General medical illness can contribute to affective disorders in elderly patients. Treating the medical illness is an integral part in treating depression in these patients.
An important consideration in assessment of late-life depression is to distinguish late-onset depression, in which depressive disorder is experienced for the first time in later life, from early-onset depression, in which depression symptoms are the continuation of a depressive illness that started earlier in life. This distinction is clinically important because late-onset depression frequently develops in the context of medical morbidity, such as heart disease/stroke (vascular etiology), dementia (neurodegenerative illness), or multimorbidity and chronic inflammation.
Medical illness can contribute to affective disorders in elderly patients. Treating the medical illness is an integral part in treating depression in these patients. Examples of medical comorbidities recognized as being associated with a higher risk of depression include endocrinologic disorders such as hypothyroidism and Cushing syndrome.
Neurological disorders associated with depression should be considered in the treatment for depression. For more information, see Treatment Dilemmas in Depression and Coronary Heart Disease.
Several factors associated with cancer contribute to an increase in both biological and psychological risk, including suicidal ideation and completed suicide.
Vitamin deficiency may increase the risk of depression; moreover, this deficiency has been linked to poor antidepressant responses. Nevertheless, vitamin deficiencies are often underappreciated, and there are no clear clinical guidelines regarding screening for vitamin deficiencies in MDD.
Depression in elderly patients may not present with a straightforward textbook display of symptoms. There can be a myriad of atypical symptoms such as memory problems, physical symptoms (eg, fatigue, weight loss, pain), and behavioral symptoms (eg, social withdrawal, difficulty with self-care, refusal to eat or drink).
Stress may delay wound healing and pretreatment with an antidepressant may mitigate depression. Untreated depression can lead to a variety of negative outcomes such as functional impairment, increased risk of a neurocognitive disorder, increased morbidity and mortality, increased use of illicit substances and alcohol, more hospitalizations, and higher rates of suicide. Moreover, many depressed elderly patients will not respond to first-line pharmacological therapy and will need a switch to another agent or will need to have treatment augmentation
For more on this topic, see Management of Treatment Resistant Depression in the Elderly, on which this slideshow is based.