Late-Life Depression

by Roose, Steven P.; Sackeim, Harold A.

• ISBN13: 9780195152746
• ISBN10: 0195152743
• Format: Hardcover
• Copyright: 2004-07-15
• Publisher: Oxford University Press

Summary

We live in an aging world. Illnesses that are prevalent and cause significant morbidity and mortality in older people will consume an increasing share of health care resources. One such illness is depression. This illness has a particularly devastating impact in the elderly because it is oftenundiagnosed or inadequately treated. Depression not only has a profound impact on quality of life but it is associated with an increased risk of mortality from suicide and vascular disease. In fact for every medical illness studied, e.g. heart disease, diabetes, cancer, individuals who are depressedhave a worse prognosis. Research has illuminated the physiological and behavioral effects of depression that accounts for these poor outcomes. The deleterious relationship between depression and other illnesses has changed the concept of late-life depression from a "psychiatric disorder" that isdiagnosed and treated by a psychiatrist to a common and serious disorder that is the responsibility of all physicians who care for patients over the age of 60. This is the first volume devoted to the epidemiology, phenomenology, psychobiology, treatment and consequences of late-life depression. Although much has been written about depressive disorders, the focus has been primarily on the illness as experienced in younger adults. The effects of aging onthe brain, the physiological and behavioral consequences of recurrent depression, and the impact of other diseases common in the elderly, make late-life depression a distinct entity. There is a compelling need for a separate research program, specialized treatments, and a book dedicated to thisdisorder. This book will be invaluable to psychiatrists, gerontologists, clinical psychologists, social workers, students, trainees, and others who care for individuals over the age of sixty.

Table of Contents

Contributors	xvii
Introduction	xxi
PART I EPIDEMIOLOGY AND THE BURDEN OF ILLNESS
The Epidemiology of Depressive Disorders in Late Life	3	(9)
Dan G. Blazer
Case Identification	3	(1)
Prevalence, Incidence, and Distribution	4	(3)
Prognosis	7	(1)
Historical Trends	8	(1)
Use of Psychiatric Services	8	(4)
The Social and Financial Burden of Late-Life Depression to Society and Individuals	12	(9)
Barry D. Lebowitz
Jason T. Olin
Mortality	13	(1)
Co-Morbidity and Disability	13	(1)
Health-Care Service and Resource Use	13	(1)
Suicide and Late-Life Depression	14	(7)
PART II THE PHENOMENOLOGY AND DIFFERENTIAL DIAGNOSIS OF LATE-LIFE MOOD DISORDERS
Unipolar Depression	21	(13)
George S. Alexopoulos
William Apfeldorf
Diagnosing Late-Life Depression	21	(2)
Other Syndromes of Late-Life Depression	23	(1)
Assessment	24	(2)
Course and Consequences of Late-Life Depression	26	(1)
Medical Co-Morbidity	27	(1)
Cognitive Impairment Disorders	27	(1)
Disability	28	(1)
Suicide	29	(1)
Barriers to Effective Recognition and Treatment of Geriatric Unipolar Depression	29	(5)
Bipolar Disorders	34	(15)
Robert C. Young
Historical Perspective	34	(1)
Diagnosis	34	(1)
Differential Diagnosis of Mania in Late Life	35	(1)
Epidemiology	35	(1)
Pathophysiology and Etiology	36	(2)
