Assessing and Treating Depression in Older Adults

Posted: April 4th, 2019

Assessing and Treating Vulnerable for Depressive Disorders

TO PREPARE FOR THIS ASSIGNMENT

• Review this week’s Learning Resources, including the Medication Resources indicated for this week.

• Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of vulnerable patient populations requiring antidepressant therapy.

THE ASSIGNMENT: 5 PAGES

For this assignment, you will develop a patient medication guide for treatment of depressive disorders in a vulnerable population (your choice for one vulnerable patient population to choose from: children, adolescents, older adults, dementia patients, pregnant women). Be sure to use language appropriate for your audience (patient, caregiver, parent, etc.). You will include non-copyright images and/or information tables to make your patient medication guide interesting and appealing. Limit your patient medication guide to 5 pages. You will create this guide as an assignment; therefore, a title page, introduction, conclusion, and reference page are required. You must include a minimum of 4 scholarly supporting resources outside of your course provided resources.

In your patient guide, include discussion on the following:

• Depressive disorder causes and symptoms

• How depression is diagnosed for the vulnerable population of your choice, why is this population considered vulnerable

• Medication treatment options including risk vs benefits; side effects; FDA approvals for the vulnerable population of your choice

• Medication considerations of medication examples prescribed (see last bullet item)

• What is important to monitor in terms of labs, comorbid medical issues with why important for monitoring.

• Special Considerations (you must be specific, not general and address at least one for EACH category; you must demonstrate critical thinking beyond basics of HIPPA and informed consent!): legal considerations, ethical considerations, cultural considerations, social determinants of health

• Where to follow up in your local community for further information

• Provide 3 examples of how to write a proper prescription that you would provide to the patient or transmit to the pharmacy.

Assessing and Treating Depression in Older Adults
Introduction
Depression is a serious medical condition that affects both mental and physical health. While depression can impact people of all ages, older adults aged 65 and over are particularly vulnerable. This patient guide will discuss causes and symptoms of depression, how it is diagnosed in older adults, medication treatment options and considerations, monitoring safety, and community resources. The goal is to empower older adults and their caregivers to better understand and manage depression with medical support.
Causes and Symptoms
Depression in older adults can stem from biological, psychological, social and environmental factors (American Psychiatric Association, 2013). Common biological causes include chronic illness, brain changes, and medication side effects. Psychological stressors may involve bereavement, loneliness, and loss of independence. Social determinants like low income, lack of social support, and caregiver stress also contribute (Centers for Disease Control and Prevention, 2020). Symptoms in older adults are similar to younger adults but may present differently, like physical complaints instead of mood changes (National Institute of Mental Health, 2016). Key signs to watch for include persistent sad mood, loss of interest in activities, changes in appetite, sleep disturbances, lack of energy, difficulty concentrating, and thoughts of death or suicide (American Psychiatric Association, 2013).
Diagnosis
A thorough medical exam and patient interview are required to diagnose depression in older adults (National Institute of Mental Health, 2016). Doctors will ask about symptoms, medical history, living situation, and family history of mental illness. They may also conduct physical exams, lab tests, and cognitive assessments to rule out other potential causes of symptoms like thyroid problems, dementia, or medication side effects (American Psychiatric Association, 2013). A clinical diagnosis of major depressive disorder requires at least five symptoms nearly every day for at least two weeks, along with significant impairment in daily life (American Psychiatric Association, 2013).
Medication Treatment Options

Once diagnosed, antidepressant medication is usually the first-line treatment for depression in older adults (National Institute of Mental Health, 2016). Selective serotonin reuptake inhibitors (SSRIs) are generally the safest and best-tolerated class of antidepressants for this population (American Psychiatric Association, 2013). Common SSRIs prescribed include escitalopram (Lexapro), sertraline (Zoloft), and citalopram (Celexa). Other options include serotonin-norepinephrine reuptake inhibitors (SNRIs) like duloxetine (Cymbalta) and venlafaxine (Effexor). Benefits of antidepressants include reducing depressive symptoms and risk for relapse (National Institute of Mental Health, 2016). However, side effects like insomnia, nausea, dizziness, and sexual dysfunction are more common in older adults and require careful monitoring (American Psychiatric Association, 2013). Dosages also need to be lower and increased more gradually to avoid adverse drug reactions (Centers for Disease Control and Prevention, 2020).
Medication Considerations

When prescribing antidepressants for older adults, doctors consider several important factors. Due to changes in liver and kidney function, drug metabolism may be slower in this population (National Institute of Mental Health, 2016). This requires adjusting dosages and monitoring for drug-drug interactions from other medications (Centers for Disease Control and Prevention, 2020). Comorbid medical conditions like heart disease and diabetes also necessitate extra precautions and coordination of care (American Psychiatric Association, 2013). Older adults are more prone to side effects like falls and fractures from dizziness or sedation, so starting at low doses is critical (National Institute of Mental Health, 2016). Adherence challenges from multiple medications or cognitive impairment also require support strategies like pill organizers and caregiver involvement (Centers for Disease Control and Prevention, 2020).
Monitoring Safety

Close monitoring by both doctors and caregivers is vital when treating depression in older adults with medication (American Psychiatric Association, 2013). Initial check-ins may occur weekly to assess response and side effects before transitioning to monthly follow-ups (National Institute of Mental Health, 2016). At each visit, doctors should review medical history, check vital signs and conduct physical exams looking for signs of toxicity or adverse drug reactions (Centers for Disease Control and Prevention, 2020). They may also order routine bloodwork to screen for changes in electrolytes, liver or kidney function from drug interactions (American Psychiatric Association, 2013). At home, caregivers play a key role in observing mood, appetite, sleep patterns and daily functioning between appointments (National Institute of Mental Health, 2016). Any concerning new symptoms should prompt contacting the prescribing doctor.
Community Resources
Local mental health agencies provide counseling, support groups, and case management that can augment antidepressant treatment (American Psychiatric Association, 2013). Examples include county mental health departments and nonprofit organizations (National Institute of Mental Health, 2016). Primary care offices also deliver mental healthcare and can connect patients to community services (Centers for Disease Control and Prevention, 2020). Senior centers offer social activities and referrals that address loneliness impacting depression. National hotlines like 911 can dispatch emergency responders for urgent psychiatric needs like suicidal thoughts (American Psychiatric Association, 2013).
Conclusion
Depression significantly impacts quality of life for many older adults. With a combination of antidepressant medication, therapy, social support and monitoring, treatment outcomes are promising. This guide aimed to demystify depression care for vulnerable seniors and caregivers. Managing both mental and physical health is key, as is leveraging community resources available. With medical support and advocacy, older adults can better understand and self-manage their depression.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Centers for Disease Control and Prevention. (2020, June 5). Depression in older adults. https://www.cdc.gov/aging/mentalhealth/depression.htm
National Institute of Mental Health. (2016, February). Older adults and depression. https://www.nimh.nih.gov/health/publications/older-adults-and-depression/index.shtml