Recognizing and Treating Depression in the Elderly

Mark D. Miller, MD

Medscape Psychiatry & Mental Health eJournal. 1997;2(2) 

In This Article

Medical Comorbidity

Commonly, the hallmark of depression in the elderly is its comorbidity with medical illness. The increased longevity of the elderly in the US has been accompanied by an increase in the rate of attendant chronic medical problems, such as arthritis, chronic pain, or sensory impairment. Quality of life may be compromised by the morbidity associated with these chronic medical problems which, in turn, can contribute to depression.

Depression makes medical illness or physical disability worse, and an increase in medical problems is a risk factor for depression.[11,12] Depression can also make chronic pain feel more intense, and living with chronic pain can contribute to depression.[13,14] For this reason, antidepressant medications are now commonly used to help manage chronic pain syndromes.

Recognizing the syndrome of depression in an elderly patient's list of medical ailments is not always straightforward. It is, therefore, not surprising that the diagnosis of depression is often missed in primary care settings. However, when the diagnosis is made correctly and effective treatment is carried out, studies have shown that patients function better even though their underlying medical condition has not changed. For example, Borson and associates[15] reported on patients with chronic obstructive pulmonary disease (COPD) who were depressed. Half the group was randomly assigned to receive nortriptyline, and the other half received a placebo in a double-blind trial. Depression improved only in the nortriptyline group. In addition, self-ratings of anxiety, physical comfort, and functionality also improved in the nortriptyline group, despite no change in the underlying severity of the COPD in either group (Fig. 2).

Treatment reduces disaability in patients with chronic obstructive pulmonary disease. Data from Borson et al.[15]

In another study of ambulatory elders treated for recurrent depression, Miller and others[11] found no correlation between rates of response to a standard treatment for depression and the patient's level of medical burden. The patients with the greatest degree of medical problems responded just as frequently as did the medically healthier patients. This finding suggests that depression can and should be adequately treated, regardless of the level of comorbid medical condition. Miller and coworkers[16] also demonstrated in another study that depressed geriatric patients showed improvement in self-rated general health scores when treated to remission of their depression, even though there was no change in their actual medical status.

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