Geriatric Depression and Its Management

Introduction

Depression is a major psychological disorder. Around 280 million people around the world suffer from depression. Aging is a natural physiological process. This causes functional and physiological changes in the body and in various organs. As a result, senior people often suffer from different health-related conditions. However, psychological disorders are common among geriatric people. Even psychological disorders like depression are a major health concern for elderly people.

What Is Depression?

Depression, referred to as major depressive disorder or clinical depression, is a mental illness that can have adverse effects on emotions, cognitive processes, and daily routines. It can disrupt the physical activities, sleep schedules, and eating habits of individuals, irrespective of their age, gender, educational background, cultural heritage, or financial status.

1. Symptoms:

• Persistent feelings of sadness and emptiness.

• Continuous feelings of hopelessness and pessimism.

• Short temperament with continuous irritability.

• Persons often feel frustration, guilt, and worthlessness.

• Lack of concentration, along with diminished interest in hobbies, can be observed.

• Altered sleeping patterns like lack of sleep, oversleeping, and awakening in the morning.

• Change in food habits and appetite. Sudden weight loss and excessive weight gain can be seen.

What Is Depression in the Elderly People?

Geriatric depression is a depressive state of mind that is seen in persons older than 65 years of age. Sometimes, this is known as late-life depression. Around five percent of older individuals suffer from depression in the United States. The causative factors for geriatric depression are:

1. Biological Factors: Changes in the level of neurotransmitters are one of the main causes of depression in elderly people. The main causative neurotransmitter for depression is serotonin. In elderly people, serotonin dysregulation is caused by disruption of the cortisol (adrenal gland) pathway (the pathway that regulates the functioning of the adrenal gland) and disruption of the functioning of the pituitary gland. Apart from this, dysregulation of norepinephrine and dopamine is also associated with depression in geriatric people.

2. Genetic Factors: In certain cases, the influence of genes is responsible for the development of psychological abnormalities associated with addiction. These genes are; GABRG2 and GABRA2, COMT Val158Met, DRD2 Taq1A, and KIAA0040. On the other hand, genetic factors such as the alcohol dehydrogenase gene (ADH1B), corticotropin-releasing hormone receptor 1 (CRHR1), and aldehyde dehydrogenase gene (ALDH2) have a protective effect in developing such abnormalities. Some patients with late-onset depression have been found to possess a mutation in the enzyme MTHFR (methylene tetrahydrofuran reductase).

3. Psychological and Social Factors: Psychological well-being is the most important factor associated with depression. Elderly people often live their lives in isolation or in a lonely state. Also, previous psychological trauma, stress, and a history of post-traumatic stress disorder may cause depression.

4. Personal Factors: Personal factors like family loss, economic condition, and family-related issues may cause depression.

5. Physical Condition: The physical condition of the person often leads to depression. Elderly people persons often suffer from physical disabilities and functional problems. Apart from this, suffering due to other chronic disorders like diabetes, hypertension, and heart disease may impact mental health negatively. Ischemic changes of the brain due to stroke or degenerative changes in the white matter due to diabetes are the main causative factors for depression in the elderly.

As a result, dysfunction in various brain regions such as the frontal cortex (responsible for cognitive function and attention), ventral hippocampus (related to cognitive function and memory), nucleus accumbens (involved in responding to emotional stimuli), the hypothalamus (regulating sleep, appetite, energy, and libido), ventral tegmental area (sending dopaminergic projections), dorsal raphe nucleus (sending serotonergic inputs), and locus coeruleus (sending noradrenergic input to other regions) can be observed.

The symptoms of geriatric depression are:

1. Lack of sleep or change in sleeping patterns.

2. Lack or low interest in interaction with the outside world.

3. Difficulty in recalling people or incidents.

4. Patients often suffer from guilt.

What Are the Differences Between Young and Geriatric Depression?

Some symptomatic differences can be seen between young and geriatric patients suffering from depression.

• In geriatric patients, symptoms like sleep disturbance, fatigue, psychomotor retardation, loss of interest in living, and unhappiness are prevalent.

• Poor memory, memory loss, and lack of concentration are more prevalent in older patients.

• Older individuals may show slower cognitive response and functional dysfunction.

• Neural degeneration and brain dysfunctions are also responsible for such complications.

According to researchers, several different variations can be seen among geriatric patients. These variations are depression without sadness, depletion syndrome, and depression-executive dysfunction syndrome. All these variants are associated with impaired cognitive functions, verbal irregularities, and symptoms like lack of interest. Proper diagnosis and cognitive testing of older adults are necessary to rule out complications like dementia, Alzheimer's disease, cerebral stroke, and parkinsonism.

What Are the Treatment Options?

The treatment options can be divided into pharmacological treatment options and non-pharmacological treatment options.

In the non-pharmacological approach, procedures like cognitive behavior therapy and interpersonal therapy are used. These are the first line of treatment procedures to treat geriatric depression. Cognitive behavior therapy is an organized, instructive, and objective-focused therapeutic approach. This method is interactive and pragmatic, involving a cooperative effort between the therapist and the patient. The ultimate aim is to alter thought and behavioral patterns, positively transforming the patient's emotional state and overall lifestyle.

In the pharmacological approach, different medications are used. These are:

1. Selective Serotonin Reuptake Inhibitor (SSRI): These drugs are the first line of drugs used to treat geriatric depression. The drugs belonging to this group should be consumed for four to six weeks. However, certain drugs like Citalopram may cause cardiac complications.

2. Serotonin-norepinephrine Reuptake Inhibitors (SNRI): Drugs belonging to this category are the second line of drugs for elderly people. Drugs like Venlafaxine, Desvenlafaxine, and Duloxetine are safe for elderly people. However, according to some researchers, these drugs may cause high blood pressure.

3. Atypical Antidepressants: Drugs like Bupropion and Mirtazapine belong to this category. These drugs provide relief from additional symptoms like lack of sleep, eating disorders, and restlessness.

Conclusion

Geriatric depression is a major mental depression among elderly people. Different conditions like biological factors, genetic disorders, and psychological factors are responsible for this condition. Cognitive behavioral therapy and different medications are used for treating such conditions.