Treating depression

| The goals of depression treatment are to reduce depressive symptoms, prevent suicidal ideation, relapses or recurrences, improve cognitive and functional status, and help patients develop the skills necessary to cope with their disability. or psychosocial adversity, if necessary.

The objectives of the depression treatment They consist of reducing depressive symptoms, avoiding suicidal ideation, relapses or recurrences, improving cognitive and functional status and helping patients develop the necessary skills to deal with their disability or psychosocial adversity, if necessary .

Treatment planning should begin with an evaluation that focuses on identifying the intake of any drug that predisposes to the onset of depression. Treatment of the underlying cause or discontinuation of the offending drug is necessary, but is usually not sufficient to achieve remission of the depression. antidepressants, psychotherapy, or both are necessary and their combination is the preferred treatment option for depression in the elderly; however, drug therapy or psychotherapy alone are acceptable alternatives if the depression is mild.

Psychotherapy as a treatment for depression

Psychotherapy, in very diverse forms (cognitive, interpersonal, psychodynamic therapies, etc.), has an important role in the treatment of depression in the elderly in cases of mild or moderate intensity within a comprehensive approach to the problem.

Drugs for depression

antidepressant drugs, with significant development in recent years, have been known for decades for their high efficacy in the treatment of depression. The elderly present some peculiarities when using these drugs.

On the one hand, they are extremely sensitive to some side effects present in several of these drugs: cognitive deterioration, cardiovascular and urinary effects, sedation, ... On the other hand, they can present several diseases accompanying depression, which are sensitive to these adverse effects: heart disease, dementia, prostate hypertrophy, ... In addition, they may be taking other drugs that interact adversely with the antidepressant, reducing its effect or enhancing side effects.

For all these reasons, the choice of antidepressant must be adjusted to the characteristics of the patient by the primary care physician, psychiatrist or geriatrician, who are the professionals most frequently involved in these situations. The first step is to address any physical ailments (pain, limitations, etc.) and consider continuing any medications that may be making symptoms worse.

antidepressant therapy should be carefully monitored for its side effects, which may be more frequent in the elderly, as well as for interactions with other drugs that the elderly may take. Doctors generally prescribe lower doses of antidepressants for older people and increase the dose more slowly than in younger adults.

Among antidepressants, selective serotonin reuptake inhibitors (SSRIs) and those that inhibit the reuptake of serotonin and noreadrenaline (called mixed) are the first choice. Starting doses should be low, although they can be slowly increased to those used in younger people.

For depression initiated by a stressor, psychotherapy alone or in combination with pharmacological agents is recommended. Minor depression is more likely to respond better to non-specific forms of intervention than other forms of the illness. In these cases, close observation for at least 2 weeks is appropriate. However, if symptoms persist, the treatment of choice is the combination of SSRI plus psychotherapy.

Appropriate doses of the chosen agents should be indicated for at least 4 weeks before trying a new agent or qualifying the therapy as ineffective. If the response is poor, you can try increasing the dose, before changing or combining another drug.

Depression in the elderly can be a recurring disorder; for its maintenance, the doses of the antidepressants used must be the same as for the treatment. In cases with a single depressive episode, drug treatment should last at least one year. Patients with three or more episodes during their lifetime should receive maintenance drug therapy for at least three years.

To better manage depression at home, the elderly should follow a number of recommendations:

• Exercise regularly, seek enjoyable activities, and maintain good sleep habits.
• Learn to watch for early signs of depression and how to react if they get worse.
• Minimize alcohol consumption and avoid psychoactive drugs. These substances can make depression worse over time and can also impair judgment about suicide.
• Surround yourself with people who are loving and positive.
• Talk about your feelings with someone you trust.
• Take medications correctly and learn how to manage side effects.