Mitchell Philip B, Harvey Samuel B
School of Psychiatry, University of New South Wales, Australia; Black Dog Institute, Sydney, NSW, Australia.
School of Psychiatry, University of New South Wales, Australia; Black Dog Institute, Sydney, NSW, Australia; St George Hospital, Sydney, Australia.
Maturitas. 2014 Oct;79(2):153-9. doi: 10.1016/j.maturitas.2014.05.010. Epub 2014 May 29.
Depression in the elderly, particularly those with chronic physical health problems, is a common, but complex problem. In this paper we review the research literature on both the epidemiology and management of depression in the older medical patient. After a general overview of depression in the elderly, we discuss some of the particular issues relevant to depression and co-morbid physical illness amongst elderly patients. Depression can be difficult to diagnose in medically unwell older adults, particularly when there is substantial overlap in symptomatology. The epidemiology and evidence base for the treatment of depression in a number of chronic health problems common in an older adults population are then discussed, specifically cardiac disease, cerebrovascular disease, cancer, chronic kidney disease, chronic obstructive pulmonary disease, and Parkinson's disease. For many of these conditions there is emerging evidence that treatments can be effective in reducing depressive symptoms. However, these potential benefits need to be balanced against the often-increased risk of adverse events or interactions with medical treatments. Although co-morbid depression is consistently associated with poorer medical outcomes, there is limited evidence that standard anti-depressive therapy has additional benefits in terms of physical health outcomes. Collaborative care models appear particularly well suited to medically unwell older adult patients, and may provide more generalised benefits across both mental and physical health measures.
老年人的抑郁症，尤其是那些患有慢性身体健康问题的老年人，是一个常见但复杂的问题。在本文中，我们回顾了有关老年内科患者抑郁症的流行病学和管理的研究文献。在对老年人抑郁症进行总体概述之后，我们讨论了一些与老年患者抑郁症及共病身体疾病相关的特殊问题。在身体不适的老年人中，抑郁症可能难以诊断，尤其是当症状有大量重叠时。然后讨论了老年人群中常见的一些慢性健康问题（特别是心脏病、脑血管疾病、癌症、慢性肾病、慢性阻塞性肺疾病和帕金森病）中抑郁症治疗的流行病学和证据基础。对于其中许多病症，越来越多的证据表明治疗可有效减轻抑郁症状。然而，这些潜在益处需要与不良事件风险或与药物治疗相互作用通常增加的风险相权衡。虽然共病抑郁症始终与较差的医疗结果相关，但仅有有限的证据表明标准抗抑郁治疗在身体健康结果方面有额外益处。协作护理模式似乎特别适合身体不适的老年患者，并且可能在精神和身体健康指标方面提供更广泛的益处。
