Biology:Late life depression

From HandWiki
Revision as of 11:34, 9 March 2024 by Sherlock (talk | contribs) (add)
(diff) ← Older revision | Latest revision (diff) | Newer revision → (diff)
Short description: Depression occurring in older adults


Late-life depression refers to depression occurring in older adults and has diverse presentations, including as a recurrence of early-onset depression, a new diagnosis of late-onset depression, and a mood disorder resulting from a separate medical condition, substance use, or medication regimen.[1] Research regarding late-life depression often focuses on late-onset depression, which is defined as a major depressive episode occurring for the first time in an older person (various sources define this threshold differently, typically within the range of 60–65 years old).[1][2]

Late-life depression is often underdiagnosed, which is due to numerous reasons, including that depressed mood is commonly not as prominent as other somatic and psychotic symptoms such as loss of appetite, disruptions in sleep, lack of energy or anergia, fatigue, and loss of interest and enjoyment in normal life activities.[3][4] Concurrent medical problems and lower functional expectations of elderly patients also often obscure the degree of impairment caused by late-life depression. Elderly persons sometimes dismiss less severe depression as an acceptable response to life stress or a normal part of aging.[5][6][7][8] Additional reasons for the difficulty in diagnosis include: medical illnesses and medication side effects that present similarly to depression, difficulty communicating with providers, lack of time in an appointment, and beliefs about mental illness and treatment from the patient, friends, family members, and society.[9][10][11][12] Even when diagnosed, late-life depression is frequently undertreated as well.[4]

Primary care is most often where diagnosis and treatment of late-life depression occurs.[9][2] Notably, the DSM-5 does not specifically define diagnostic criteria for late-life depression and concludes that the characteristics of major depressive disorder do not vary by age, although research suggests that late life depression can present differently, as described above.[4] Broadly speaking, however, diagnosis is made in the same way as other age groups, using DSM-5 criteria for major depressive disorder.[13][9] The American Psychological Association and other clinical recommendations also recognize the spectrum of depressive symptoms that extend beyond the formal criteria for major depressive disorder, including subthreshold/minor depression and dysthymic disorder; these diagnoses that fall under the umbrella of late-life depression can also present with debilitating and disruptive symptoms.[1][14][4] Treatments for late-life depression include medicine and psychotherapy, along with lifestyle changes such as exercise, bright light therapy, and family support.[9][14] In patients who do not respond to initial treatments, neurostimulation techniques such as electroconvulsive therapy (ECT) can be used.[13] ECT has demonstrated effectiveness in treating the elderly.[15]

Symptoms and diagnosis

Diagnosis of depression in late life is made using the same criteria for Major Depressive Disorder found in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)

To meet criteria for a major depressive episode, a patient must have five of the nine symptoms listed below nearly every day for at least two weeks and must have at least either a depressed mood or anhedonia.[16][17] The symptoms they are facing must also harm their ability to function in daily life and must not be better explained by a medical illness or a substance.[17] To further meet criteria for Major Depressive Disorder, the depressive episode must not be attributable to another psychiatric disorder such as psychosis or a bipolar disorder.[17]

  1. Depressed or sad mood
  2. Anhedonia (loss of interest in pleasurable activities)
  3. Sleep disturbance (increased or decreased sleep)
  4. Appetite disturbance (increased or decreased appetite) typically with weight change
  5. Energy disturbance (increased or decreased energy/activity level), usually fatigue
  6. Poor memory or concentration
  7. Feelings of guilt or worthlessness
  8. Psychomotor retardation or agitation (a change in mental and physical speed perceived by other people)
  9. Thoughts of wishing they were dead; suicidal ideation or suicide attempts

Causes and Risk Factors

The exact changes in brain chemistry and function that cause either late-life or earlier onset depression are unknown. It is known, however, that brain changes can be triggered by the stresses of certain life events such as illness, childbirth, death of a loved one, life transitions (such as retirement), interpersonal conflicts, or social isolation. Risk factors for depression in older persons include a history of depression, social isolation, lower socioeconomic status, uncontrolled pain, co-morbid chronic medical illness, insomnia, female sex, being single or divorced, cognitive or functional impairment, brain disease, alcohol use disorder, use of certain medications, and stressful life events.[18][19][20]

