BibTex RIS Kaynak Göster

Management of bipolar and unipolar depression in geriatric population

Yıl 2013, Cilt: 3 Sayı: 5, 0 - 0, 01.05.2013

Öz

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.

Kaynakça

  • Chiu E, Ames D, Draper B, Snowdon J. (1999) Depressive disorders in the elderly: a review In (Eds. Maj, M, Sartorius, N. Depressive Disorders John Wiley & Sons Ltd. 313-363.
  • Lebowitz BD, Pearson JL, Schneider L. et al. Consensus statement. Diagnosis and treatment of depression in late life. JAMA 1997;278:1186-90.
  • Blazer D, Williams CD. Epidemiology of dysphoria and depression in an elderly population. Am J Psychiatry. 1980;137: 439-44.
  • Kulaksızoğlu IB, Gurvit H, Polat A, et al. Unrecognized Depression in Community-Dwelling Elderly in İstanbul. Int psychogeriatrics 2005;17:303
  • Bernstein JG: Pharmacologic management of the elderly patient.(1984) İn Bernstein JG(ed): Clinical psycopharmacology, ed 2. Boston, John WrightPSG, pp 233-56.
  • Abernaty DR: (1992) Psychotropic drugs and the aging process: pharmacokinetics and pharmacodynamics, in Clinical Geriatric Psychiatry, 2nd edition. Edited by Salzman C. Baltimore, MD, Willims&Wilkins, p 61Alexopoulos GS.(1992) Treatment of depression , in Clinical Geriatric Psychiatry, 2nd edition. Edited by Salzman C. Baltimore, Md, Williams& Wilkins, pp 137-74.
  • Bressler R, Katz MD. Drug therapy for geriatric depression. Drugs Aging 1993;3:195-219, Flint AJ. Recent developments in geriatric psychopharmacotherapy. Can J Psychiatry 1994;39:9-18.
  • Young RC, Gyulai L, Mulsant BH, et al. Pharmacotherapy of bipolar disorder in old age. Am J Ger Psychiatry 2004;12:342-57.
  • ReynoldsCFIII, LebowitzBD, SchneiderLS. The NIH consensus development conference on the diagnosis and treatment of depression in late life: an overview. Psychopharmacol Bull 1993;29:83-5.
  • Lebowitz BD, Pearson JL, Schneider LS etal. Diagnosis and treatment of depression in late life: consensus statement update. JAMA 1997;278:1186
  • Anderson IM. Selective serotonin reuptake inhibitors versus tricyclic antidepressants: a meta-analysis of efficacy and tolerability. J Affect Disord 2000;58:19-36.
  • TaylorWD, Doraiswamy PM. A systematic review of antidepressant placebo-controlled trials for geriatric depression: limitations of current data and directions for the future. Neuro- psychopharmacology 2004;29:2285-99.
  • Wilson K, Mottram P, Sivanranthan A, et al. Antidepressant versus placebo for depressed elderly. Cochrane Database Syst Rev 2005(3):CD000561.
  • Bains J, Birks JS, Dening TR. The efficacy of antidepressants in the treatment of depression in dementia. Cochrane Database Syst Rev 2005(3):CD003944.
  • American geriatrics society updated Beers Criteria for potentially inappropriate medication use in older adults. The American geriatrics society expert panel 2012 doi:10.1111/j.1532-5415.2012.03923.x
  • Mahatapa SN, Hackett D. A randomized, duble blind, parallel group comparison of venlafaxine and dothiepine in geriatric patients with major depression. Int J Clin Pract 1997;51:209-13.
  • Wilson K, Mottoram P et all. Antidepresant versus placebo for depressed elderly. Cocrane database Syst rev. 2001(2); CD 000561
  • Raskin J, Wiltse CG, Siegal A et all: Efficacy of duloxetine on cognition, depression and pain in elderly patients with major depression: 8 week double blind placebo controlled trait. Am. J Psychiatry 2007;164:900-9.
  • Schatzberg AF, Kremer C, Rodrigues HE et al. Double blind randomized comparison of mirtazapine and paroxetine in elderly depressed patients. Am J Geriatr Psychiatry 2002;10:541-50.
  • Gerner R, Estabrook W, Stuer J. et all. Treatment of geriatric depression with trazadone , imipramine and placebo. J Clin Psychiatry 1980;41:216
  • Van der Wurff FB, Stek ML, Hoogendijk WJ, et al. The efficacy and safety of ECT in depressed older adults: a literature review. Int J Geriatr Psychiatry 2003;894-904.
  • Sackeim HA, Haskett RF, MulsantBH, etall. Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. JAMA 2001;285:1299-307.
  • Alexopoulos G, Katz I, Reynolds CI et all. The expert consensus guideline series pharmacotherapy of depressive disorders in older patients. Postgraduate Medicine Report 2001(oct):1-88.
  • Young R. Evidence based pharmacological treatment of bipolar disorder in geriatric patients Psychiatr Clin N Am 2005;28:837-69.
  • Sajatovic M, Gyulai L, Calabrese JR et al. Maintenance treatment outcomes in older patients with bipolar I disorder. Am J Geriatr Psychiatry 2005;13:305-11.
  • Alexopoulos G, Stream JE, Carpenter D. Expert consensus guidelines for using antipschotic agents in older patients. J Clin Psychiatry 2004;65; 5-99. Essali A., Ali G.: Antipscyhotic drug treatment for elderly people with late onset psychosis. Cocrane database of systematic reviews 2012 ıssue 2 art no: CD004162.
  • Young RC, Gyulai L, Mulsant BH, et al. Pharmacotherapy of bipolar disorder in old age. Am J Ger Psychiatry 2004;12:342-57.
  • Mc Farland BH, Miller MR, Strumfjord AA. Valproate use in the older manic patient. J Clin Psychiatry 1990;51:479-81.
  • BowdenC. Anticonvulsantsin bipolar elderly. n:NelsonJC, editor. Geriatricpsychophar- macology. New York: Marcel Dekker; 1998. p. 285

