Skip to main content Accessibility help
×
Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-10T15:15:20.902Z Has data issue: false hasContentIssue false

Chapter 27 - Considerations about the Treatment of Mood Disorders in Elderly Patients

Published online by Cambridge University Press:  16 May 2024

Allan Young
Affiliation:
Institute of Psychiatry, King's College London
Marsal Sanches
Affiliation:
Baylor College of Medicine, Texas
Jair C. Soares
Affiliation:
McGovern Medical School, The University of Texas
Mario Juruena
Affiliation:
King's College London
Get access

Summary

Among older adults, mood symptoms can present differently than in the general adult population. Their assessment, comorbidity pattern, and treatment approach are discussed here with emphasis on the special characteristics of depression as it presents in later life. While little is known about the course of manic episodes in elderly patients, they are associated with significant morbidity, high rates of mortality, and considerable use of mental health services. This chapter also focuses on the assessment, diagnosis, and treatment of geriatric bipolar disorder.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2024

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Kyomen, HH, Gottlieb, GL. Financial issues in the delivery of geriatric psychiatric care. In Sadock, BJ, Sadock, VA, Ruiz, P, editors. Comprehensive Textbook of Psychiatry IX. Philadelphia: Lippincott Williams and Wilkins, 2009; 4185–93.Google Scholar
Weissman, MM, Bruce, ML, Leaf, PJ, et al. Affective disorders. In Robins, LN, Regier, DA, editors. Psychiatric Disorders in America: The Epidemiologic Catchment Study. New York: Free Press, 1991; 5380.Google Scholar
U.S. Census Bureau. Older people projected to outnumber children for first time in U.S. history. Press release number CB18-41. March 13, 2018. Available at www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.htmlGoogle Scholar
Kotlyar, M, Dysken, M, Adson, DE. Update on drug-induced depression in the elderly. Am J Geriatr Pharmacother 2005;3(4):288300.CrossRefGoogle ScholarPubMed
Yasavage, JA, Brink, TL, Rose, TL et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1983;17: 3749.CrossRefGoogle Scholar
Montgomery, SA, Asberg, M. A new depression scale intended to be sensitive to change. Br J Psychiatry 1979;134:382–9.CrossRefGoogle Scholar
Hamilton, M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23 5662.CrossRefGoogle ScholarPubMed
Mottram, P, Wilson, K, Copeland, J. Validation of the Hamilton Depression Scale and Montgomery and Asberg rating scales in terms of AGECAT depression cases. Int J Geriatr Psychiatry 2000;15:111 319.3.0.CO;2-Y>CrossRefGoogle Scholar
Kok, RM, Nolen, WA, Heeren, TJ. Efficacy of treatment in older depressed patients: a systematic review and meta-analysis of double-blind randomized controlled trials with antidepressants. J Affect Disord 2012;141(2–3):103–15.CrossRefGoogle ScholarPubMed
Papakostas, GI, Fava, M. Does the probability of receiving placebo influence clinical trial outcome? A meta-regression of double-blind, randomized clinical trials in MDD. Eur Neuropsychopharmacol 2009;19(1):3440.CrossRefGoogle ScholarPubMed
Calati, R, Salvina Signorelli, M, Balestri, M, et al. Antidepressants in elderly: metaregression of double-blind, randomized clinical trials. J Affect Disord 2013;147(1–3):18.CrossRefGoogle ScholarPubMed
Alexopoulos, GS, Katz, IR, Reynolds, CF 3rd, et al. The expert consensus guideline series. Pharmacotherapy of depressive disorders in older patients. Postgrad Med 2001; Spec No Pharmacotherapy:1–86.Google ScholarPubMed