Research suggests that individuals with late life depression are more likely to develop Alzheimer's Disease, vascular dementia, and all-cause dementia. Dementia, however, can present early in its disease course with depressive symptoms, meaning that this association could actually be reflecting that dementia causes late life depression.[21] Studies that have directly tried to determine whether depression is an independent risk factor for dementia have led to inconclusive results. Guidelines exist to help clinicians distinguish dementia versus a primary psychiatric disorder as the cause of a late-life depression diagnosis.[22]

Treatments

Treatment is effective in about 80% of identified cases, when treatment is provided. Effective management requires a biopsychosocial approach, combining pharmacotherapy, art therapy, and psychotherapy. Therapy generally results in improved quality of life, enhanced functional capacity, possible improvement in medical health status, increased longevity, and lower health care costs. Improvement should be evident as early as two weeks after the start of therapy, but full therapeutic effects may require several months of treatment. Therapy for older patients should be continued for longer periods than are typically used in younger patients.[23][24]

Psychotherapy

Psychologic therapies are recommended for elderly patients with depression because of this group's vulnerability to adverse effects and high rates of medical problems and medication use. Psychotherapeutic approaches include cognitive behavioral therapy, supportive psychotherapy, problem-solving therapy, and interpersonal therapy.[25] Life review therapy is another type of therapy with evidence supporting its usefulness in older adults with moderate depression.[26] The potential benefit of psychotherapy is not diminished by increasing age. Older adults often have better treatment compliance, lower dropout rates, and more positive responses to psychotherapy than younger patients.[25] While therapy can be beneficial, it is not always provided due to factors such as lack of trained therapists or lack of coverage by health insurance.[27]

Art Therapy

Art therapy can be suggested to those with depression, Alzheimer's, dementia, anxiety, and other mental health issues. Up to 27% of older adults have been diagnosed with depression in the U.S. Thus art therapy and its several uses, whether physical(dancing), auditory (music), or visual (painting), can be used differently to additionally help those on top of mental health issues but cognitive, physical, and behavioral/emotional disabilities as well.[28] Art therapy has been seen to help those in their late life, engage, and support healthy habits.[29] Specifically, those with depression have been seen to relax, hit physical and emotional distress, and overall increase well-being over time, the longer the participation.[30] Patients are able to express themselves in ways where it may be hard to communicate.[28] It has also been found that patients do not even need to partake in the use of art, as "studies have found that a landscape picture in a hospital room had reduced need for narcotic pain killers and less time in recovery at the hospital."[31] The use of art as a form of therapy helps patients who are engaged with it physically or visually. Those within their late life, diagnosed with depression can participate regardless of age, gender, or physical/mental disability.[32][33]

Pharmacotherapy

Pharmacotherapy for acute episodes of depression usually is effective and free of complications. Antidepressant medications are often the first treatment choice for adults with moderate or severe depression, sometimes along with psychotherapy. The most promising therapeutic effect is achieved when the treatment continues for at least six weeks.[34] Underuse or misuse of antidepressants and prescribing inadequate dosages are the most common mistakes physicians make when treating elderly patients for depression. Only 10% to 40% of depressed elderly patients are given medication.

Selective serotonin reuptake inhibitors, commonly referred to as SSRIs, are considered first line pharmacotherapy for depression in late life as they are more tolerable and safer than other antidepressants.[35] Serotonin-norepinephrine reuptake inhibitors (SNRIs) are considered second-line but also can be useful for patients with chronic pain.[36][37] Atypical antidepressants such as bupropion and mirtazapine have not been studied extensively in older adults but appear to offer some benefit.[38][39] Monoamine oxidase inhibitors (MAOIs) similarly have been shown to offer some benefit, but have not been studied extensively[40] MAOIs must be used with caution to prevent side effects such as serotonin syndrome and adrenergic crisis.[41]

Tricyclic antidepressants are no longer the first line therapy for depression, but can still benefit patients who do not respond to initial therapies.[37] TCAs have also demonstrated a unique ability to prevent re-occurrence of depression following electroconvulsive therapy.[42][43][44] TCAs are typically not used initially due to their side effects and risk from overdose compared to SSRIs.[45][46] A TCA overdose can be fatal at a much lower dose than SSRIs.[46]

