Depression and suicides among the elderly members of society are a serious public health problem. The prevalence of major depression ranges from 1.6% to 6%, and depressive symptoms occur in 7% – 13% of people of retirement age. Moreover, the disease is often associated with stressful life events: a death of family members, lack of respect from adult children, accumulated physical ailments, a sharp decline in social activity.
Depression must be identified and treated, especially in the elderly people because this psychopathology greatly increases the risk of mortality and adverse outcomes of somatic diseases. For example, after myocardial infarction or stroke among patients with depression, a significantly higher mortality rate was noted.
It should be borne in mind that the manifestation of depression in the elderly is significantly different from the manifestations of this psychopathology in young patients. The former are more likely to deny having a low mood because they are mostly fixed on their somatic symptoms and complaints about memory loss. This contingent of patients is much less likely than the rest to seek help from psychiatrists and explain their condition by violations in the mental sphere.
In elderly patients, there are key symptoms of depression:
- suicidal thoughts
- sleep disorders
- decrease in interest in everyday life
For greater detail of the clinical picture and, accordingly, for more effective treatment, one should also assess the severity of such indicators as lack of energy, violation of concentration and memory, changes in appetite, psychomotor disorders, suicidal thoughts. A summary analysis of these characteristics provides valuable information for the diagnosis of depression.
Antidepressants, even those with similar efficacy, differ in the profile of tolerability and behavioral toxicity. Some of them depress the cognitive sphere, even more, causing increased fatigue, memory loss, and confusion. The risk of such effects is higher in the elderly people. Individual antidepressants, in particular, Zoloft and other drugs available in pharmacies, help significantly improve cognitive function.
The sedative effect of a number of antidepressants leads to problems at any age, but especially in the old age.
All antidepressants have side effects due to the peculiarities of their pharmacological properties. There is no evidence of superiority in the effectiveness of one group of antidepressants over the others. However, when prescribing drugs for the treatment of depression, differences in their tolerability should be taken into account. The clinical decision to choose an antidepressant should be based on such details as pharmacokinetic properties, concomitant diseases (e.g., cardiovascular, neurological, renal, hepatic pathology) and the possibility of drug interactions.