Depression in older adults

Nabil Kotbi, MD, Assistant professor of psychiatry, Weill Medical College of Cornell University, New York-Presbyterian Hospital, White Plains, NY

Nahla Mahgoub, MD, Instructor in psychiatry, Weill Medical College of Cornell University, New York-Presbyterian Hospital, White Plains, NY

Anna Odom, PhD, Instructor of psychology in psychiatry, Weill Medical College of Cornell University, New York-Presbyterian Hospital, White Plains, NY

Depression in older adults (age ≥65) can devastate their quality of life and increase the likelihood of institutionalization because of behavioral problems. Depression is a primary risk factor for suicide, and suicide rates are highest among those age ≥65, especially among white males. The burden of geriatric depression can extend to caregivers. Prompt recognition and treatment of depression could help minimize morbidity and reduce suffering in older adults and their caregivers.

Although geriatric depression varies in severity and presentation, common categories include:

• major depressive disorder (MDD)
• vascular depression
• dysthymia
• depression in the context of dementias, psychosis, bipolar disorder, and executive dysfunction.

Diagnoses in this population generally correspond with DSM-IV-TR criteria, but geriatric depression has distinct clinical manifestations.

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Treat the patient, not the disease

Henry A. Nasrallah, MD
Editor-in-Chief

Personalized care is at the heart of good medical care. It is an indispensable ingredient for optimal clinical outcomes because each patient is unique, as an individual and as a patient, and requires customized treatment.

If 10 patients with depression walk into a psychiatrist’s office on any given day, each will be different and should be treated accordingly. Their symptoms may be similar thematically but they differ widely in presentation and content. Their medical and psychiatric histories and social, educational, religious, ethnic, socioeconomic, and attitudinal diversity can be stunning in complexity and disparity. Just as patients’ symptoms can be similar yet different, so can their response to a specific antidepressant or psychotherapy. Their clinical and functional outcomes will vary widely in degree and valence. Every psychiatrist expects (and enjoys) the richness of patient backgrounds and manages each individually.

Given these individual differences among our psychiatric patients, why are practitioners being barraged by various entities to abandon the traditional medical approach to their patients? Why is there a push to transform personalized clinical care to an assembly-line system, where patients are defined by their disease and are managed like “human widgets” as though they can be “processed” in an identical, protocolized, mechanical manner? This is completely antithetical to the magnificent personal approach inherent in the classic and highly effective doctor-patient relationship.

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