Antidepressants, in general, may also work by playing a neuroprotective role in how they relieve anxiety and depression. It's thought that antidepressants may increase the effects of brain receptors that help nerve cells keep sensitivity to glutamate which is an organic compound of a nonessential amino acid. This increased support of nerve cells lowers glutamate sensitivity, providing protection against the glutamate overwhelming and exciting key brain areas related to depression. Although antidepressants may not cure depression, they can lead to remission, which is the disappearance or nearly complete reduction of depression symptoms.[47][48][49]

Continuation and maintenance treatments for depression in older people

A 2016 Cochrane review provided limited evidence that continuing antidepressant medication for one year seems to reduce the risk of depression recurrence with no additional harm.[50] However, a robust recommendation can not be drawn about psychological treatments or combination treatments in preventing recurrence.  

Neurostimulation

Neurostimulation, specifically electroconvulsive therapy (ECT) is an effective treatment for depression in the elderly. It is particularly useful in treating severe major depression that does not respond well to the above treatments.[51] In the geriatric population specifically, including patients over the age of 85, ECT provides a safe and effective treatment option.[52][53] Compared to treatment with younger patients, ECT appears to work more effectively in the older patients.[54] A typical course of ECT treatment ranges from 6 to 12 treatments, with some requiring more or less.[55] A normal treatment schedule in the United States might include three treatments a week on Monday, Wednesday, and Friday. Two treatments a week compares favorably with three and can also be used.[56] Maintenance ECT, which is ECT given longitudinally after the initial set of acute treatments, also helps depression in late life and helps prevent reoccurring depression.[57]

If an older person requires hospitalization for their depression, ECT has been shown in multiple studies to work faster than medicine and reduce mortality associated with depression.[58][59] Even in cases such as depression following a stroke, ECT can be efficacious; however, the evidence is not as strong on its ability to treat vascular depression caused by long-term disease, versus an acute event like a stroke.[60][61]

Transcranial magnetic stimulation (TMS) is another example of neurostimulation used to treat depression, but ECT is considered to be the more effective modality.[62][63][64]

Epidemiology

Major depression is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Nearly five million of the 31 million Americans who are 65 years or older are clinically depressed, and one million have major depression. Approximately 3% of healthy elderly persons living in the community have major depression. Recurrence may be as high as 40%. Suicide rates are nearly twice as high in depressed patients as in the general population. Major depression is more common in medically ill patients who are older than 70 years and hospitalized or institutionalized. Severe or chronic diseases associated with high rates of depression include stroke (30–60%), coronary heart disease (8–44%), cancer (1–40%), Parkinson's disease (40%), Alzheimer's disease (20–40%), and dementia (17–31%).[65]

Minor depression is a clinically significant depressive disorder that does not fulfill the duration criterion or the number of symptoms necessary for the diagnosis of major depression. Minor depression, which is more common than major depression in elderly patients, may follow a major depressive episode. It also can be a reaction to routine stressors in older populations. 15–50% of patients with minor depression develop major depression within two years.[66]

Research

Brain imaging (functional/structural MRI) may help direct the search for microscopic abnormalities in brain structure and function responsible for late life depression. Ultimately, imaging technologies may serve as tools for early diagnosis and subtyping of depression.[67]

Genetics research studying late life depression is focused on identifying associated genetic markers linked to the development of late life depression. It is understood that genetic variants of APOE, BDNF, and SLC6A4 may be attributed to an increased risk. Regions of the brain that have been associated with these genes are hippocampal remodeling and the endocrine pathway of the Hypothalamus-Pituitary-Adrenal axis when managing stress.[68]

