The geriatric psychiatry believes that there is a specific age depression is not. All types of depressive syndromes occur in old age . Hence it is better to speak of depression in old age. In old age, the depressive symptoms are often not in the foreground, but are often overlaid by physical complaints. Also, depressive symptoms in old age are often mistakenly viewed as a normal feature of arduous living conditions.
The causes of age depression are made up of genetic, biological and psychosocial factors. The genetic predisposition of a person is always individual and can make him more susceptible to depression in some circumstances. Biological factors (e.g. multimorbidity ) also play an important role, as one automatically becomes more frail in later life. Under the aspect of psychosocial factors z. B the loss of role that can occur when you can no longer pursue your job and retire. An additional psychosocial factor would be that in old age it can happen that you lose family, friends or your spouse.
One speaks of an episode of major depression if at least 5 of the following symptoms persist for at least 2 weeks and 1 of them is a “depressed mood” (1) or “significantly reduced interest” (2).
- Depressive mood
- Significantly reduced interest
- Significant loss of weight and appetite
- Insomnia / increased sleep
- Psychomotor restlessness / slowing down
- Fatigue / loss of energy
- Feelings of worthlessness / guilt
- Concentration and decision-making problems
- Death, thoughts or actions
In the case of age-related depression, in contrast to normal depression, physical complaints, delusional thoughts, bizarre behavior and dementia symptoms are in the foreground.
- Loss of appetite , severe weight loss
- Insomnia , difficulty sleeping through the night
- Pain in the head and back
- Anxiety and heart trouble
- Other physical complaints (including pressure in the head, tinnitus , shallow breathing)
- Drive malfunctions
- Loss of interest
- Feeling of futility
- Feelings of guilt
- Pessimistic thoughts, self-blame
- Attention and concentration disorder
The effectiveness of psychotherapy depends on:
- Correct and appropriate method
- Trustful therapeutic relationship
- Motivation and cooperation of the patient
Psychotherapy is therefore only useful for mild and moderate depression. However, the positive effects of psychotherapeutic approaches are not reduced by age and older people often have a higher compliance , drop out of therapy less often and often have a more positive response than younger people. The psychotherapeutic methods include cognitive behavioral therapy , deep psychological therapy and psychoanalysis.
In the case of drug treatment, it should be noted that there is a higher risk of side effects due to age and the use of internal medication and therefore specialist supervision is all the more important.
Tricyclic and Tetracyclic Antidepressants (TCAs)
Tricyclic and tetracyclic antidepressants inhibit the reuptake of serotonin and norepinephrine to varying degrees . TCAs also inhibit a number of different receptors for other messenger substances , which can result in side effects. In older people, for example, blocking acetylcholine can lead to temporary states of confusion
Selective serotonin reuptake inhibitors
Selective serotonin reuptake inhibitors only influence the action of the messenger substance serotonin and, because of this selectivity, are better tolerated by many patients. There is less risk of symptoms of poisoning.
Differentiation between old age depression and dementia
Many depressed older people have symptoms that look like dementia syndrome. Diagnostic work-up indicates that cognitive disorders are symptoms of depression, not dementia. In addition, it should be taken into account that depressed people sometimes also have cognitive disorders and that 30% of dementia sufferers from depressive symptoms.
|Beginning||Mostly creeping, unclear||Quickly recognizable after 2 weeks|
|Duration||More than 6 months||Less than 6 months|
|Doctor visit||In company||Alone|
|Deficits||Patient tries to hide deficits||Patient reveals deficits|
There is no definite prevention against depression in old age. It is important to actively participate in life in order to maintain self-esteem. For this, you should regularly train your psychomotor skills and memory. Furthermore, you should have a structured everyday life. This includes the fixed planning of activities, meals and even regular waking and sleeping times. As depression of old age is often associated with physical complaints, the health of older people should be examined regularly.
- Gerd Laux: Depression of old age. Recognize and treat . Ed .: Walter E. Müller. LinguaMed-Verlags-GmbH, Neu-Isenburg 1999, ISBN 3-928610-28-7 .
- G. Nikelewski: Depression in: Gerontology . Ed .: Wolf D. Oswald. Kohlhammer, Stuttgart 2006.
- Schneider, F. & Nesseler T .: Depression in old age: The misunderstood widespread disease . Herbig, Munich 2011, ISBN 978-3-7766-2662-9 .
- American Psychiatric Association: Diagnostic and statistical manual of mental disorders (4th ed., Text rev.) . Washington, DC. 2000.
- George S. Alexopoulos, Patrick J. Raue, Dora Kanellopoulos, Scott Mackin, Patricia A. Arean: Problem solving therapy for the depression-executive dysfunction syndrome of late life . In: International Journal of Geriatric Psychiatry . tape 23 , no. 8 , August 2008, ISSN 0885-6230 , p. 782-788 , doi : 10.1002 / gps.1988 , PMID 18213605 .
- Niescken, Svenja .: Overcoming depression - rediscovering the joy of life: How to recognize depression early, use the wealth of therapies sensibly, effectively prevent a relapse . TRIAS, 2004, ISBN 978-3-8304-3127-5 .
- Möller, Hans-Jürgen,: Psychiatry and psychotherapy: with 712 tables . Springer, 2005, ISBN 3-540-25074-3 .
- Depression of old age: prevention - www.neurologen-und-psychiater-im-netz.org. Retrieved June 7, 2017 .