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Lancet (London, England)In elderly people, depression mainly affects those with chronic medical illnesses and cognitive impairment, causes suffering, family disruption, and disability, worsens... (Review)
Review
In elderly people, depression mainly affects those with chronic medical illnesses and cognitive impairment, causes suffering, family disruption, and disability, worsens the outcomes of many medical illnesses, and increases mortality. Ageing-related and disease-related processes, including arteriosclerosis and inflammatory, endocrine, and immune changes compromise the integrity of frontostriatal pathways, the amygdala, and the hippocampus, and increase vulnerability to depression. Heredity factors might also play a part. Psychosocial adversity-economic impoverishment, disability, isolation, relocation, caregiving, and bereavement-contributes to physiological changes, further increasing susceptibility to depression or triggering depression in already vulnerable elderly individuals. Treatment with antidepressants is well tolerated by elderly people and is, overall, as effective as in young adults. Evidence-based guidelines for prevention of new episodes of depression are available as are care-delivery systems that increase the likelihood of diagnosis, and improve the treatment of, late-life depression. However, in North America at least, public insurance covers these services inadequately.
Topics: Aged; Aging; Depression; Depressive Disorder; Humans
PubMed: 15936426
DOI: 10.1016/S0140-6736(05)66665-2 -
Archives of Internal Medicine Nov 2003Because depression and painful symptoms commonly occur together, we conducted a literature review to determine the prevalence of both conditions and the effects of... (Review)
Review
Because depression and painful symptoms commonly occur together, we conducted a literature review to determine the prevalence of both conditions and the effects of comorbidity on diagnosis, clinical outcomes, and treatment. The prevalences of pain in depressed cohorts and depression in pain cohorts are higher than when these conditions are individually examined. The presence of pain negatively affects the recognition and treatment of depression. When pain is moderate to severe, impairs function, and/or is refractory to treatment, it is associated with more depressive symptoms and worse depression outcomes (eg, lower quality of life, decreased work function, and increased health care utilization). Similarly, depression in patients with pain is associated with more pain complaints and greater impairment. Depression and pain share biological pathways and neurotransmitters, which has implications for the treatment of both concurrently. A model that incorporates assessment and treatment of depression and pain simultaneously is necessary for improved outcomes.
Topics: Antidepressive Agents; Chronic Disease; Comorbidity; Depression; Depressive Disorder; Humans; Pain; Prevalence; Treatment Outcome
PubMed: 14609780
DOI: 10.1001/archinte.163.20.2433 -
Annual Review of Clinical Psychology May 2022Major depression is one of the most prevalent and debilitating personal and public health conditions worldwide. Less appreciated is that depression's tremendous burdens... (Review)
Review
Major depression is one of the most prevalent and debilitating personal and public health conditions worldwide. Less appreciated is that depression's tremendous burdens are not shared equally among all who become depressed. Some will suffer recurrences over the rest of their lives, whereas half or more will never have a recurrence. Based on these two distinctive life course prototypes, we propose a subtype distinction for research on the origins and lifetime course of major depression. A pressing goal is to determine at the time of depression's first onset who will follow which clinical trajectory. The lack of recognition of this distinction has resulted in many obstacles, including conceptual biases, methodological oversights, and definitional dead ends. Current theories are reviewed and compared. The implications for contemporary diagnostic controversies, reevaluating research on treatment and prevention, and enhancing the predictive strength of traditionally weak indicators of recurrences and recurrent depression are discussed.
Topics: Depression; Depressive Disorder, Major; Humans; Life Change Events; Recurrence
PubMed: 35216520
DOI: 10.1146/annurev-clinpsy-072220-021440 -
Journal of Clinical Neuroscience :... Jan 2018Geriatric depression is a major public health problem and has an especially large effect on health when comorbid with a chronic medical condition. Hypertension, coronary... (Review)
Review
Geriatric depression is a major public health problem and has an especially large effect on health when comorbid with a chronic medical condition. Hypertension, coronary heart disease, and diabetes are accompanied by a high incidence of depression and can affect the treatment and prognosis. Depression is a highly prevalent risk factor for incident of and is associated with morbidity and mortality of cardiovascular disease. In addition to the proactive and effective control of primary diseases, efforts should also be made to improve patients' psychological and social function. Current evidence on antidepressive therapy in patients with coronary diseases is limited. A better understanding of pathophysiological mechanisms underpinning depression and cardiovascular disease as well as the complex biological crosstalk of cardiovascular disease complicated with depression is particularly important for future therapeutic strategies. The following review is on current understanding of geriatric depression and cardiovascular disease.