See also

References

  1. ↑ 1.0 1.1 1.2 Aziz, Rehan; Steffens, David C. (2013-12-01). "What Are the Causes of Late-Life Depression?" (in English). Psychiatric Clinics 36 (4): 497–516. doi:10.1016/j.psc.2013.08.001. ISSN 0193-953X. PMID 24229653. PMC 4084923. https://www.psych.theclinics.com/article/S0193-953X(13)00083-X/abstract. 
  2. ↑ 2.0 2.1 "Clinical practice. Depression in the elderly". The New England Journal of Medicine 371 (13): 1228–36. September 2014. doi:10.1056/NEJMcp1402180. PMID 25251617. 
  3. ↑ Lebowitz, Barry D.; Pearson, Jane L.; Schneider, Lon S.; Reynolds, Charles F. III; Alexopoulos, George S.; Bruce, Martha Livingston; Conwell, Yeates; Katz, Ira R. et al. (1997-10-08). "Diagnosis and Treatment of Depression in Late Life: Consensus Statement Update". JAMA 278 (14): 1186–1190. doi:10.1001/jama.1997.03550140078045. ISSN 0098-7484. PMID 9326481. 
  4. ↑ 4.0 4.1 4.2 4.3 Husain-Krautter, Sehba; Ellison, James M. (2021-07-01). "Late Life Depression: The Essentials and the Essential Distinctions". FOCUS 19 (3): 282–293. doi:10.1176/appi.focus.20210006. ISSN 1541-4094. PMID 34690594. 
  5. ↑ "Research advances in geriatric depression". World Psychiatry 8 (3): 140–9. October 2009. doi:10.1002/j.2051-5545.2009.tb00234.x. PMID 19812743. 
  6. ↑ "Geriatric depression and cognitive impairment". Psychological Medicine 38 (2): 163–75. February 2008. doi:10.1017/S003329170700102X. PMID 17588275. 
  7. ↑ "Prognosis of depression in old age compared to middle age: a systematic review of comparative studies". The American Journal of Psychiatry 162 (9): 1588–601. September 2005. doi:10.1176/appi.ajp.162.9.1588. PMID 16135616. 
  8. ↑ "Medical Comorbidities in Late-Life Depression". Psychiatric Times 25 (14). 2008. 
  9. ↑ 9.0 9.1 9.2 9.3 "UpToDate". https://www.uptodate.com/contents/diagnosis-and-management-of-late-life-unipolar-depression. 
  10. ↑ "Perceived stigma as a predictor of treatment discontinuation in young and older outpatients with depression". The American Journal of Psychiatry 158 (3): 479–81. March 2001. doi:10.1176/appi.ajp.158.3.479. PMID 11229992. 
  11. ↑ "Concept of disease in geriatric psychiatry". The American Journal of Geriatric Psychiatry 15 (1): 1–11. January 2007. doi:10.1097/01.JGP.0000224600.37387.4b. PMID 17095750. 
  12. ↑ "Depression in the elderly". Lancet 365 (9475): 1961–70. 2005. doi:10.1016/S0140-6736(05)66665-2. PMID 15936426. 
  13. ↑ 13.0 13.1 "UpToDate". https://www.uptodate.com/contents/image?imageKey=PSYCH/89994&topicKey=PULM/1619. 
  14. ↑ 14.0 14.1 American Psychological Association. "APA Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts". https://www.apa.org/depression-guideline/guideline.pdf. 
  15. ↑ "The efficacy and safety of ECT in depressed older adults: a literature review". International Journal of Geriatric Psychiatry 18 (10): 894–904. October 2003. doi:10.1002/gps.944. PMID 14533122. 
  16. ↑ "Depression in later life: a diagnostic and therapeutic challenge". American Family Physician 69 (10): 2375–82. May 2004. PMID 15168957. 
  17. ↑ 17.0 17.1 17.2 American Psychiatric Association (2013-05-22) (in en). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). American Psychiatric Association. doi:10.1176/appi.books.9780890425596. ISBN 978-0-89042-555-8. https://archive.org/details/diagnosticstatis0005unse. 
  18. ↑ Aziz, Rehan; Steffens, David C. (December 2013). "What are the causes of late-life depression?". The Psychiatric Clinics of North America 36 (4): 497–516. doi:10.1016/j.psc.2013.08.001. ISSN 1558-3147. PMID 24229653. 
  19. ↑ Büchtemann, Dorothea; Luppa, Melanie; Bramesfeld, Anke; Riedel-Heller, Steffi (2012-12-15). "Incidence of late-life depression: a systematic review". Journal of Affective Disorders 142 (1–3): 172–179. doi:10.1016/j.jad.2012.05.010. ISSN 1573-2517. PMID 22940498. 