Features of Episodes: Psychopathology and Its Assessment	38	(1)
Cognitive Impairment	39	(1)
Function/Behavioral Disability	40	(1)
Course of Illness: Chronicity	40	(1)
Course of Illness: Relapse and Recurrence	41	(1)
Course of Illness: Suicide	41	(1)
Course of Illness: Psychiatric Services Use and Caregiver Burden	41	(1)
Modification of the Course by Other Age-Associated Factors	41	(1)
Nonaffective Outcomes	42	(1)
Response to Antimanic Treatment	43	(1)
Response to Antidepressant Treatment in Bipolar Depression	44	(1)
Relapse and Recurrence in Maintenance Treatment	44	(5)
Dysthymic Disorder in the Elderly	49	(15)
D.P. Devanand
Prevalence	49	(1)
Diagnosis	50	(1)
Age-at-Onset	51	(1)
Co-Morbidity	52	(1)
Family History	52	(1)
Social Adjustment, Quality of Life, and Disability	53	(1)
Prognosis	53	(1)
Dysthymic Disorder in Primary Care	54	(1)
Rating Scales	54	(1)
Neurobiology	55	(2)
Treatment	57	(1)
Long-Term Response and Relapse	58	(1)
Antipsychotic Medications	58	(1)
Psychotherapy	58	(6)
Nonmajor Clinically Significant Depression in the Elderly	64	(17)
Anand Kumar
Helen Lavretsky
Virginia Elderkin-Thompson
Nosological and Diagnostic Complexities	64	(1)
Historical Perspective	64	(1)
Stability of Syndromes and Psychiatric Diagnoses	65	(1)
Differential Diagnosis: Minor Depression	66	(1)
Differential Diagnosis: Subsyndromal Depressive Spectrum	67	(1)
Differential Diagnosis: Other Diagnostic Categories	67	(1)
Does Geriatric Nonmajor Clinically Significant Depression Differ from Depression in Younger Adults?	67	(1)
Epidemiology and Clinical Features	68	(2)
Genetics	70	(1)
Neuroimaging, and Neuropsychological and Polysomnographic Studies	70	(5)
Treatment	75	(6)
Mixed Cognitive and Depressive Syndromes	81	(14)
Helen Lavretsky
Gary W. Small
Depression in Dementia	82	(1)
Putative Common Neurobiological Mechanisms of Dementia and Depression	82	(1)
Cerebrovascular Disease and Depression in Dementia	83	(1)
Cognition in Late-Life Depression	84	(1)
Is ``Pseudodementia'' Real?	84	(1)
Neuropsychological Studies of Cognition in Late-Life Depression	85	(1)
Cognitive Impairment Associated with Subclinical Cerebrovascular Disease in Late-Life Depression	86	(1)
Other Markers of Cognitive Impairment and Decline in Geriatric Depression: Neuropsychological Measures	86	(1)
Other Markers: Structural Neuroimaging	86	(1)
Other Markers: Functional Neuroimaging	87	(1)
Other Markers: Genetic Markers	87	(1)
Other Markers: Stress Hormones and Other Peripheral Biochemical Markers	88	(1)
Course and Outcome of Depression with Cognitive Impairment	88	(1)
Effects of Antidepressant Treatment on Cognitive Functions	89	(1)
Diagnosis and Differential Diagnosis	89	(6)
Suicide	95	(12)
Yeates Conwell
Methodological Issues	95	(1)
Prevalence of Suicidal Behaviors in Late Life	95	(2)
Neurobiology of Late-Life Suicide	97	(1)
Mental Health	98	(1)
Physical Health and Function	99	(1)
Social Factors	100	(1)
Access to Lethal Means	100	(1)
Summary of Risk	101	(1)
Approaches to Prevention	101	(1)
Universal Prevention	101	(1)
Selective Prevention	101	(1)
Indicated Prevention	102	(5)
Bereavement and Depression	107	(10)
Paula J. Clayton
Stages	107	(1)
Psychological and Somatic Depressive Symptoms and Course of Bereavement	107	(2)
Physical Symptoms, Substance Use, and Medical Treatment	109	(1)
