Understanding Late-Life Depression: Causes, Prevalence, and Diagnosis

Late-life depression is a prevalent condition among older adults, with factors such as personal history, medical comorbidities, and lack of social support contributing to its onset. This article discusses mood disorders, prevalence rates, risk factors, and differential diagnosis for depressed mood in the elderly. Screening tools like the Geriatric Depression Scale and Mood Disorder Questionnaire are highlighted for assessment. Treatment options and the importance of early detection are also explored.

• Late-Life Depression
• Mood Disorders
• Geriatric Depression
• Differential Diagnosis
• Screening Tools

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1. Late-Life Depression Andrew Baumgartner, MD Assistant Professor Department Of Psychiatry University of Nebraska Medical Center

2. Objectives Review mood and mood disorders Identify causes and contributors to late-life depression Discuss treatment options for late-life depression

3. Mood A sustained and pervasive emotional state, a kind of feeling Dysphoria = low or uncomfortable mood Euthymia = normal mood euphoria = elevated mood

4. Mood Disorder Prolonged or episodic abnormal mood Example from DSM 5 - Major Depressive Episode Two weeks or more with depressed mood and/or anhedonia plus at least 3-4 of the following Sleep changes Negative feelings Low energy Concentration difficulties Appetite changes Psychomotor changes Thoughts of death or suicide

5. Prevalence Of Late-Life Depression Any depressive symptoms/subsyndromal depression 11% 12-month prevalence of Major Depressive Disorder (MDD) 3-4.5% Increases with illness burden Primary care 5-10% Acute hospital 11.5% Nursing homes 14.4%

6. Risk Factors For Late-Life Depression History of previous depressive/mood episodes Family history of mood disorders Substance use Medical comorbidities Acute Subacute Chronic Female Socioeconomic status Lack of social supports

7. Differential Diagnosis For Depressed Mood Mood disorders MDD Bipolar disorder, current mood depressed or mixed Anxiety disorders Posttraumatic Stress Disorder Substance/Medication induced Cognitive changes Medical conditions Psychosocial factors Personality factors Transitions Life stage Interpersonal

8. Screening Geriatric Depression Scale Preferred for older adults with cog changes due to yes/no Short and long PHQ (2 or 9) Free, quick, not designed for older adults, but good enough and more sensitive for DSM MDD Mood Disorder Questionnaire (MDQ) Good specificity but low sensitivity for bipolar 1 If suggestive of bipolar... Widely available online

9. Treatments Psychotherapy Medications Interventional

10. Psychotherapy Cognitive Behavioral Therapy Goal setting Behavioral activation Cognitive reframing Others Interpersonal Brief psychodynamic Acceptance and commitment Life review/reminiscence

11. Medications SSRIs Sertraline Citalopram Escitalopram SNRIs Venlafaxine Duloxetine Mirtazapine Bupropion

12. Other Interventions Electroconvulsive Therapy Psychotic depression Catatonia Transcranial Magnetic Stimulation Esketamine

13. Discussion and Questions?