  20. ↑ Cole, Martin G.; Dendukuri, Nandini (June 2003). "Risk factors for depression among elderly community subjects: a systematic review and meta-analysis". The American Journal of Psychiatry 160 (6): 1147–1156. doi:10.1176/appi.ajp.160.6.1147. ISSN 0002-953X. PMID 12777274. 
  21. ↑ Diniz, Breno S.; Butters, Meryl A.; Albert, Steven M.; Dew, Mary Amanda; Reynolds, Charles F. (May 2013). "Late-life depression and risk of vascular dementia and Alzheimer's disease: systematic review and meta-analysis of community-based cohort studies". The British Journal of Psychiatry: The Journal of Mental Science 202 (5): 329–335. doi:10.1192/bjp.bp.112.118307. ISSN 1472-1465. PMID 23637108. 
  22. ↑ Ducharme, Simon; Pearl-Dowler, Leora; Gossink, Flora; McCarthy, Jillian; Lai, Jimmy; Dickerson, Bradford C.; Chertkow, Howard; Rapin, Lucile et al. (2019-01-01). "The Frontotemporal Dementia versus Primary Psychiatric Disorder (FTD versus PPD) Checklist: A Bedside Clinical Tool to Identify Behavioral Variant FTD in Patients with Late-Onset Behavioral Changes" (in en). Journal of Alzheimer's Disease 67 (1): 113–124. doi:10.3233/JAD-180839. ISSN 1387-2877. PMID 30584146. https://content.iospress.com/articles/journal-of-alzheimers-disease/jad180839. 
  23. ↑ "Effectiveness of treatments for depression in older people". The Medical Journal of Australia 182 (12): 627–32. June 2005. doi:10.5694/j.1326-5377.2005.tb06849.x. PMID 15963019. 
  24. ↑ "Neuroimaging in geriatric psychiatry". International Journal of Geriatric Psychiatry 24 (8): 783–7. August 2009. doi:10.1002/gps.2335. PMID 19593778. 
  25. ↑ 25.0 25.1 "Problem solving therapy for the depression-executive dysfunction syndrome of late life". International Journal of Geriatric Psychiatry 23 (8): 782–8. August 2008. doi:10.1002/gps.1988. PMID 18213605. 
  26. ↑ "Life review therapy for older adults with moderate depressive symptomatology: a pragmatic randomized controlled trial". Psychological Medicine 42 (6): 1163–73. June 2012. doi:10.1017/S0033291711002042. PMID 21995889. https://ris.utwente.nl/ws/files/6751301/Korte12life.pdf. 
  27. ↑ "UpToDate". https://www.uptodate.com/contents/diagnosis-and-management-of-late-life-unipolar-depression. 
  28. ↑ 28.0 28.1 Dunphy, Kim; Baker, Felicity A.; Dumaresq, Ella; Carroll-Haskins, Katrina; Eickholt, Jasmin; Ercole, Maya; Kaimal, Girija; Meyer, Kirsten et al. (2019). "Creative Arts Interventions to Address Depression in Older Adults: A Systematic Review of Outcomes, Processes, and Mechanisms". Frontiers in Psychology 9: 2655. doi:10.3389/fpsyg.2018.02655. ISSN 1664-1078. PMID 30671000. 
  29. ↑ "Aging: What's Art Got To Do With It?". https://www.todaysgeriatricmedicine.com/news/ex_082809_03.shtml. 
  30. ↑ Stallings, J. W.; Thompson, S. K. (June 2012). "Use of Art Therapy in Geriatric Populations". Annals of Long Term Care. https://www.hmpgloballearningnetwork.com/site/altc/articles/use-art-therapy-geriatric-populations. 
  31. ↑ Stuckey, Heather L.; Nobel, Jeremy (February 2010). "The Connection Between Art, Healing, and Public Health: A Review of Current Literature". American Journal of Public Health 100 (2): 254–263. doi:10.2105/AJPH.2008.156497. ISSN 0090-0036. PMID 20019311. PMC 2804629. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2804629/. 
  32. ↑ Flood, Matthew (2019-08-01). "Art Therapy for Seniors – How Art Can Help the Elderly" (in en-US). https://www.completecare.ca/blog/art-therapy-seniors/. 