Geriatrik hastalarda iki uçlu ve tek uçlu depresyon tedavi yönetimi

Yıl 2013, Cilt: 3 Sayı: 5, 0 - 0, 01.05.2013

Öz

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.

Kaynakça

  • Chiu E, Ames D, Draper B, Snowdon J. (1999) Depressive disorders in the elderly: a review In (Eds. Maj, M, Sartorius, N. Depressive Disorders John Wiley & Sons Ltd. 313-363.
  • Lebowitz BD, Pearson JL, Schneider L. et al. Consensus statement. Diagnosis and treatment of depression in late life. JAMA 1997;278:1186-90.
  • Blazer D, Williams CD. Epidemiology of dysphoria and depression in an elderly population. Am J Psychiatry. 1980;137: 439-44.
  • Kulaksızoğlu IB, Gurvit H, Polat A, et al. Unrecognized Depression in Community-Dwelling Elderly in İstanbul. Int psychogeriatrics 2005;17:303
  • Bernstein JG: Pharmacologic management of the elderly patient.(1984) İn Bernstein JG(ed): Clinical psycopharmacology, ed 2. Boston, John WrightPSG, pp 233-56.
  • Abernaty DR: (1992) Psychotropic drugs and the aging process: pharmacokinetics and pharmacodynamics, in Clinical Geriatric Psychiatry, 2nd edition. Edited by Salzman C. Baltimore, MD, Willims&Wilkins, p 61Alexopoulos GS.(1992) Treatment of depression , in Clinical Geriatric Psychiatry, 2nd edition. Edited by Salzman C. Baltimore, Md, Williams& Wilkins, pp 137-74.
  • Bressler R, Katz MD. Drug therapy for geriatric depression. Drugs Aging 1993;3:195-219, Flint AJ. Recent developments in geriatric psychopharmacotherapy. Can J Psychiatry 1994;39:9-18.
  • Young RC, Gyulai L, Mulsant BH, et al. Pharmacotherapy of bipolar disorder in old age. Am J Ger Psychiatry 2004;12:342-57.
  • ReynoldsCFIII, LebowitzBD, SchneiderLS. The NIH consensus development conference on the diagnosis and treatment of depression in late life: an overview. Psychopharmacol Bull 1993;29:83-5.
  • Lebowitz BD, Pearson JL, Schneider LS etal. Diagnosis and treatment of depression in late life: consensus statement update. JAMA 1997;278:1186
  • Anderson IM. Selective serotonin reuptake inhibitors versus tricyclic antidepressants: a meta-analysis of efficacy and tolerability. J Affect Disord 2000;58:19-36.
  • TaylorWD, Doraiswamy PM. A systematic review of antidepressant placebo-controlled trials for geriatric depression: limitations of current data and directions for the future. Neuro- psychopharmacology 2004;29:2285-99.
  • Wilson K, Mottram P, Sivanranthan A, et al. Antidepressant versus placebo for depressed elderly. Cochrane Database Syst Rev 2005(3):CD000561.
  • Bains J, Birks JS, Dening TR. The efficacy of antidepressants in the treatment of depression in dementia. Cochrane Database Syst Rev 2005(3):CD003944.
  • American geriatrics society updated Beers Criteria for potentially inappropriate medication use in older adults. The American geriatrics society expert panel 2012 doi:10.1111/j.1532-5415.2012.03923.x
  • Mahatapa SN, Hackett D. A randomized, duble blind, parallel group comparison of venlafaxine and dothiepine in geriatric patients with major depression. Int J Clin Pract 1997;51:209-13.
