Department of Pharmacy Practice, The University of Montana, Skaggs School of Pharmacy, College of Health Professions, Missoula, Montana.
Sr Care Pharm. 2021 Jan 1;36(1):11-21. doi: 10.4140/TCP.n.2021.11.
Depression is common in older people, and while the approach to treatment is similar to a younger population, there are several additional treatment considerations to make based on comorbidities and cognitive impairment. Evidence-based psychotherapies such as cognitive behavioral therapy, interpersonal psychotherapy, and problem-solving therapy are recommended for mild-moderate depression in older people; however, the efficacy of these are limited in very old patients (older than 75 years of age) and those with cognitive impairment. Additionally, neuromodulation treatments such as electroconvulsive therapy and transcranial magnetic stimulation could prove beneficial for specific older people with depression. Use of pharmacotherapy that has demonstrated to be safe in older adults, as well as agents with adequate clinical experience in this population, should be considered based on patient-specific characteristics. Because of generally more complex medication regimens, risks of pharmacotherapy should be minimized with careful dosing strategies and special attention to avoid significant drug-drug interactions. While some data are available, antidepressant combination or augmentation strategies are less well studied in older people who fail to achieve remission or those with treatment-resistant depression, compared with younger populations.
抑郁症在老年人中很常见，虽然治疗方法与年轻人相似，但基于合并症和认知障碍，还需要考虑一些额外的治疗注意事项。对于老年人的轻中度抑郁症，推荐使用认知行为疗法、人际心理疗法和问题解决疗法等循证心理疗法；然而，对于非常老的患者（75 岁以上）和认知障碍患者，这些疗法的疗效有限。此外，对于有抑郁症状的特定老年人，神经调节治疗，如电惊厥治疗和经颅磁刺激，可能证明是有益的。应根据患者的具体特征，考虑使用已证明在老年人中安全的药物治疗，以及在该人群中有足够临床经验的药物。由于一般来说药物治疗方案更为复杂，因此应通过仔细的剂量策略和特别注意避免严重的药物相互作用，将药物治疗的风险降至最低。虽然有一些数据，但与年轻人群相比，对于未能达到缓解或治疗抵抗的老年患者，抗抑郁药联合或增效策略的研究较少。
