologist, 22, 241–5.

    Google Scholar 

  • Newton, R. (1981) The side effect profile of trazodone in comparison to an active control and placebo. Journal of Clinical Psychopharmacology, 1, 895.

    Article  Google Scholar 

  • Paykel, E.S., Dimascio A., Haswell, D. and Prusoff, B.A. (1975) Effects of maintenance of amitriptyline and psychotherapy on symptoms of depression. Psychological Medicine, 5, 67–71.

    Article  PubMed  CAS  Google Scholar 

  • Paykel, E.S., Dimascio, A., Haswell, D. and Prusoff, J.A. (1979) Predictors of treatment response in Psycho-pharmacology of Affective Disorders (eds E.S. Paykel and A. Coppen), Oxford University Press.

    Google Scholar 

  • Post, F. (1972) The management and nature of depressive illnesses in later life; a follow through study. British Journal of Psychiatry, 121, 393–404.

    Article  PubMed  CAS  Google Scholar 

  • Post, F. (1982) The Psychiatry of Late Life. Functional Disorders; description, incidence and recognition. 176–96. (eds R. Levy and F. Post), Blackwell Scientific Publications.

    Google Scholar 

  • Post, F. (1985) Psychotherapy, electro-convulsive treatments and long term management of elderly patients. In Management of depression in late life. Journal of Affective Disorders Suppl., 41–5.

    Google Scholar 

  • Post, R.M., Uhde, T.W., Ballenger, J.C. et al. (1983) Prophylactic efficacy of carbamazepine in manic-depressive illness. American Journal of Psychiatry, 140, 1602.

    PubMed  CAS  Google Scholar 

  • Quitkin, F.M., Rabkin, J.G., Ross, D. et al. (1984b) Duration of anti-depressant drug treatment. Archives of General Psychiatry, 41, 238.

    Article  PubMed  CAS  Google Scholar 

  • Quitkin, F.M., Rabkin, J.G., Ross, D. and McGrath, P.J. (1984a) Duration of anti-depressant drug treatment. What is an adequate trial? Archives of General Psychiatry, 29, 420–5.

    Google Scholar 

  • Quitkin, F.M., Rabkin, J.G., Ross, D. and McGrath, P.J. (1984b) Identification of true drug response to anti-depressants, use of pattern analysis. Archives of General Psychiatry, 41, 782–6.

    Article  PubMed  CAS  Google Scholar 

  • Razani, J., White, K.L., White, J. et al. (1983) The safety and efficacy of combined amitriptyline and tranylcypramine anti-depressant treatment. Archives of General Psychiatry, 40, 657.

    Article  PubMed  CAS  Google Scholar 

  • Reifler, B.V., Lawson, E. and Hanley, R. (1982) Co-existence of cognitive impairment and depression in geriatric outpatients. American Journal of Psychiatry, 139, 5.

    Google Scholar 

  • Richelsen, E. (1982) Pharmacology of anti-depressants in use in the United States. Journal of Clinical Psychiatry, 43, 4–11.

    Google Scholar 

  • Robinson, D.S. (1979) Age related factors affecting anti-depressant drug metabolism and clinical response. In Geriatric Psychopharmacology. (ed. K. Vandy) Elsevier North-Holland, New York.

    Google Scholar 

  • Robinson, P.D., Saurkes, J.L., Nies, A. et al. (1977) Monoamine metabolism in the human brain. Archives of General Psychiatry, 34, 89.

    Article  PubMed  CAS  Google Scholar 

  • Ron, M.A., Toone, B.K., Garralda, M.E. et al. (1979) Diagnostic accuracy in presenile dementia. British Journal of Psychiatry, 134, 161–8.

    Article  PubMed  CAS  Google Scholar 

  • Roose, S.P., Glassman, A.H., Siris, S. et al. (1981) Comparison of imipramine and nortriptyline induced orthostatic hypotension — a meaningful difference. Journal of Clinical Psychopharmacology, 1, 316–21.

    Article  PubMed  CAS  Google Scholar 

  • Scardigli, G. and Jans, G. (1982) Comparative double blind study on efficacy and side effects of trazodone, nomifensine and mianserin in elderly patients. Advances in Biochemistry and Psychopharmacology, 32, 229–36.

    CAS  Google Scholar 

  • Schatsberg, A.F., Lipkin, B., Satlin, A. and Cole, J.O. (1984) Diagnosis of affective disorders in the elderly. Psychosomatics, 25, 126–31.

    Article  Google Scholar 

  • Sloane, R.B., Staples, F., Bender, M., Razani, J. and Schneider, L. (1984) Psychotherapy versus nortriptyline for depression in the elderly. In Abstracts of the 14th CINP Congress, Florence, p. 169.

    Google Scholar 

  • Smith, A.H.W., Naylor, G.S. and Moody, J.P. (1978) Placebo-controlled double blind trial of mianserin hydrochloride. British Journal of Clinical Pharmacology, 5, 675.

    Google Scholar 

  • Spar, J.E., Ford, C.V. and Liston E.H. (1979) Bipolar affective disorder in aged patients. Journal of Clinical Psychiatry, 40, 504–7.

    PubMed  CAS  Google Scholar 

  • Spar, J.E. and Gerner, R.H. (1982) Major depression in the elderly: DSM III criteria and the dexamethasone suppression test as predictors of treatment response. American Journal of Psychiatry, 140, 844.

    Google Scholar 

  • Stein, M.K., Rickeis, K. and Weisse, C.C. (1980) Maintenance therapy with amitriptyline: A controlled trial. American Journal of Psychiatry, 137, 370–1.

    PubMed  CAS  Google Scholar 

  • Thayssen, P., Bjekre, M., Krogh-Sorenson, L. et al. (1981) Cardiovascular effects of imipramine and nortriptyline in elderly patients. Psychopharmacology, 74, 360.

    Article  PubMed  CAS  Google Scholar 

  • Tsuang, M.T., Woolson, R.F. and Fleming, J.A. (1980) Premature deaths in schizophrenia and affective disorders. Archives of General Psychiatry, 37, 979.

    Article  PubMed  CAS  Google Scholar 

  • Van der Velde, C.D. (1971) Toxicity of Lithium Carbonate in elderly patients. American Journal of Psychiatry, 127, 1075–7.

    PubMed  Google Scholar 

  • Von Ammon, K. and Cavanaugh, S. (1984) Diagnosing depression in the hospitalized patient with chronic medical illness. Journal of Clinical Psychiatry, 45, 13.

    Google Scholar 

  • Ware, J.C. (1983) Tricyclic anti-depressants in the treatment of insomnia. Journal of Clinical Psychiatry, 44, 25.

    PubMed  CAS  Google Scholar 

  • Weiner, R.D. (1982) The role of electroconvulsive therapy in the treatment of depression in the elderly. Journal of American Geriatric Society, 30, 710–12.

    CAS  Google Scholar 

  • Williamson, J. (1978) Depression in the elderly. Age and ageing, 7, 35–40.

    Article  Google Scholar 

  • Wills, L.E. (1963) Pseudodementia. American Journal of Psychiatry, 120, 244.

    Google Scholar 

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Authors
  1. Hilary Standish-Barry
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Editors and Affiliations

  1. University of Wales College of Medicine, UK

    Karabi Ghose (Honorary Consultant in Geriatric Medicine) (Honorary Consultant in Geriatric Medicine)

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Standish-Barry, H. (1989). Management of acute episodes of depression. In: Ghose, K. (eds) Antidepressants for Elderly People. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-3436-9_13

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  • DOI: https://doi.org/10.1007/978-1-4899-3436-9_13

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