Late onset depression: A recent update
Byline: Ananya. Mahapatra, Pawan. Sharma, Sudhir. Khandelwal
Late onset depression has recently emerged as a serious mental health issue in the geriatric population with significant public health implications. It is often challenging to diagnose and treat this entity. Various theories have been postulated to elucidate the etiology of late onset depression, but a unifying hypothesis is lacking. Although the vascular hypothesis is most researched; a complex interaction of multiple vulnerability factors is the current focus of attention. Numerous psychosocial variables have been implicated to play a significant role in predicting the onset and severity of late-life depression. Phenomenological differences have been delineated from depression occurring at a younger age, but the findings are equivocal. A better understanding of the natural trajectory of depression in the elderly is required for early diagnosis and effective treatment. This review attempts to summarize the current status of evidence regarding epidemiology, etiology, clinical features, and treatment options available for late-onset depression.
Late-onset depression constitutes a complex terrain, both in terms of diagnosis, as well as management. Elderly patients are not only physically frail; they often suffer from multiple medical comorbidities, which makes the diagnosis of depression difficult and at the same time pose challenges in its management. Because of this, depression in them remains at risk of being under-recognized and undertreated. Patients in this age group often have limited access to health services and meager social support, further complicating the picture. Evidence accumulated from recent research seems to suggest that depression in the elderly follows a more adverse course than in younger patients. There is no consensus regarding the age that distinguishes between the late- and early-onset depressions. Late-onset depression generally refers to depressive syndromes defined in the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV) and in the International Classification of Diseases (ICD-10) that arise in adults older than age 65 years. [sup]
The point prevalence estimates for major depressive disorders (MDD) in elderly in the community have been reported to be 4.4% in women and 2.7% in men in the cache county study. [sup] The prevalence of either a major depressive episode or dysthymia in the epidemiologic catchment area survey was 2.5% in the geriatric age group. [sup] Although depression is common and clinically significant in late life, estimating its prevalence is usually challenging. The variability in the definition of late-life depression, as well as the measurement of depression, makes it difficult to estimate its prevalence. [sup] A review of the prevalence of depression in adults aged 65 years or older found a range from 0.9% to 42.0%, with clinically relevant depressive symptom cases in similar settings varying between 7.2% and 49.0%. [sup] An extensive body of literature is available regarding the prevalence of old age depression, in spite of the methodological issues. However, same cannot be said about its incidence. Incidence studies are more relevant in terms of service planning, and to identify, as well as quantify the causal relationship, between risk factors and disease onset. A systematic review of...
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