Depression in the elderly

Severe depression affects 1-2% of the elderly population while 10% have significant depression affecting their life. Milder depression can affect a further 20%. Depression can have bizarre features in the elderly and may be misdiagnosed as dementia or psychosis. Agitated depression is the most frequent type of depression in the aged. 1 Features may include histrionic behaviour, delusions and disordered thinking.

Depression is often missed in the elderly because it is atypical and less expressive, and patients tend to be ashamed and reluctant to admit it. Four key guidelines help diagnosis:

• Are you basically satisfied with your life?

• Do you feel that your life is empty?

• Are you afraid that something bad is going to happen to you?

A useful clue is a change in sleep pattern; so a request for sleeping tablets may lead to the prescription for a more sedating antidepressant. Medical illness is an important precipitant of depression in the elderly. Tricyclic antidepressants have to be used with caution in the elderly and most have some contraindications to their use. ECT has a useful place in treatment of severe cases.

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