Management of bipolar and unipolar depression in geriatric population

Abstract

Major depression, dysthymic disorders and subclinical depressions are common psychiatric problems after the age of 65. Bipolar depression in elderly, however, is either an aging previous patient or someone whose first attack has appeared on late life. The first step of treatment in the elderly depression is the investigation of the etiology for excluding any medical background. Treatment involves pharmacological agents such as antidepressants and mood stabilizer drugs, electroconvulsive therapy and various enforcement therapies. Response to drug therapy maybe more delayed than younger patients. Polypharmacy, and especially those drugs with anti-cholinergic properties should be avoided. The first line treatment of choice for geriatric depression should be serotonin-uptake-inhibitors (SSRI’s). Serotonin- noradrenaline re-uptake inhibitors (SNRI) may also be used. Mood stabilizers such as lithium, valproate, and carbamazepine should be utilized in much lower doses in older people, keeping in mind that they can easily be toxic. Insufficient double blind, randomized studies on the treatment of bipolar depression treatment in the elderly and the inadequacy of guidelines are the major downsides in this situation.

Keywords

• geriatric population, bipolar disorder, unipolar

Geriatrik hastalarda iki uçlu ve tek uçlu depresyon tedavi yönetimi

Abstract

Major depresyon distimik bozukluk eşik altıı depresyonlar 65 yaş sonrasında en sık görülen psikiyatrik bozukluklardır. İki uçlu bozukluk zemininde depresyon ise ya yaşlanan eski hastalar yada ilk atağını ileri yaşta geçiren hastalar olarak karşımıza çıkar. Yaşlı kişilerde tedavinin en önemli basamağı olası tıbbi nedenlerin sorgulandığı etyolojik araştırmadır. Farmakolojik tedavi de ise antidepresanlar mizaç düzenleyicileri elektrokonvulsif terapi ve çeşitli güçlendirme tedavileri uygulanabilir. Tedavi yanıtı gençlere göre daha geç ortaya çıkabilir. Bu arada polifarmasiden, başta antikolinerjik etkiler olmak üzere yan etkilerden kaçınmak önemlidir. Yaşlılık depresyonunda birinci sırada serotonin geri alım inibitörleri (SSRI) önerilir. Seratonin noradrenalin geri alım inhibitörleri (SNRI) de kullanılabilir. Lityum, valpoat, karbamazepin gibi duygudurum dengeleyiciler gençlere göre düşük dozlarda kullanılmalı ve çok çabuk toksik olabilecekleri akılda tutulmalıdır. Yaşlı iki uçlu depresyon tedavisinde yeterince çift kör randomize çalışma olmaması uzlaşı raporlarının yetersizliği önemli bir eksiklik olarak görünmektedir.

Keywords

• geriatrik toplum, iki uçlu bozukluk, tek uçlu

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