Canadian Coalition for Seniors’ Mental Health. National guidelines for seniors’ mental health – the assessment and treatment of depression. 2006. Available at: http://ccsmh.ca/ccsmh-nationalguidelines-for-seniors-mental-healthGoogle Scholar
Food and Drug Administration. FDA drug safety communication: revised recommendations for Celexa (citalopram hydrobromide) related to a potential risk of abnormal heart rhythms with high doses. 2012. Available at: www.fda.gov/Drugs/DrugSafety/ucm297391.htmGoogle Scholar
MacQueen, GM, Frey, BN, Ismail, Z, et al.; CANMAT Depression Work Group. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder section 6. Special populations: youth, women, and the elderly. Can J Psychiatry 2016;61(9):588603.CrossRefGoogle Scholar
Cooper, C, Katona, C, Lyketsos, K, et al. A systematic review of treatments for refractory depression in older people. Am J Psychiatry. 2011;168(7):681–8.CrossRefGoogle ScholarPubMed
Zhou, X, Ravindran, AV, Qin, B, et al. Comparative efficacy, acceptability, and tolerability of augmentation agents in treatment-resistant depression: systematic review and network meta-analysis. J Clin Psychiatry 2015;76(4):487–98.CrossRefGoogle ScholarPubMed
American Psychiatric Association. Practice Guideline for the Treatment of Patients with Major Depressive Disorder. 3rd ed. Arlington, VA: American Psychiatric Association, 2010.Google Scholar
Huang, AX, Delucchi, K, Dunn, LB, Nelson, JC. A systematic review and meta-analysis of psychotherapy for late-life depression. Am J Geriatr Psychiatry 2015 Mar;23(3):261–73.CrossRefGoogle ScholarPubMed
Kellner, CH, Husain, MM, Knapp, RG, et al. Right unilateral ultrabrief pulse ECT in geriatric depression: phase 1 of the PRIDE study. Am J Psychiatry 2016;173(11): 1101–9.Google ScholarPubMed
Spaans, HP, Sienaert, P, Bouckaert, F, et al. Speed of remission in elderly patients with depression: electroconvulsive therapy v. medication. Br J Psychiatry 2015;206(1):6771.CrossRefGoogle ScholarPubMed
Tørring, N, Sanghani, SN, Petrides, G, et al. The mortality rate of electroconvulsive therapy: a systematic review and pooled analysis. Acta Psychiatr Scand 2017;135(5):388–97.CrossRefGoogle ScholarPubMed
Kessler, RC, Berglund, P, Demler, O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62(6):593602.CrossRefGoogle ScholarPubMed
Yassa, R, Nair, V, Nastase, C, et al. Prevalence of bipolar disorder in a psychogeriatric population. J Affect Disord 1988;14(3):197201.CrossRefGoogle Scholar
Depp, CA, Lindamer, LA, Folsom, DP, et al. Differences in clinical features and mental health service use in bipolar disorder across the lifespan. Am J Geriatr Psychiatry 2005;13(4):290–8.CrossRefGoogle ScholarPubMed
Bartels, SJ, Forester, B, Miles, KM, et al. Mental health service use by elderly patients with bipolar disorder and unipolar depression. Am J Geriatr Psychiatry 2000;8:160–6.CrossRefGoogle Scholar
Evans, DL, Byerly, MJ, Greer, RA. Secondary mania: diagnosis and treatment. J Clin Psychiatry 1995;56(Suppl 3):31–7.Google ScholarPubMed
Young, RC, Mulsant, BH, Sajatovic, M, et al. GERI-BD: a randomized double-blind controlled trial of lithium and divalproex in the treatment of mania in older patients with bipolar disorder. Am J Psychiatry 2017 Nov 1;174(11):1086–93.CrossRefGoogle ScholarPubMed
Shulman, KI, Rochon, P, Sykora, K, et al. Changing prescription patterns for lithium and valproic acid in old age: shifting practice without evidence. BMJ 2003;326(7396):960–1.CrossRefGoogle ScholarPubMed
