What are the treatment guidelines for depression in patients with geriatric depressive disorder?

Updated: Mar 28, 2019
  • Author: Jerry L Halverson, MD; Chief Editor: David Bienenfeld, MD  more...
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Answer

In adults over age 65 years, it is recommended, during an episode of MDD, that a physical examination and laboratory studies be performed to identify medical problems that could exacerbate or mimic depressive symptoms. Assessment includes the following:

  • Clinical examination
  • Biologic checkup - Ie, complete blood count, blood electrolytes, liver and renal function, and thyroid-stimulating hormone
  • Electrocardiographic evaluation
  • Mini-Mental State Examination
  • Evaluation of clinical severity using clinician- and self-rated scales

First-intention treatments for geriatric depression include the following:

  • Mild to moderate depression - SSRI, α2 antagonist
  • Moderate to severe depression - SSRI, SNRI, α2 antagonist
  • Severe cognitive impairment - SSRI, SNRI
  • Severe psychomotor agitation - SSRI, α2 antagonist
  • Severe psychomotor retardation - SSRI, SNRI
  • Severe sleep disorders - SSRI, α2 antagonist
  • Severe anhedonia - SSRI, SNRI
  • Psychotic symptoms - SNRI, potentiation with an atypical antipsychotic
  • High suicide risk - SSRI, SNRI

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