Mortality	110	(1)
Psychiatric Disorders---Depression, Anxiety, and Mania	111	(1)
Complicated or Traumatic Bereavement	111	(1)
Predictors of Pathological Outcomes	112	(1)
Treatment	112	(5)
PART III THE PSYCHOBIOLOGY OF LATE-LIFE DEPRESSION
Neuropsychological Assessment of Late-Life Depression	117	(12)
Wilfred G. Van Gorp
James C. Root
Harold A. Sackeim
The Effect of Age on Neuropsychological Functioning: Age-Appropriate Cognitive Decline	117	(2)
Profile of Depression-Associated Cognitive Decline	119	(1)
Attention	119	(1)
Verbal Processing	120	(1)
Visuospatial Processing	120	(1)
Memory	121	(1)
Processing Speed	122	(1)
Executive Functioning	122	(1)
The Interaction of Age and Depression on Neuropsychological Functioning	123	(1)
The Interaction of Age-at-Onset and Depressive Cognitive Decline	124	(1)
Neuropsychological Assessment of Late-Life Depression	125	(4)
Structural and Functional Brain Imaging in Late-Life Depression	129	(19)
Harold A. Sackeim
Brain Structural Abnormalities: Magnetic Resonance Imaging Hyperintensities	129	(2)
Clinical Correlates	131	(2)
Etiology of Encephalomalacia	133	(3)
Longitudinal Perspective	136	(1)
Volumetric Brain Structural Abnormalities: Ventricular Enlargement and Sulcal Prominence	136	(3)
Brain Structural Morphometry	139	(1)
Functional Brain Abnormalities	139	(2)
Treatment and Recovery Effects in Late-Life Depression	141	(7)
Late-Life Depression and the Vascular Hypothesis	148	(9)
K. Ranga R. Krishnan
Development of Concepts Relating Brain Structural Change and Depression	148	(1)
Risk Factors for Hyperintensities	148	(1)
Lesion Location and Geriatric Depression	149	(1)
Depression Outcomes of Patients with Vascular Brain Changes	150	(1)
Lesions and Electroconvulsive Therapy Outcome	150	(1)
Executive Dysfunction and Vascular Depression	151	(1)
Cognitive Outcomes of Geriatric Depression	151	(1)
Cognitive Outcomes of Vascular Depression	151	(1)
Apolipoprotein E and Cognition	151	(1)
Morbidity and Mortality Outcomes of Vascular Depression	152	(1)
Leukoaraiosis and Lacunar Stroke: Apparently Different Outcomes	152	(1)
Conceptual Framework	152	(1)
Hippocampus and Geriatric Depression	153	(4)
Hypothalamic-Pituitary-Adrenal Axis Activity in Mood and Cognition in the Elderly: Implications for Symptoms and Outcomes	157	(10)
Jennifer Keller
Theresa M. Buckley
Alan F. Schatzberg
Regulation and Function of the Hypothalamic-Pituitary-Adrenal Axis	157	(1)
Hypothalamic-Pituitary-Adrenal Axis and Depression	158	(1)
Geriatric Depression, Cognition, and Hypothalamic-Pituitary-Adrenal Activity	159	(1)
Aging and Hypothalamic-Pituitary-Adrenal Activity	159	(1)
Depression, Dementia, and Hypothalamic-Pituitary-Adrenal Activity	160	(1)
Brain Structures in Cognition and Depression	160	(1)
Frontal Lobe	161	(1)
Limbic and Fronto-Striatal Connections	161	(1)
Hippocampus and Amygdala	161	(1)
Depression, Againg, and Mortality	162	(5)
The Neuroendocrinology of Aging	167	(18)
Stuart N. Seidman
Hormones and Neuropsychiatry	167	(1)
Central Nervous System Mechanisms of Hormonal Action	167	(1)
Age-Related Changes in Hormone Axes	168	(1)
Carbohydrate Metabolism	168	(1)
Parathyroid	168	(1)
Hypothalamic-Pituitary-Thyroid Axis	168	(1)
Hypothalamic-Pituitary-Adrenal Axis	169	(1)
Dehydroepiandrosterone	169	(1)
Growth Hormone	170	(1)
