Craig Nelson J
Leon J. Epstein Professor of Psychiatry, University of California San Francisco, San Francisco, CA, USA.
Handb Exp Pharmacol. 2019;250:389-413. doi: 10.1007/164_2018_170.
Depression is a common disorder in late life that is associated with poor quality of life, increased disability, and increased all-cause mortality. Rates of completed suicide are the highest in older depressed men compared with any other age group. In this age group, depression is often concurrent with medical illness and it can aggravate the course of medical illness. Cognitive impairment is frequently present and may be the result of the depression itself or may be the consequence of a neurodegenerative disorder such as Alzheimer's disease. Evidence-based psychotherapies, antidepressants, and somatic treatments such as electroconvulsive therapy are employed in the treatment of older depressed adults. Treatment may be complicated by the presence of cognitive impairment, other comorbid medical disorders, and medications used to treat these disorders. Certain safety issues such as increased bleeding risk, hyponatremia, decreased bone density and falls may be associated with antidepressant treatment, may be more common in older depressed adults, and their consequences may be more severe in late life. These risks, however, need to be weighed against the hazards of untreated depression. With appropriate care, most older depressed patients can be successfully treated and a positive outcome can have a significant effect on the patient's quality of life.
抑郁症是一种常见的老年疾病，与生活质量差、残疾增加和全因死亡率上升相关。与其他任何年龄组相比，老年男性抑郁症患者的自杀完成率最高。在这个年龄组中，抑郁症常与躯体疾病并发，并且会加重躯体疾病的病程。认知障碍经常出现，可能是抑郁症本身导致的结果，也可能是诸如阿尔茨海默病等神经退行性疾病的后果。基于证据的心理治疗、抗抑郁药以及诸如电休克治疗等躯体治疗方法被用于治疗老年抑郁症患者。由于存在认知障碍、其他共病的躯体疾病以及用于治疗这些疾病的药物，治疗可能会变得复杂。某些安全问题，如出血风险增加、低钠血症、骨密度降低和跌倒，可能与抗抑郁治疗有关，在老年抑郁症患者中可能更常见，并且它们的后果在老年期可能更严重。然而，这些风险需要与未治疗的抑郁症的危害相权衡。通过适当的护理，大多数老年抑郁症患者可以得到成功治疗，积极的治疗结果会对患者的生活质量产生重大影响。
