Volume 2 Issue 2 February, 2012
It is a major misconception among many that depression is a normal phenomenon in the aged population. However, it is not true, as a majority of the aged population enjoy a sense of well being as all others. Late onset depression is considered a distinct clinical entity and is defined as Depression with onset in old age (>65 yrs) , without prior history of hypomania or mania or depression. The prevalence of late onset depression is 2‐5%.This is of great concern as the aged population is increasing around the globe. The numbers will increase further, as in a few years from now, India will witness a phenomenal increase in population, and become one of the most populated countries, overtaking China by 2025.
Late onset depression is more likely to manifest with certain unique features and characteristics when compared to depression in young, as they are more likely to be associated with the following features ‐ structural changes in the brain, without a family history of mood disorders, insidious in onset, more of an irritable mood than low mood, heightened & excess concern with their health, loss of weight, feelings of guilt, suicidal ideations and more likely to have psychotic symptoms. Whether they have more cognitive impairment is not certain.
Management of late onset depression is a challenge right from diagnosis to treatment. Diagnosis can be difficult when the condition is associated with physical illness or organic brain disorders like Dementia. It may be more important to sensitize physicians about identification of the conditions as most aged population are assessed by them initially. Management involves investigation, when organic causes are suspected. CT Scan may suffice in majority of suspected cases. Addressing the co morbid conditions adequately can make management of depression more meaningful and complete. Multiple medications, decreased body mass, liver & kidney status in aged can add up to challenges when Antidepressants are prescribed. Choice of antidepressants should be made keeping the side effect profile in mind. It may be fruitful to utilize the side effect profile of the antidepressant – for example, using mirtazepine in those with poor sleep. Sertraline may be a safer choice in cardiac patients. Non pharmacological intervention such as supportive therapy, cognitive behavioral therapy and interpersonal therapy are important aspects of management, and should not be neglected.
More studies on late onset depression from urban and rural India may be necessary to address this challenge in years to come.
Dr.Kasthuri Pandiyan MD
Assistant Professor of Psychiatry, Bangalore Medical College & Research center