Sajatovic, M. Treatment of bipolar disorder in older adults. Int J Geriatr Psychiatry 2002;17(9):865–73.CrossRefGoogle ScholarPubMed
Bayer, JL, Siegal, A, Kennedy, JS. Olanzapine, divalproex and placebo treatment, non-head to head comparisons of older adults acute mania. 10th Congress of the International Psychogeriatric Association. Nice, France, September 9–14, 2001.Google Scholar
Sajatovic, M, Calabrese, JR, Mullen, J. Quetiapine for the treatment of bipolar mania in older adults. Bipolar Disord 2008;10(6):662–71.CrossRefGoogle ScholarPubMed
Food and Drug Administration. FDA Public Health Advisory: deaths with antipsychotics in elderly patients with behavioral disturbances. April 11, 2005. Available at https://psychrights.org/drugs/FDAatypicalswarning4elderly.pdfGoogle Scholar
Kales, HC, Valenstein, M, Kim, HM, et al. Mortality risk in patients with dementia treated with antipsychotics versus other psychiatric medications. Am J Psychiatry 2007;164:1568.CrossRefGoogle ScholarPubMed
Sajatovic, M, Gildengers, A, Al Jurdi, R, et al. Multi-Site, Open-Label, Prospective Trial of Lamotrigine for Geriatric Bipolar Depression. Hollywood, FL: American College of Neuropsychopharmacology (ACNP), 2009.Google Scholar
Cruz, N, Sanchez-Moreno, J, Torres, F, et al. Efficacy of modern antipsychotics in placebo-controlled trials in bipolar depression: a meta-analysis. Int J Neuropsychopharmacol 2010;13(1):514.CrossRefGoogle ScholarPubMed
Correll, CU, Frederickson, AM, Kane, JM, et al. Metabolic syndrome and the risk of coronary heart disease in 367 patients treated with second-generation antipsychotic drugs. J Clin Psychiatry 2006;67(4):575–83.CrossRefGoogle ScholarPubMed
Sajatovic, M. Quetiapine for the Treatment of Depressive Episodes in Adults Aged 55 to 65 Years with Bipolar Disorder. New Orleans, LA: American Association of Geriatric Psychiatry (AAGP), 2007.Google Scholar
Schaffer, A, Mamdani, M, Levitt, A, et al. Effect of antidepressant use on admissions to hospital among elderly bipolar patients. Int J Geriatr Psychiatry 2006;21(3):275–80.CrossRefGoogle ScholarPubMed
Al Jurdi, RK, Marangell, LB, Petersen, NJ, et al. Prescription patterns of psychotropic medications in elderly compared with younger participants who achieved a “recovered” status in the systematic treatment enhancement program for bipolar disorder. Am J Geriatr Psychiatry 2008;16(11):922–33.CrossRefGoogle ScholarPubMed
Calabrese, JR, Bowden, CL, Sachs, G, et al. A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently depressed patients with bipolar I disorder. J Clin Psychiatry 2003;64(9):1013–24.CrossRefGoogle ScholarPubMed
Bowden, CL, Calabrese, JR, Sachs, G, et al. A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently manic or hypomanic patients with bipolar I disorder. Arch Gen Psychiatry 2003;60(4):392400.CrossRefGoogle ScholarPubMed
Sajatovic, M, Gyulai, L, Calabrese, JR, et al. Maintenance treatment outcomes in older patients with bipolar I disorder. Am J Geriatr Psychiatry 2005;13(4):305–11.CrossRefGoogle ScholarPubMed
Lepkifker, E, Iancu, I, Horesh, N, et al. Lithium therapy for unipolar and bipolar depression among the middle-aged and older adult patient subpopulation. Depress Anxiety 2007;24(8):571–6.CrossRefGoogle ScholarPubMed
BALANCE Investigators and Collaborators, Geddes, JR, Goodwin, GM, et al. Lithium plus valproate combination therapy versus monotherapy for relapse prevention in bipolar I disorder (BALANCE): a randomised open-label trial. Lancet 2010;375(9712):385–95.Google ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×