Topics: Aged; Aging; Cardiovascular Diseases; Comorbidity; Depression; Depressive Disorder; Humans
PubMed: 29066229
DOI: 10.1016/j.jocn.2017.09.022 -
The Journals of Gerontology. Series A,... Mar 2003Depression is perhaps the most frequent cause of emotional suffering in later life and significantly decreases quality of life in older adults. In recent years, the... (Review)
Review
Depression is perhaps the most frequent cause of emotional suffering in later life and significantly decreases quality of life in older adults. In recent years, the literature on late-life depression has exploded. Many gaps in our understanding of the outcome of late-life depression have been filled. Intriguing findings have emerged regarding the etiology of late-onset depression. The number of studies documenting the evidence base for therapy has increased dramatically. Here, I first address case definition, and then I review the current community- and clinic-based epidemiological studies. Next I address the outcome of late-life depression, including morbidity and mortality studies. Then I present the extant evidence regarding the etiology of depression in late life from a biopsychosocial perspective. Finally, I present evidence for the current therapies prescribed for depressed elders, ranging from medications to group therapy.
Topics: Aged; Depression; Depressive Disorder; Humans
PubMed: 12634292
DOI: 10.1093/gerona/58.3.m249 -
Primary Care Jun 1999Depression often presents with physical symptoms, primarily fatigue, pain, or sleep disturbance. Depressed mood may or may not be present. Supportive counseling and... (Review)
Review
Depression often presents with physical symptoms, primarily fatigue, pain, or sleep disturbance. Depressed mood may or may not be present. Supportive counseling and pharmacotherapy are more effective than either modality alone. The newer drugs are better tolerated than earlier agents, and they achieve much greater patient adherence. Depression is considered a chronic disease. The likelihood of recurrence increases with the number of episodes, often calling for prolonged maintenance of medication. Most patients with mild to moderate depression can be effectively managed by their primary care physician, with referral required only for those who are unresponsive to therapy or who are suicidal.
Topics: Antidepressive Agents; Depression; Depressive Disorder; Diagnosis, Differential; Family Practice; Humans; Primary Health Care; Psychotherapy; Referral and Consultation; Risk Factors
PubMed: 10318745
DOI: 10.1016/s0095-4543(08)70003-4 -
Current Neuropharmacology 2015
Review
Topics: Animals; Depression; Depressive Disorder; Humans; Sleep
PubMed: 26412067
DOI: 10.2174/1570159x1304150831123535 -
The New England Journal of Medicine Feb 2019A 45-year-old woman with hypothyroidism that has been treated with a stable dose of levothyroxine presents to her primary care provider with depressed mood, negative... (Review)
Review
A 45-year-old woman with hypothyroidism that has been treated with a stable dose of levothyroxine presents to her primary care provider with depressed mood, negative feelings about herself, poor sleep, low appetite, poor concentration, and lack of energy. These symptoms began several months ago during a conflict with her partner. Although she has been able to continue with work and life responsibilities, she feels sadness most days and occasionally thinks that she would be better off dead. How would you evaluate and treat this patient?
Topics: Antidepressive Agents; Combined Modality Therapy; Depression; Depressive Disorder; Depressive Disorder, Major; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Middle Aged; Practice Guidelines as Topic; Primary Health Care; Psychotherapy
PubMed: 30726688
DOI: 10.1056/NEJMcp1712493 -
Journal of Obstetric, Gynecologic, and... 2003Major depressive disorder is a common problem for adolescents. It has a wide array of symptoms affecting somatic, cognitive, affective, and social processes. Academic... (Review)
Review
Major depressive disorder is a common problem for adolescents. It has a wide array of symptoms affecting somatic, cognitive, affective, and social processes. Academic failure, poor peer relationships, behavioral problems, conflict with parents and other authority figures, and substance abuse are some of the consequences of major depressive disorder in this age group. Effective treatments include nontricyclic antidepressants and coping skills training. The nurse is key to depression detection and suicide prevention, especially in primary care settings. Through psychoeducation, nurses can promote recovery from depression by encouraging a healthy lifestyle, enhancing social skills, and assisting the adolescent to identify and use sources of social support. These measures can prevent premature death and promote long-term well-being of the adolescent.
Topics: Adolescent; Adolescent Behavior; Antidepressive Agents; Depression; Depressive Disorder; Humans; Life Style; Nurse's Role; Nurse-Patient Relations; Prevalence; Psychology, Adolescent; Quality Assurance, Health Care; Social Support; United States
PubMed: 12685676
DOI: 10.1177/0884217503252133 -
AMA Journal of Ethics Jul 2021Too many men who suffer from depression remain undiagnosed. While men are diagnosed with depression at half the rate of women, they die by suicide 3 to 4 times as...
Too many men who suffer from depression remain undiagnosed. While men are diagnosed with depression at half the rate of women, they die by suicide 3 to 4 times as frequently. Gendered processes of socialization affect how some boys and men express depression. Notably, gender disparities in diagnosis disappear when "male-typical" symptoms of depression are incorporated. Historically and to this day, masculinities have created barriers to care. Addressing disparities in depression diagnoses and treatment requires making psychological services affordable, adopting collaborative care models, revisiting sex as a risk factor for depression, and reexamining major depressive disorder's diagnostic criteria.
Topics: Anxiety; Depression; Depressive Disorder, Major; Female; Humans; Male; Suicide
PubMed: 34351273
DOI: 10.1001/amajethics.2021.586