[Melancholic Brain]Treatment of Depression in the Elderly (1) | Fanggezi vocus

Treatment of geriatric depression requires individualized assessment. (Photo: Edward Blanco on Unsplash)

Author: Jian Wanxi, a psychiatrist

Release date: 2022/09/02

This article is based on the experience of in-office whispers, cognitive behavioral therapy, and mindfulness-based cognitive psychotherapy in a psychiatric outpatient clinic. All conversations have been rewritten to remove all descriptions that could identify specific identities. If there is a coincidence, please do not be seated.

The treatment of senile depression is different from that of general adult depression in terms of drug selection and treatment selection, and requires individual evaluation. In this article, let’s take a look at what treatments are available and what issues should be paid attention to during treatment.

The treatment dilemma of senile depression

Unlike general adult depression, late-life depression (LLD) has a poor response to drug therapy and non-drug therapy, is prone to co-morbid physical diseases, and also affects each other. (Extended reading: “[Melancholic Brain]What is geriatric depression?》)

Clinically, when using drugs to treat senile depression, considering the burden of liver and kidney function, drug side effects, risk of falling, and impact on cognitive function, it is often necessary to slowly increase the drug from low doses to ensure safety. Even if the treatment is in the right direction and the drug is effective, the response to the treatment of senile depression is slow. Patients often doubt whether the drug treatment is effective, and patients and their families often lack the tolerance to stop continuing treatment.

Different treatment methods and therapeutic effects of senile depression

Basically, we can divide the treatment of geriatric depression into five types: drug therapy, psychotherapy, life and behavior therapy, diet and nutrition, and non-invasive brain stimulation therapy.

Pharmacological treatment of senile depression

Drug treatment is based on selective serotonin recovery inhibitors (SSRIs) and serotonin norepinephrine recovery inhibitors (SNRIs), and SARS antidepressants are second-line drugs. SSRIs and SNRIs are safe to use in older adults.

In the treatment of senile depression, antidepressant drugs should be started at low doses, so as to avoid too strong side effects, which would make patients intolerable and affect the compatibility of treatment. Complete drug treatment is at least six months after the symptoms of depression are relieved. If depression recurs or cannot be relieved, drug treatment may take longer. Stopping the medication early increases the chance of a depression relapse.

It is worth noting that nearly 1/3 of the elderly depression is drug-resistant major depression. Possible reasons include: (1) Insufficient dose of depression drugs, but the dose cannot be increased due to drug side effects; (2) There are many interactions with other drugs, and there are not many drug choices, and falls should be avoided; (3) Objective conditions such as external environment, aging, The mental state, physical health, nutritional status or disability state cannot be completely changed, improved or overcome; ④The mental state cannot be changed or treated, etc.

In addition, compared with young people, the elderly are often accompanied by many physical ailments, take multiple drugs, have many interactions with depression drugs, and have less room for drug choices. During drug treatment, the principles of fewer types of drugs, low doses, slow adjustment, and avoidance of falls or drug side effects are the principles.

Psychotherapy of senile depression

Among the psychotherapy techniques, cognitive-behavioral psychotherapy is the preferred treatment method, and other psychotherapies include psychoanalysis, supportive psychotherapy, nostalgic groups, narrative therapy, and mindfulness-based cognitive-behavioral therapy.

Psychotherapy mainly focuses on dealing with the depressed mood of elderly patients with depression and melding the meaning of life in elderly patients. If the patient has strong anger and resistance, the effect of psychotherapy will be greatly reduced. Geriatric depression is less responsive to psychotherapy than depression that develops in adolescence or adulthood.

However, in the treatment of senile depression, we cannot rely on drugs alone. The more psychological issues of senile depression patients, the worse the treatment response of drug therapy alone without psychotherapy.

Life and Behavior Therapy for Depression in the Elderly

Regular work and rest (sunshine rules), not lying in bed during the day, regular aerobic exercise, mindfulness practice and increasing social interaction (in addition to friends you met when you were young, church activities, community colleges, and neighborhood activities, you can also consider participating in the C of Long-term Care 2.0 Activities related to long-term care stations in high-level alleys) can help prevent and treat senile depression.

Regular work and rest and sunshine rules are very important. With the increase of age, the secretion of melatonin in the brain gradually declines at night, which affects the circadian rhythm. It is easy to sleep lightly and have many dreams. Even turning on the night light or operating the mobile phone may affect sleep. If there is sufficient light during the day (especially in the early morning, it is recommended to be in the sun for at least 1~2 hours), reduce the light before going to bed at night and reduce the stimulation of the light source of 3C products, which will help the mind to judge when to rest.

(To be continued)

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