  33. ↑ Ciasca, Eliana C.; Ferreira, Rita C.; Santana, Carmen L.A.; Forlenza, Orestes V.; dos Santos, Glenda D.; Brum, Paula S.; Nunes, Paula V. (2018-02-01). "Art therapy as an adjuvant treatment for depression in elderly women: a randomized controlled trial". Brazilian Journal of Psychiatry 40 (3): 256–263. doi:10.1590/1516-4446-2017-2250. ISSN 1516-4446. PMID 29412335. 
  34. ↑ "Antidepressant versus placebo for depressed elderly". The Cochrane Database of Systematic Reviews 2001 (2): CD000561. 2001. doi:10.1002/14651858.CD000561. PMID 11405969. 
  35. ↑ "Selective serotonin reuptake inhibitors for late-life depression: a comparative review". Drugs & Aging 18 (5): 355–68. 2001. doi:10.2165/00002512-200118050-00006. PMID 11392444. 
  36. ↑ "Duloxetine for the treatment of major depressive disorder in older patients". The American Journal of Geriatric Psychiatry 13 (3): 227–35. March 2005. doi:10.1176/appi.ajgp.13.3.227. PMID 15728754. 
  37. ↑ 37.0 37.1 "UpToDate". https://www.uptodate.com/contents/image?imageKey=PC/57207&topicKey=PSYCH/1719&source=see_link. 
  38. ↑ "Bupropion SR in the naturalistic treatment of elderly patients with major depression". International Journal of Geriatric Psychiatry 16 (9): 862–5. September 2001. doi:10.1002/gps.424. PMID 11571765. 
  39. ↑ "A review of the pharmacological and clinical profile of mirtazapine". CNS Drug Reviews 7 (3): 249–64. 2001. doi:10.1111/j.1527-3458.2001.tb00198.x. PMID 11607047. 
  40. ↑ "Comparative efficacy and safety of MAOIs versus TCAs in treating depression in the elderly". Biological Psychiatry 21 (12): 1155–66. October 1986. doi:10.1016/0006-3223(86)90222-2. PMID 3756264. 
  41. ↑ "UpToDate". https://www.uptodate.com/contents/diagnosis-and-management-of-late-life-unipolar-depression?source=history_widget#H29. 
  42. ↑ "The treatment of psychotic depression in later life: a comparison of pharmacotherapy and ECT". International Journal of Geriatric Psychiatry 13 (1): 23–8. January 1998. doi:10.1002/(SICI)1099-1166(199801)13:1<23::AID-GPS725>3.0.CO;2-J. PMID 9489577. 
  43. ↑ "Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial". JAMA 285 (10): 1299–307. March 2001. doi:10.1001/jama.285.10.1299. PMID 11255384. 
  44. ↑ "The effectiveness of antidepressants in elderly depressed outpatients: a prospective case series study". The Journal of Clinical Psychiatry 60 (10): 690–7. October 1999. doi:10.4088/jcp.v60n1008. PMID 10549686. 
  45. ↑ "Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2000 British Association for Psychopharmacology guidelines". Journal of Psychopharmacology 22 (4): 343–96. June 2008. doi:10.1177/0269881107088441. PMID 18413657. https://kclpure.kcl.ac.uk/ws/files/52545391/PMH_24_3_15_British_Association_forPsychopharmacology_Final_Reconciliation_Draft_2_.docx. 
  46. ↑ 46.0 46.1 "Tricyclic and Tetracyclic Drugs". The American Psychiatric Association Publishing Textbook of Psychopharmacology. American Psychiatric Association Publishing. May 2017. doi:10.1176/appi.books.9781615371624.as09. ISBN 978-1-58562-523-9. 
  47. ↑ "Frontal white matter anisotropy and antidepressant remission in late-life depression". PLOS ONE 3 (9): e3267. September 2008. doi:10.1371/journal.pone.0003267. PMID 18813343. Bibcode: 2008PLoSO...3.3267T. 
  48. ↑ "Pharmacogenetics of antidepressant medication intolerance". The American Journal of Psychiatry 160 (10): 1830–5. October 2003. doi:10.1176/appi.ajp.160.10.1830. PMID 14514498. 
  49. ↑ "Selective serotonin reuptake inhibitors directly signal for apoptosis in biopsy-like Burkitt lymphoma cells". Blood 101 (8): 3212–9. April 2003. doi:10.1182/blood-2002-07-2044. PMID 12515726. 
  50. ↑ "Continuation and maintenance treatments for depression in older people". The Cochrane Database of Systematic Reviews 2016 (9): CD006727. September 2016. doi:10.1002/14651858.cd006727.pub3. PMID 27609183. 
