Antidepressants for depressed elderly

Mottram, Pat; Wilson, Kenneth; Strobl, Judith

doi:10.1002/14651858.cd003491.pub2

Cited by 187 publications

(85 citation statements)

References 124 publications

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“…Pharmacological and psychological interventions have established efficacy in the treatment of depression Mottram et al, 2006), but remission of symptoms may fail to occur in as many as 50% of patients (Kirsch et al, 2008;Turner et al, 2008). In addition, existing evidence from observational studies indicates that most cases of depression in the community remain undiagnosed and that only a small proportion of those who are depressed gain access to adequate antidepressant treatment (Goldberg et al, 1998;Pfaff and Almeida, 2005).…”

Section: Introductionmentioning

confidence: 99%

A practical approach to assess depression risk and to guide risk reduction strategies in later life

Almeida

Alfonso

Pirkis

et al. 2010

Int. Psychogeriatr.

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Background:Many factors have been associated with the onset and maintenance of depressive symptoms in later life, although this knowledge is yet to be translated into significant health gains for the population. This study gathered information about common modifiable and non-modifiable risk factors for depression with the aim of developing a practical probabilistic model of depression that can be used to guide risk reduction strategies.Methods:A cross-sectional study was undertaken of 20,677 community-dwelling Australians aged 60 years or over in contact with their general practitioner during the preceding 12 months. Prevalent depression (minor or major) according to the Patient Health Questionnaire (PHQ-9) assessment was the main outcome of interest. Other measured exposures included self-reported age, gender, education, loss of mother or father before age 15 years, physical or sexual abuse before age 15 years, marital status, financial stress, social support, smoking and alcohol use, physical activity, obesity, diabetes, hypertension, and prevalent cardiovascular diseases, chronic respiratory diseases and cancer.Results:The mean age of participants was 71.7 ± 7.6 years and 57.9% were women. Depression was present in 1665 (8.0%) of our subjects. Multivariate logistic regression showed depression was independently associated with age older than 75 years, childhood adverse experiences, adverse lifestyle practices (smoking, risk alcohol use, physical inactivity), intermediate health hazards (obesity, diabetes and hypertension), comorbid medical conditions (clinical history of coronary heart disease, stroke, asthma, chronic obstructive pulmonary disease, emphysema or cancers), and social or financial strain. We stratified the exposures to build a matrix that showed that the probability of depression increased progressively with the accumulation of risk factors, from less than 3% for those with no adverse factors to more than 80% for people reporting the maximum number of risk factors.Conclusions:Our probabilistic matrix can be used to estimate depression risk and to guide the introduction of risk reduction strategies. Future studies should now aim to clarify whether interventions designed to mitigate the impact of risk factors can change the prevalence and incidence of depression in later life.

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Section: Introductionmentioning

confidence: 99%

A practical approach to assess depression risk and to guide risk reduction strategies in later life

Almeida

Alfonso

Pirkis

et al. 2010

Int. Psychogeriatr.

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“…Por ejemplo, en un estudio se asoció el consumo de antidepresivos (en personas deprimidas y no deprimidas) y las limitaciones funcionales en AM y registró un incremento en el riesgo entre quienes informaron haber consumido antidepresivos durante más de un año (HR: 1.07; IC 95%: 1,03-1,10) en comparación con quienes no consumían; así como el inicio de limitaciones funcionales entre quienes reportaron su uso, pero que no estaban deprimidos en ese momento (HR: 1,08; IC 95%: 1,03-1,13), pero no entre quienes estaban deprimidos (HR: 1.01; IC 95%:=0.99, 1.05) 48 . Por otro lado, se reconoce que no se ha llegado a resultados concluyentes con respecto a la eficacia de los antidepresivos en AM, debido a las limitaciones de los estudios evaluados y lo reportado en distintas revisiones sistemáticas y metaanálisis (tamaño de muestra, exclusión de comorbilidades comunes, ausencia de comparaciones adecuadas, entre otros) [49][50][51] ; adicionalmente pocos estudios evalúan sus efectos secundarios, los cuales podrían estar relacionados con un impacto negativo en la realización de sus actividades cotidianas 24 .…”

Section: Discussionunclassified

Depresión como predictor de discapacidad en adultos mayores

2017

revsal

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RESUMENIntroducción: Estimaciones prevén que el número de personas con discapacidad aumentará como consecuencia del envejecimiento de la población, ante lo cual es importe identificar los principales factores de riesgo para su prevención. En los adultos mayores (AM) la depresión es una de las alteraciones de salud mental más frecuentes. Objetivo: Describir el estado de la investigación de la depresión como predictor de discapacidad en AM de la comunidad. Metodologia: Revisión de la literatura en bases de datos electrónicas como Pubmed (Medline), Sciencedirect, Ebsco y Lilacs, de estudios longitudinales publicados entre 2007-2017. Resultados: Se seleccionaron 15 artículos, en su mayoría formaron parte de estudios de cohortes de envejecimiento, con participantes con un rango de edad de 55-90 años, con seguimiento de 2 a 10 años. Conclusión: Se presenta un análisis general de las implicaciones de los resultados descritos.Palabras clave: Depresión, discapacidad, envejecimiento, actividades cotidianas, estudios longitudinales ABSTRACT Introduction: Current estimates predict that the number of people with disabilities will increase as a consequence of the aging population, and so it is important to identify the main risk factors for its prevention. In older adults (OA) depression is one of the most frequent mental health alterations. Objective: To describe the status of current research on depression as a predictor of disability in OA in the community. Methodology: Review of the literature in the electronic databases of Pubmed (Medline), Sciencedirect, Ebsco and Lilacs, from longitudinal studies published between 2007-2017. Results: Fifteen articles were selected that were mostly part of cohort aging studies, with participants in the age range of 55-90 years old, and with a follow-up period of 2 to 10 years. Conclusion: A general analysis is presented of the implications of the described results.

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“…It is not uncommon for clinical trials to define older patients as those aged over 60 years, 65 years or even, in the Cochrane review of antidepressants in older patients, 55 years old. 8 In contrast, many of the patients seen in modern geriatrics services are in their ninth or tenth decades. Where evidence exists for the very old patient, the proven benefit may differ from that seen in younger patients.…”

Section: The Evidence Basementioning

confidence: 99%