Approaches to decrease the prevalence of depression in later life
ABSTRACT Depression is a common and disabling disorder that affects people of all ages and 10% of those older than 65 years. Current strategies to decrease the personal and societal burden of depression in older age rely on the management of people with depression or of those at risk, but benefits have been limited and data remain scant.
Existing data suggest that decreasing the onset of a depressive disorder in people at risk is a reasonable way of reducing its prevalence in the community. Older adults with subthreshold symptoms of depression and those who have suffered a stroke have been successfully targeted with various interventions. In addition, the use of collaborative care has improved the immediate and long-term outcome of patients with depression. Finally, the findings of epidemiological studies indicate that a more systematic approach to the management of risk factors might improve the outcome of patients and those at risk, but trial data are still lacking.
Current evidence suggests that it is possible to decrease the prevalence of depression in later life, but a more systematic approach to the assessment and management of older adults is necessary.
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ABSTRACT: Due to their increasing frequency, mental disorders among the elderly have special importance in the clinical practice. In this article we summarize the characteristics, diagnostic problems and modern treatments of mental disorders (especially depression) in old age. As this period of life means special somatic and psychic features in people's condition, it may be difficult to find the most effective and well-tolerated treatment, especially in case of comorbid dementia or agitated behaviour. In this article we review the therapeutic experience with the SARI antidepressant trazodone. Clinical studies and everyday practice indicate that trazodone due to its special multifunctional receptorprofile can be particularly effective in the treatment of depression accompanied by severe insomnia and anxiety. Due to its special anxiolytic and sleep normalising effect and well-tolerated side effect profile trazodone is found to be clinically useful not only in the treatment of depression in the elderly, but also in the case of serious comorbidity with dementia or agitated behaviour. We also illustrate the possibilities of using trazodone in the everyday practice with the presentation of two case reports. Furthermore we review the viewpoints of complex therapy which facilitates the successful treatment of depression in the elderly and the restoration of quality of life.Neuropsychopharmacologia Hungarica: a Magyar Pszichofarmakológiai Egyesület lapja = official journal of the Hungarian Association of Psychopharmacology 09/2013; 15(3):147-155.
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ABSTRACT: This study aimed to develop a simple risk table of modifiable factors prospectively associated with depression in later life that could be used to guide the assessment, management and introduction of preventive strategies in clinical practice. This retrospective cohort study included 4636 men aged 65 to 83years living in the community who denied history of past diagnosis or treatment for depression. They self-reported information about their physical activity, weight and height, smoking history, alcohol consumption and dietary habits, as well as history of hypertension, diabetes, coronary heart disease and stroke. We calculated the body mass index (BMI) in Kg/m(2). Three to 8years later they were assessed with the Geriatric Depression Scale 15 (GDS-15) and those with a total score of 7 or greater were considered to display clinically significant symptoms of depression. We used binomial exponentiated log-linked general linear models to estimate the risk ratio (RR) and 95% confidence interval (95%CI) of incident depression after adjusting for age, education, marital status and prevalent medical illnesses. We calculated the probability of depression for each individual combination of risk factors and displayed the results in a risk table. Two hundred and twenty-nine men (4.5%) showed evidence of incident depression 5.7±0.9 (mean±standard deviation) years later. Measured dietary factors showed no association with incident depression. The probability of depression was highest for older men who were underweight, overweight or obese, physically inactive, risk drinkers and smokers (12.0%, 95%CI=7.0%, 17.1%), and lowest for those who had all 4 healthy lifestyle markers: physically active, normal body mass, non-risk drinking and non-smoking (1.6%, 95%CI=0.6%, 2.5%). The probability of incident depression fell between these two extremes for different combinations of lifestyle practices. Four modifiable lifestyle factors can be used in combination to produce a risk table that predicts the probability of incident depression over a period of 3 to 8years. The risk table is simple, informative and can be easily incorporated into clinical practice to guide assessment and risk reduction interventions.Preventive Medicine 10/2013; 57(6). DOI:10.1016/j.ypmed.2013.09.021 · 2.93 Impact Factor
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ABSTRACT: Background The menopausal transition (MT) is a biological inevitability for all ageing women that can be associated with changes in mood, including depressive symptoms. There is tentative evidence that women who develop depression during the MT have greater risk of subsequent depressive episodes, as well as increased health morbidity and mortality. Thus, preventing depression during the MT could enhance both current and the future health and well-being of women. This study aims to test the efficacy of a client-centred health promotion intervention to decrease the 12-month incidence of clinically significant symptoms of depression among women undergoing the MT. Methods/Design This randomised controlled trial will recruit 300 women undergoing the MT living in the Perth metropolitan area. They will be free of clinically significant symptoms of depression and of psychotic or bipolar disorders. Consenting participants will be stratified for the presence of subsyndromal symptoms of depression and then randomly assigned to the intervention or control group. The intervention will consist of eight telephone health promotion sessions that will provide training in problem solving and education about the MT, healthy ageing, depression and anxiety, and management of chronic health symptoms and problems. The primary outcome of interest is the onset of a major depressive episode according the DSM-IV-TR criteria during the 12-month follow-up or of clinically significant symptoms of depression, as established by a score of 15 or greater on the Patient Health Questionnaire (PHQ-9). Secondary outcomes of interest include changes in the severity of symptoms of depression and anxiety (Hospital Anxiety and Depression Scale, HADS), quality of life (Short Form Health Survey, SF-12), and lifestyle. Discussion Current evidence shows that depressive symptoms and disorders are leading causes of disability worldwide, and that they are relatively common during the MT. This study will use a multifaceted health promotion intervention with the aim of preventing depression in these women. If successful, the results of this trial will have implications for the management of women undergoing the MT. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12613000724774. Date registered: 1 July 2013.Trials 08/2014; 15(1):312. DOI:10.1186/1745-6215-15-312 · 2.12 Impact Factor