Management of Depression in Older Adults

Kok, Rob M.; Reynolds, Charles F.

doi:10.1001/jama.2017.5706

Cited by 688 publications

(495 citation statements)

References 85 publications

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“…107,108 Antidepressant medications also carry significant side effects, especially in elderly patients already under a burden of iatrogenic polypharmacy. 109 Our survey respondents reported marked improvements in symptoms of anxiety and depression after starting a low-carbohydrate diet. These findings support low-carbohydrate nutrition as an alternative therapeutic approach for some mental health conditions and warrant continued research.…”

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confidence: 78%

A low-carbohydrate survey: Evidence for sustainable metabolic syndrome reversal

Cucuzzella

Tondt

Dockter

et al. 2017

JMH

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Background: Metabolic syndrome has become a significant problem, with the American Diabetes Association estimating the cost of diabetes and pre-diabetes in the United States alone to be $322 billion per year. Numerous clinical trials have demonstrated the efficacy of low-carbohydrate diets in reversing metabolic syndrome and its associated disorders.Aim: This study was designed to examine how voluntary adherents to a low-carbohydrate diet rate its effectiveness and sustainability using an online survey.Setting and methods: The 57-question survey was administered online and shared internationally via social media and ‘low-carb’ communities. Where appropriate, chi-squared tests and paired t-tests were used to analyse the responses.Results: There were 1580 respondents. The majority of respondents had consumed less than 100 g of carbohydrates per day for over a year, typically for reasons of weight loss or disease management. There was a reported decrease in waist circumference and weight with a simultaneous decrease in hunger and increase in energy level. Of those who provided laboratory values, the majority saw improvements in their HbA1c, blood glucose measurements, and lipid panel results. There was a reduction in usage of various medications, and 25% reported medication cost savings, with average monthly savings of $288 for those respondents. In particular, the usage of pain relievers and anti-inflammatories dropped with a simultaneous decreased rating of pain and increase in mobility.Conclusion: We conclude that low-carbohydrate diets are a sustainable method of metabolic syndrome reversal in a community setting.

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confidence: 78%

A low-carbohydrate survey: Evidence for sustainable metabolic syndrome reversal

Cucuzzella

Tondt

Dockter

et al. 2017

JMH

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“…8,9 Recent surveys have indicated that around 8% of community-dwelling Australians aged over 60 years 10 and 11% of over 70 years US population experience clinically significant depression. 17,18 Although rates of depression treatment are increasing, 19 many people still do not have adequate control of depressive symptoms. Regardless of cutoff's for diagnosis of major depression, the presence of minor or subthreshold symptoms was shown to severely impact outcomes in older individuals.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of depressive symptoms and its associated factors among healthy community‐dwelling older adults living in Australia and the United States

Mohebbi

Agustini

Woods

et al. 2019

Int J Geriat Psychiatry

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Objective This study was conducted to estimate prevalence rates and factors associated with depressive symptoms indexed by the Centre for Epidemiological Studies‐Depression (CES‐D‐10) score in a large sample of community‐dwelling healthy older adults from Australia and the United States. Convergent and divergent validity of the CES‐D‐10 were also examined. Methods A total of 19 114 individuals aged greater than or equal to 65 years old were enrolled from a primary prevention clinical trial. Depressive symptoms were classified using the CES‐D‐10 score greater than or equal to 8 and greater than or equal to 10. Gender‐specific prevalence for subgroups according to sociodemographic characteristics were reported, and factors associated with depressive symptoms were estimated. Results The overall prevalence rates of depressive symptoms were 9.8%, 95% CI, 8.5‐11.2 and 5.0%, 95% CI, 4.0‐6.0, according to the CES‐D‐10 score greater than or equal to 8 and greater than or equal to 10, respectively. Depressive symptoms were more common in women, individuals with less than 12 years of education, those living alone or in a residential care, ethnic minorities, current smokers, and former alcohol users. Convergent and divergent validities of the CES‐D‐10 were confirmed by observing strong negative association with the SF‐12 mental health component and a modest negative association with SF‐12 physical component, respectively. Conclusions This study reports the prevalence of depressive symptoms in Australian and US community‐dwelling healthy older populations. These findings emphasize the high burden of the condition and factors associated with depressive symptoms, to better inform clinicians and help with early detection and treatment of depression in this age group.

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“…5,6 A large representative German sample of people aged 53 to 80 years showed a U-shaped association between age category and depression prevalence. 9 Various factors account for the difficulties surrounding diagnosis of depression in older adults such as somatic comorbidities, a tendency that older persons are more likely to seek care in the primary care sector rather than in specialized mental health care institutions, 10 and a shortage of mental health care providers. According to the most recent German guideline, both pharmacotherapy and psychotherapy are considered as evidence-based treatment options for patients with depression.…”

Section: Introductionmentioning

confidence: 99%

Evidence for underuse and overuse of antidepressants in older adults: Results of a large population‐based study

Boehlen

Freigofas

Herzog

et al. 2019

Int J Geriat Psychiatry

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Objectives Depression is common among elderly people. However, diagnosis and adequate treatment is frequently difficult. Research on underuse and overuse of antidepressants in elderly persons is scarce. This study investigates the utilization and appropriateness of pharmacological and psychological depression treatment in a large cohort of community‐dwelling adults. Methods A subsample of 3117 participants (aged 55‐85 y) of the third follow‐up (2008‐2010) of the large population‐based German ESTHER study was included. Depression was assessed using the eight‐item Patient Health Questionnaire (PHQ‐8). In the course of a home visit, study doctors collected complete information on medication. Logistic regression analyses were conducted to determine the relationship of depression with both underuse and overuse of antidepressants. The analyses were then adjusted for socioeconomic variables, psychosomatic comorbidities, and motivation to seek help. Results One hundred sixty‐three participants (5.2%; 95% confidence interval [CI], 4.5‐6.1) fulfilled the criteria for major depression. Underuse of antidepressants was present in 126 depressed participants (77.3%; 70.1‐83.5). Persons who were motivated to seek help, who had an established depression diagnosis, or who were taking more than five different medications had lower odds of underuse. Anxiety was associated with higher odds for underuse. Overuse of antidepressants (prescription without clinical indication) was found in 96 cases (41.7%; 35.3‐48.4) of all antidepressant prescriptions. Conclusions Depression treatment in older adults is frequently insufficient; it appears to depend on diagnosis as well as the patients' motivation to seek help. Education regarding the diagnosis of depression in the elderly as well as guidelines for appropriate treatment is needed.

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Management of Depression in Older Adults

Cited by 688 publications

References 85 publications

A low-carbohydrate survey: Evidence for sustainable metabolic syndrome reversal

A low-carbohydrate survey: Evidence for sustainable metabolic syndrome reversal

Prevalence of depressive symptoms and its associated factors among healthy community‐dwelling older adults living in Australia and the United States

Evidence for underuse and overuse of antidepressants in older adults: Results of a large population‐based study

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