文档介绍：geriatricdepression-老年抑郁症
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Introduction of Depression(1)
Difinition of depression
Depressive disorder is characterion
Cognitive impairment
Neurological evidence of ischemic brain damage
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Features of Geriatric Depression(1)
Compared with young-adult depression, the depression in later life has special clinical features
Anxiety
Somatization
Anxiety, somatization may be the most common symptoms, sometimes it covers up the depressed mood. Some geriatric depressive patients often go to see doctors in division of digestive diseases, division of cardiology, department of neuroloy, instead of the psychiatry.
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Chronic Stress in Geriatric Depression
Declining health or have to depend on others
Sensory loss or cognitive decline
Housing problems
Major problems affecting family member
Socioeconomic decline
Marital difficulty
Retirement
Social isolation
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Neurobiological Basis of Geriatric Depression (1)
Neurotransmitter changes
Serotonin (5-HT)
Dopamine (DA)
Noradrenaline (NE)
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Neurobiological Basis of Geriatric Depression (2)
Neuroendocrine changes
Hyperactivity and dysregulation of HPA
High cortisol levels
DST (Dexamethasone suppression test)
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Neurobiological Basis of Geriatric Depression(3)
Structural brain changes
Cerebral atrophy
Deep white matter lesions
Subcortical lesions in gray matter
Damage to the subcortical-frontal circuitry
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Neurobiological Basis of Geriatric Depression(4)
Functional brain changes
PET
SPECT
RTIP
event related fMRI
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Treatment in Geriatric Depression (1)
Psychoeducation
Depression is a treatable disorder
Antidepressants are non-addictive
The importance of compliance
Not to stop treatment when recovery has occurred
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Treatment in Geriatric Depression (2)
Antidepressants
Tricyclics(TCAs): seldom used
Selective serotonin reuptake inhibitors(SSRIs)
Fluvoxamine
Fluoxetine
Paroxetine
Sertraline
Citalopram, S-citalopram
Other newer antidepressants
Trazodone
Moclobemide
Venlafaxine
Mirtazepine
Bupropion
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