Prolactin	170	(1)
Female Hypothalamic-Pituitary-Gonadal Axis	171	(1)
Male Hypothalamic-Pituitary-Gonadal Axis	171	(1)
Depression and Neuroendocrine Dysregulation in the Elderly	172	(1)
Hormonal Axis Dysregulation and Late-Life Depression	173	(1)
Hypothalamic-Pituitary-Adrenal Axis, Depression, and Age	173	(1)
Dehydroepiandrosterone, Depression, and Age	174	(1)
Hypothalamic-Pituitary-Thyroid Axis, Depression, and Age	175	(1)
Hypothalamic-Pituitary-Gonadal Axis, Depression, and Age	175	(1)
Testosterone and Male Neuropsychiatric Functioning	175	(2)
Male Depressive Illness, Hypothalamic-Pituitary-Gonadal Axis Functioning, and Age	177	(8)
PART IV TREATMENT
Pharmacokinetics and Pharmacodynamics in Late Life	185	(7)
Bruce G. Pollock
Age-Associated Physiological Changes	186	(1)
Pharmacokinetics	187	(2)
Pharmacodynamics	189	(3)
Antidepressant Medication for the Treatment of Late-Life Depression	192	(11)
Steven P. Roose
Harold A. Sackeim
Moderators and Mediators of the Antidepressant Response	192	(3)
Antidepressant Medications	195	(1)
Tricyclic Antidepressants	195	(1)
Selective Serotonin Reuptake Inhibitors	196	(1)
Fluoxetine	196	(1)
Sertraline	196	(1)
Paroxetine	197	(1)
Citalopram	197	(1)
Selective Serotonin Reuptake Inhibitor Side Effect Profile in Geriatric Patients	197	(1)
Other Antidepressants	197	(1)
Placebo versus Comparator Controlled Trials	198	(5)
Antidepressant Side Effects	203	(8)
Carl Salzman
The Increased Likelihood of an Elderly Person Developing Side Effects	203	(1)
Receptor Mechanisms of Antidepressant Side Effects in the Elderly	204	(2)
Cardiovascular Side Effects	206	(1)
Vascular Side Effects	207	(1)
Falls	207	(1)
Inappropriate Antidiuretic Hormone Secretion	207	(1)
Weight Alterations	208	(1)
Medication Noncompliance as a Risk for Antidepressant Adverse Events	208	(3)
Mood Stabilizers	211	(11)
Charles L. Bowden
The Prevention of Depression in Elderly Bipolar Patients	212	(1)
Difficulties in Conducting Studies of Mood Stabilizers in Elderly Patients	212	(1)
Evidence of Spectrum of Efficacy, Tolerability, and Dosing	213	(1)
Effects of Other Disorders on Lithium Efficacy and Tolerability	214	(1)
Effects of Lithium on Organ Systems	214	(1)
Valproate Use in Elderly Patients	215	(7)
Stimulants	222	(10)
J. Craig Nelson
History	222	(1)
Pharmacology	222	(1)
Mechanism of Action	222	(2)
Evidence for the Efficacy of Stimulants in Depression	224	(2)
Stimulants for Augmentation	226	(1)
Dextroamphetamine versus Methylphenidate	227	(1)
Development of Tolerance during Depression Treatment	227	(1)
Abuse Potential	227	(1)
Side Effects	228	(4)
Antipsychotics	232	(9)
Christian R. Dolder
Jonathan P. Lacro
Dilip V. Jeste
Principles of Antipsychotic Use	232	(1)
Antipsychotics in Depressive Disorders	233	(2)
Antipsychotic Treatment Issues in the Elderly	235	(6)
Electroconvulsive Therapy in Late-Life Depression	241	(38)
Harold A. Sackeim
Use and Indications	241	(2)
When to Consider Electroconvulsive Therapy	243	(1)
Efficacy	244	(10)
Medical Complications and Relative Contraindications	254	(3)
Cognitive Side Effects	257	(22)
Pharmacological Treatment of Depression in Alzheimer's Disease	279	(8)
John L. Beyer
P. Murali Doraiswamy
Tricyclic Antidepressants	279	(4)
Selective Serotonin Reuptake Inhibitors	283	(1)
Monoamine Oxidase Inhibitors	284	(1)
