Diagnosis And Treatment Of Depression In The Elderly

.. nitive therapy on elderly depressed patients. In addition to the success, “the US National Institute of Health consensus conference highlighted the need for continued development in this area (January 1997).” The types of psychological treatments used on the elderly are specifically designed for aged persons. The central idea in cognitive therapy is to take the negative self-opinion and teach ways to reverse this opinion. Validation and reminiscence are examples of techniques used to get the patient to reflect on the accomplishments of his or her lifetime. Hopefully, this will bring back some pleasant memories of family or other accomplishments.

It also allows the patient to look at the impact he or she has made in the lives of others and provides feelings of usefulness. These memories and feelings aid in the individual viewing himself as he once did, with a positive outlook. People often develop negative opinions, called cognitive distortions based on difficulties adapting to change. Normal changes in physical ability, memory, living arrangements, etc. that occur naturally with time can cause an individual to view his life as worthless. The tendency to blame oneself becomes popular because the person likely has an unrealistic view of the aging process.

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Thus, the goal of cognitive therapy becomes equipping the patient with the ability to alter their internal biased view of life events (January 1997). Medication, specifically antidepressants are among the other treatment options for depression in the elderly. Antidepressants are drugs the patient takes to improve his or her overall mood. These pills must be taken regularly and require several weeks of ingestion before any results will be noticeable. According to Dr. Sunderland, “every primary care physician should have at least two or three medicines they feel comfortable using (April 1997).” To feel comfortable using a medicine, one must be informed about side effects, how to begin dosing, when to switch dosage, and what to look for in blood tests. Many senior citizens take prescriptions regularly for various ailments.

Due to the fact that many senior citizens take multiple prescriptions daily, the physician must also be familiar with how the various drugs interact with prescriptions the patient is currently taking (April 1997). The most commonly used and most successful antidepressants are tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRI’s). Tricyclic antidepressants include nortriptyline and desipramine and are frequently used for depressed patients with insomnia. Their side effects include hypotension and constipation, which may be too much for the patient to bear. SSRIs include fluoxetine (Prozac) and paroxetine (Paxil) and are generally classified as safer, with fewer side effects.

The known side effects are insomnia, nausea, and mild headache, which may be more bearable to the individual (April 1996). MAO inhibitors are another type of antidepressant, but not prescribed as frequently due to the alterations a patient must make to his or her diet (August 1995). Electroconvulsive therapy (ECT) is the treatment for depression used when results are needed immediately and is nearly 80% effective. Only 25% of depressed patients receive this treatment, but it has proved effective when it has been utilized. ECT sends electric pulses (shock waves) into the brain, which enhance the patients mood as an antidepressant would. Patients with suicidal tendencies or severe weight problems would be justifiable in using ECT.

ECT is a great solution to short term depression because the patient feels better quickly and avoids having to take expensive drugs for an extended period of time. Recent technological advancements allow for treatment of just one side of the brain if so desired whereas in the past it was the entire brain or not at all (April 1997). Most experts will agree that the most effective way to treat depression is a combination of any or all methods. Each treatment has merits by itself, but those multiply when combined. The most popular combination of treatments includes using antidepressants in conjunction with regularly scheduled visits to a professional. This allows for the drugs to aid in improving the mood between visits, while the visits teach the person how to cope with any cognitive distortions that may arise.

The biggest challenge when treating depression is convincing the patient to stick with any type of therapy. Patients become stubborn and quit taking their medication or visiting the doctor as soon as they begin to feel better. This is a huge mistake because it will only cause the individual to fall back into the old patterns and problems. Depression is one of those conditions that can return if proper preventative measures are not taken. Patients need to understand that depression can return at any time and certain precautions must be taken.

The individual needs to continue drug treatments in conjunction with doctor visits to have the highest rate of recovery. A study done by Dr. Reynolds showed that 3 years after being treated for depression, patients who used drug treatments and continued regular visits to the doctor only had a 20% relapse rate. Those who did not continue their medication or doctor visits had a 90% rate of relapse. Dr.

Reynolds states, “Our results demonstrate the importance of adding just one counseling secession a month to a medication regimen (March 1999).” It is important to treat depression as early as possible because once the patient passes the age of 70 it becomes difficult for any long-term results. Depression is no different from most other medical problems in that the earlier the problem is detected the better the chances of a successful recovery. Elderly individuals have many potential reasons to be depressed ranging from societys perception of them to their own self-opinion. The health of a person also begins to decline as they age which reinforces the depressed state of mind. The elderly deserve our respect and support through their physical and emotional difficulties because we would not be around if not for them.

The diagnosis and treatment of depression in the elderly may not be a simple task, but it is one that deserves more attention and further advancement. Diagnosing & Treating Depression in the Elderly Adult Psychology Bibliography Works Cited Ahmed, Iqbal & Junji Takeshita. “Late-life Depression.” Generations. Winter 1996. V20n4. P17-22.

Barrett-Connor, Elizabeth & Lawrence A. Palinkas. “Low Blood Pressure and Depression in Older Men: A Population Based Study. British Medical Journal. February 12, 1994. V308n6926. P446-450.

Butler, Cohen, et al. “Late-life Depression: Treatment Strategies for Primary Care Practice.” Geriatrics. April 1997. V52. P51-57. Butler, Robert N.

& Myrna Lewis. “Late Life Depression: When and How to Intervene. Geriatrics. August 1995. V50. P44-51.

Friedrich, M. J. “Recognizing and Treating Depression in the Elderly.” Journal of the American Medical Association. October 6, 1999. V282i13. P1215. Jackson, Rupert & Bob Baldwin.

“Detecting Depression in Elderly Mentally Ill Patients: The Use of Geriatric Depression Scale Compared with Medical and Nursing Observations. Age and Aging. September 1993. V22n5. P349-354. “Management of Anxiety and Depression in Elderly Persons. American Family Physician.

April 1996. V53n5. P1861-1863. Pinkowish, Mary Desmond. “Keeping Older Patients Depression Free.” Patient Care. March 30, 1999. V3.

P19. Robinson, Gail K. et al. “Managed Care Policy: Meeting the Mental Health Needs of the Aged?” Generations. Summer 1998. V22n2. P58-63.

Wilkinson, Phillip. “Cognitive Therapy With Elderly People. Age and Aging. January 1997. V26n1. P53-59.


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