Explained | What is late-life depression and how can you navigate it?

What are the biological risk factors?

Scientists have yet to identify candidate biomarkers for LLD—biological molecules in the blood, body fluids, or other tissues that are indicative of the disease process.On the other hand, research found some evidence On the genetic contribution to LLD.Scientists have advanced some hypotheses Genes encoding serotonin synthesis, norepinephrine transporters, and neurotrophic factors are involved, but these ideas require more testing. may be related With cerebrovascular lesions.

Accumulated stress throughout life leads to sustained secretion of cortisol, a hormone that regulates the body’s stress response.elevated cortisol levels lead to loss of brain cells The hippocampus, which is involved in memory and learning. (This loss of brain cells can be partially alleviated I am on antidepressants. )

researchers suggested A vascular theory based on the observation that depression is common in people who have had a stroke. Vascular suppression is associated with brain lesions, which appear as bright spots on brain scans.These spots called white matter hyperintensedisrupts brain signaling and brain circuits.

heart attack and heart disease often lead to LLDas Diabetes and hip fractureDepressive symptoms to manifest When a person does not recover optimally from physical illness.

What are the psychological risk factors?

Personality attributes may influence the origin and expression of depressive symptoms in older adults. Neuroticism – personality traits that experience negative emotions, anger, irritability, and emotional instability – consistently involved at LLD.

People with depression may overreact or misinterpret life events. Recent adverse life events (unemployment, bereavement, etc.) More frequently reported among older adults with depression than older adults without depression

Place of control refers to the degree to which an individual feels agency in their life.People with an external place of control will feel that external forces, such as random chance, environmental factors, or the actions of others, are more responsible for the events that occur in their lives. 1995 Long Term Aging Research Amsterdam We found that the emergence and persistence of depressive symptoms were predicted by having an outer trajectory of control.

What are the social risk factors?

decline in socioeconomic status Associated It accompanies depression throughout the life cycle.of Structure of social support It includes awareness, the structure of social networks, and specific help and assistance available. Perceived social support is the strongest predictor of LLD symptoms.

In my practice, I hear people saying that while the old social networks are fading, many new ones are emerging.

How is a clinical evaluation for depression done?

Clinical evaluation includes:

• Evaluate the length of the current episode,

• screening for previous depressive episodes,

• eliminate substance abuse,

• Looking at the course of past episodes, if any,

• Check response to previous interventions,

• See family history of depression and suicide

Assessing an individual’s cognitive status is important for evaluating older patients with depression. This is aided by the use of screening scales such as the Mini Mental-State Examination. No evaluation is complete without a thorough physical inspection of all other systems as well.

Doctors often order tests that include thyroid and metabolic panels, vitamin B12, folic acid and vitamin D levels, and other biochemistry tests. Doctors also often order brain scans for LLD. This is to rule out other medical conditions (such as stroke or tumor) that may be clinically indicative of depression.

Your doctor can also order an electrocardiogram before administering your medication.

How is late-life depression treated?

Professionals commonly treat geriatric depression with a four-pronged approach that includes psychotherapy, medication, brain stimulation, and family therapy.

Talkative therapies, such as cognitive behavioral therapy (CBT), identify maladaptive thought patterns and reconstruct these patterns to help depressed individuals cope and feel better.

Maladaptive cognitions such as “I am useless” or “Everything is going wrong” are subject to empirical investigation.therapist ask for evidence To support these ideas and a different way of looking at your life.

You may also be asked to keep an activity diary, set goals, or try something you fear. This often involves encouraging individuals to write down their goals and track their progress.

There are typically 6-20 CBT sessions, with each session lasting 30-60 minutes.there is some evidence It suggests that the long-term benefits of CBT may be comparable to drug therapy.

Range of safe and effective drugs is treatable Geriatric Depression Increases the effectiveness of either intervention when combined with talk therapy. A common adage in prescribing medications for the elderly is “start small and go slow.” Antidepressants are often asked to be taken for 6 to 9 months after remission of a depressive episode. Contrary to popular belief, these drugs are not addictive and patients can safely wean themselves off the drugs once the course is completed.

Neurostimulation modalities such as electroconvulsive therapy (ECT) are used to treat severe depression, suicidal ideation, and psychotic depression (characterized by delusions and hallucinations). ECT continue to be It is the most effective treatment for people with severe major depressive episodes.

Can family help?

A final component of LLD treatment is working with the family. Dysfunctional family members may contribute to depressive symptoms. Family support is essential for successful treatment of older people. Families are taught to acknowledge the individual’s distress with helpful responses such as “I heard what you were saying and I understand.”

Families are educated about the nature of depressive disorders and the potential risks of geriatric depression, especially suicide. They can assist clinicians by observing changes in an individual’s behavior, such as increased withdrawal, decreased verbal responses, and drug and weapon addiction.

Families can also help by removing potentially suicidal devices from easily accessible places. Families can also be responsible for administering medications to older adults who are nonadherent or who are at high risk of self-harm.

LLD is highly treatable. We have a responsibility to care for the elderly.

Dr. Alok Kulkarni is a Senior Geriatric Psychiatrist and Neurologist at the Manas Institute of Mental Health and Neuroscience, Hubli.