  51. ↑ "Efficacy of ECT in depression: a meta-analytic review". The Journal of ECT 20 (1): 13–20. March 2004. doi:10.1097/00124509-200403000-00004. PMID 15087991. 
  52. ↑ "Current electroconvulsive therapy practice and research in the geriatric population". Neuropsychiatry 4 (1): 33–54. February 2014. doi:10.2217/npy.14.3. PMID 24778709. 
  53. ↑ "Electroconvulsive Therapy in the Elderly: New Findings in Geriatric Depression". Current Psychiatry Reports 18 (4): 40. April 2016. doi:10.1007/s11920-016-0674-5. PMID 26909702. 
  54. ↑ "Older age is associated with rapid remission of depression after electroconvulsive therapy: a latent class growth analysis". The American Journal of Geriatric Psychiatry 23 (3): 274–82. March 2015. doi:10.1016/j.jagp.2014.05.002. PMID 24951182. 
  55. ↑ "UpToDate". https://www.uptodate.com/contents/unipolar-major-depression-in-adults-indications-for-and-efficacy-of-electroconvulsive-therapy-ect. 
  56. ↑ Brain Stimulation in Psychiatry. Cambridge: Cambridge University Press. 2012. doi:10.1017/cbo9780511736216. ISBN 978-0-511-73621-6. 
  57. ↑ "Efficacy and safety of continuation and maintenance electroconvulsive therapy in depressed elderly patients: a systematic review". The American Journal of Geriatric Psychiatry 20 (1): 5–17. January 2012. doi:10.1097/JGP.0b013e31820dcbf9. PMID 22183009. 
  58. ↑ "Effect of ECT on mortality and clinical outcome in geriatric unipolar depression". The Journal of Clinical Psychiatry 56 (9): 390–4. September 1995. PMID 7665536. 
  59. ↑ "Speed of remission in elderly patients with depression: electroconvulsive therapy v. medication". The British Journal of Psychiatry 206 (1): 67–71. January 2015. doi:10.1192/bjp.bp.114.148213. PMID 25323140. 
  60. ↑ "Cerebrovascular disease and late-life depression". The American Journal of Geriatric Psychiatry 13 (2): 88–98. February 2005. doi:10.1176/appi.ajgp.13.2.88. PMID 15703317. 
  61. ↑ "Electroconvulsive therapy for post-stroke depressed geriatric patients". The Journal of Neuropsychiatry and Clinical Neurosciences 4 (2): 140–4. 1992. doi:10.1176/jnp.4.2.140. PMID 1627974. 
  62. ↑ "Efficacy and acceptability of high frequency repetitive transcranial magnetic stimulation (rTMS) versus electroconvulsive therapy (ECT) for major depression: a systematic review and meta-analysis of randomized trials". Depression and Anxiety 30 (7): 614–23. July 2013. doi:10.1002/da.22060. PMID 23349112. 
  63. ↑ "Should we expand the toolbox of psychiatric treatment methods to include Repetitive Transcranial Magnetic Stimulation (rTMS)? A meta-analysis of the efficacy of rTMS in psychiatric disorders". The Journal of Clinical Psychiatry 71 (7): 873–84. July 2010. doi:10.4088/JCP.08m04872gre. PMID 20361902. 
  64. ↑ Health Quality, Ontario (2016). "Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials". Ontario Health Technology Assessment Series 16 (5): 1–66. PMID 27099642. 
  65. ↑ American Psychiatric Association 2000a, p. 354
  66. ↑ "A descriptive analysis of minor depression". The American Journal of Psychiatry 159 (4): 637–43. April 2002. doi:10.1176/appi.ajp.159.4.637. PMID 11925303. 
  67. ↑ "The anatomy of mood disorders--review of structural neuroimaging studies". Biological Psychiatry 41 (1): 86–106. January 1997. doi:10.1016/S0006-3223(96)00006-6. PMID 8988799. 
  68. ↑ Tsang, Ruby S. M.; Mather, Karen A.; Sachdev, Perminder S.; Reppermund, Simone (April 2017). "Systematic review and meta-analysis of genetic studies of late-life depression". Neuroscience and Biobehavioral Reviews 75: 129–139. doi:10.1016/j.neubiorev.2017.01.028. ISSN 1873-7528. PMID 28137459. 



Retrieved from "https://handwiki.org/wiki/index.php?title=Biology:Late_life_depression&oldid=3714333"