Depression and Affective Disorder in Later Life

Management of Depression in Medical Patients

“…Late in life, depressive syndromes or symptoms are frequently associated with so matic or cerebral disease, creating difficul ties in diagnosis and management [144]. Pa tients with late onset of affective disorders have higher rates of physical illness and lower genetic loadings than those who expe rienced depression earlier in life [126,145].…”

“…The clinical differentiation with grief is important [144], In the medically ill. a grief reaction does not only follow the death of a loved one, but also the loss of a body part of bodily function [151]. Sight, hearing, speech, reproduction and locomotion are most val ued bodily functions; breasts, hair and facial appearance are parts of the body most im portant in maintaining an integrated sense of self [151].…”

“…Pa tients with late onset of affective disorders have higher rates of physical illness and lower genetic loadings than those who expe rienced depression earlier in life [126,145]. Regardless of time of onset, depression in the elderly may be the forerunner of fatal ill ness [47], Suicide is a major complication of depression in the elderly: several studies show that the majority of those in whom fatal suicide has been recorded prove to have had the first attack of depression in the mid dle age or later [144]. An organic affective syndrome should always be suspected, espe cially if the patient has no previous family or personal history of affective illness.…”