Newer Antidepressant Agents	284	(1)
Electroconvulsive Therapy	285	(1)
Guidelines for Treatment	285	(2)
Psychotherapy in Old-Age Depression: Progress and Challenges	287	(12)
Charles F. Reynolds III
Patricia A. Arean
Thomas R. Lynch
Ellen Frank
Rationale for Psychosocial Interventions and for Psychotherapy in the Treatment of Depression in Later Life	287	(1)
Cognitive-Behavioral Therapy	288	(2)
Interpersonal Psychotherapy	290	(2)
Dialectical Behavior Therapy	292	(2)
Psychotherapeutic Management of Suicidal Older Adult Patients	294	(1)
Other Psychosocial Interventions	295	(4)
Treatment of Depression in Residential Settings	299	(12)
Ira R. Katz
Joel Streim
The Context: Nursing Homes in America	299	(1)
The Regulatory Environment	300	(1)
Clinical Psychiatry in the Nursing Home	300	(4)
Evolution in the Epidemiology of Depression and Its Treatment	304	(1)
Delivery of Clinical Care	305	(6)
PART V DEPRESSION CO-MORBID WITH OTHER ILLNESSES
Depression Co-Morbid with Ischemic Heart Disease	311	(10)
Steven P. Roose
Alexander H. Glassman
Depression in Patients with Cardiac Disease	311	(1)
Depression and Development of Coronary Artery Disease	312	(1)
The Effect of Depression on Cardiac Outcomes in Patients with Ischemic Heart Disease	312	(1)
Physiological Mechanisms Underlying the Relationship Between Vascular Disease and Depression	313	(1)
Depression and Sudden Cardiovascular Death	314	(1)
Treatment of Depression in Patients with Ischemic Heart Disease	315	(1)
The Cardiovascular Effects of Tricyclic Antidepressants	315	(1)
The Antiarrhythmic Effect of Tricyclic Antidepressants: Cardiac Risk Reconsidered	315	(1)
Tricyclic Antidepressants, Heart Rate Variability, and Cardiac Death	316	(1)
The Cardiovascular Effects of the Selective Serotonin Reuptake Inhibitors	316	(2)
Other Antidepressants	318	(1)
Psychotherapy	318	(3)
Vascular Disease and Late-Life Depression: Stroke	321	(16)
Robert G. Robinson
Historical Perspective	321	(1)
Diagnosis of Poststroke Depression	322	(2)
Prevalence of Depression	324	(1)
Duration of Depression	324	(1)
Relationship to Lesion Variables	324	(3)
Premorbid Risk Factors	327	(1)
Poststroke Depression and Activities of Daily Living	327	(2)
Poststroke Depression and Cognitive Impairment	329	(2)
Poststroke Depression and Mortality	331	(1)
Mechanism of Poststroke Depression	331	(1)
Treatment of Poststroke Depression	332	(5)
Substance Abuse Co-Morbidity	337	(11)
David W. Oslin
Defining Co-Morbidity	337	(1)
The Epidemiology of Late-Life Addictions	337	(1)
The Co-Occurrence of Late-Life Depression and Use of Addictive Substances	338	(3)
Diagnostic Considerations	341	(1)
Treatment Issues	342	(6)
Basal Ganglia Disease and Depression	348	(13)
Anjan Chatterjee
Karen Marder
Introduction to Basal Ganglia Disease	348	(1)
Anatomy and Connections of the Basal Ganglia	348	(1)
The Neuroanatomy of Depression	349	(1)
Parkinson's Disease	349	(4)
Huntington's Disease	353	(2)
Wilson's Disease	355	(1)
Parkinson-Plus Syndromes and the Tauopathies	356	(5)
Major Depressive Disorder in Alzheimer's Disease	361	(9)
George S. Zubenko
Neuropathological and Neurochemical Correlates of Major Depressive Disorder in Alzheimer's Disease	361	(3)
Mechanism(s) of Neuronal Death in Alzheimer's Disease	364	(1)
Discussion	365	(5)
Epilogue	370	(5)
Index	375