Department of Old Age Psychiatry, Parnassia Psychiatric Institute, the Hague, the Netherlands.
NIMH Center of Excellence in Late Life Depression Prevention and Treatment, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania3Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania4Aging Institute of University of Pittsburgh Medical Center Senior Services, Pittsburgh, Pennsylvania.
JAMA. 2017 May 23;317(20):2114-2122. doi: 10.1001/jama.2017.5706.
Depression in older adults is a common psychiatric disorder affecting their health-related quality of life. Major depression occurs in 2% of adults aged 55 years or older, and its prevalence rises with increasing age. In addition, 10% to 15% of older adults have clinically significant depressive symptoms, even in the absence of major depression.
Depression presents with the same symptoms in older adults as it does in younger populations. In contrast to younger patients, older adults with depression more commonly have several concurrent medical disorders and cognitive impairment. Depression occurring in older patients is often undetected or inadequately treated. Antidepressants are the best-studied treatment option, but psychotherapy, exercise therapy, and electroconvulsive therapy may also be effective. Psychotherapy is recommended for patients with mild to moderate severity depression. Many older patients need the same doses of antidepressant medication that are used for younger adult patients. Although antidepressants may effectively treat depression in older adults, they tend to pose greater risk for adverse events because of multiple medical comorbidities and drug-drug interactions in case of polypharmacy. High-quality evidence does not support the use of pharmacologic treatment of depression in patients with dementia. Polypharmacy in older patients can be minimized by using the Screening Tool of Older Persons Prescriptions and Screening Tool to Alert doctors to Right Treatment (STOPP/START) criteria, a valid and reliable screening tool that enables physicians to avoid potentially inappropriate medications, undertreatment, or errors of omissions in older people. Antidepressants can be gradually tapered over a period of several weeks, but discontinuation of antidepressants may be associated with relapse or recurrence of depression, so the patient should be closely observed.
Major depression in older adults is common and can be effectively treated with antidepressants and electroconvulsive therapy. Psychological therapies and exercise may also be effective for mild-moderate depression, for patients who prefer nonpharmacological treatment, or for patients who are too frail for drug treatments.
老年人抑郁症是一种常见的精神疾病，影响其与健康相关的生活质量。 55 岁或以上的成年人中，有 2%患有重度抑郁症，而且随着年龄的增长，其患病率会上升。此外，即使没有重度抑郁症，10%至 15%的老年人也有明显的临床抑郁症状。
老年人的抑郁症表现与年轻人相同。与年轻患者不同，老年抑郁症患者通常同时患有多种并存的医疗疾病和认知障碍。老年人的抑郁症往往未被发现或治疗不足。抗抑郁药是研究最多的治疗选择，但心理治疗、运动疗法和电惊厥疗法也可能有效。对于轻度至中度严重程度的抑郁症，建议进行心理治疗。许多老年患者需要与年轻成年患者相同剂量的抗抑郁药。尽管抗抑郁药可能有效治疗老年患者的抑郁症，但由于多种合并症和药物相互作用导致药物不良反应的风险更大，尤其是在联合用药的情况下。高质量的证据并不支持在痴呆症患者中使用药物治疗抑郁症。通过使用老年人处方筛选工具和提醒医生正确治疗的筛选工具（STOPP/START）标准，可以最大限度地减少老年患者的联合用药。这是一种有效且可靠的筛选工具，使医生能够避免老年人潜在的不适当药物、治疗不足或用药遗漏错误。抗抑郁药可以在数周内逐渐减少剂量，但停药可能会导致抑郁症复发或再次发作，因此应密切观察患者。
老年人的重度抑郁症很常见，可以用抗抑郁药和电惊厥疗法有效治疗。心理疗法和运动疗法也可能对轻度至中度抑郁症有效，适用于更喜欢非药物治疗的患者，或因身体太虚弱而不能进行药物治疗的患者。