  • Wilson K, Mottoram P et all. Antidepresant versus placebo for depressed elderly. Cocrane database Syst rev. 2001(2); CD 000561
  • Raskin J, Wiltse CG, Siegal A et all: Efficacy of duloxetine on cognition, depression and pain in elderly patients with major depression: 8 week double blind placebo controlled trait. Am. J Psychiatry 2007;164:900-9.
  • Schatzberg AF, Kremer C, Rodrigues HE et al. Double blind randomized comparison of mirtazapine and paroxetine in elderly depressed patients. Am J Geriatr Psychiatry 2002;10:541-50.
  • Gerner R, Estabrook W, Stuer J. et all. Treatment of geriatric depression with trazadone , imipramine and placebo. J Clin Psychiatry 1980;41:216
  • Van der Wurff FB, Stek ML, Hoogendijk WJ, et al. The efficacy and safety of ECT in depressed older adults: a literature review. Int J Geriatr Psychiatry 2003;894-904.
  • Sackeim HA, Haskett RF, MulsantBH, etall. Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. JAMA 2001;285:1299-307.
  • Alexopoulos G, Katz I, Reynolds CI et all. The expert consensus guideline series pharmacotherapy of depressive disorders in older patients. Postgraduate Medicine Report 2001(oct):1-88.
  • Young R. Evidence based pharmacological treatment of bipolar disorder in geriatric patients Psychiatr Clin N Am 2005;28:837-69.
  • Sajatovic M, Gyulai L, Calabrese JR et al. Maintenance treatment outcomes in older patients with bipolar I disorder. Am J Geriatr Psychiatry 2005;13:305-11.
  • Alexopoulos G, Stream JE, Carpenter D. Expert consensus guidelines for using antipschotic agents in older patients. J Clin Psychiatry 2004;65; 5-99. Essali A., Ali G.: Antipscyhotic drug treatment for elderly people with late onset psychosis. Cocrane database of systematic reviews 2012 ıssue 2 art no: CD004162.
  • Young RC, Gyulai L, Mulsant BH, et al. Pharmacotherapy of bipolar disorder in old age. Am J Ger Psychiatry 2004;12:342-57.
  • Mc Farland BH, Miller MR, Strumfjord AA. Valproate use in the older manic patient. J Clin Psychiatry 1990;51:479-81.
  • BowdenC. Anticonvulsantsin bipolar elderly. n:NelsonJC, editor. Geriatricpsychophar- macology. New York: Marcel Dekker; 1998. p. 285
Toplam 29 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Makaleler
Yazarlar

Işın Baral Kulaksızoğlu Bu kişi benim

Yayımlanma Tarihi 1 Mayıs 2013
Yayımlandığı Sayı Yıl 2013 Cilt: 3 Sayı: 5

Kaynak Göster

APA Kulaksızoğlu, I. B. (2013). Geriatrik hastalarda iki uçlu ve tek uçlu depresyon tedavi yönetimi. Journal of Mood Disorders, 3(5).
AMA Kulaksızoğlu IB. Geriatrik hastalarda iki uçlu ve tek uçlu depresyon tedavi yönetimi. Journal of Mood Disorders. Mayıs 2013;3(5).
Chicago Kulaksızoğlu, Işın Baral. “Geriatrik Hastalarda Iki uçlu Ve Tek uçlu Depresyon Tedavi yönetimi”. Journal of Mood Disorders 3, sy. 5 (Mayıs 2013).
EndNote Kulaksızoğlu IB (01 Mayıs 2013) Geriatrik hastalarda iki uçlu ve tek uçlu depresyon tedavi yönetimi. Journal of Mood Disorders 3 5
IEEE I. B. Kulaksızoğlu, “Geriatrik hastalarda iki uçlu ve tek uçlu depresyon tedavi yönetimi”, Journal of Mood Disorders, c. 3, sy. 5, 2013.
ISNAD Kulaksızoğlu, Işın Baral. “Geriatrik Hastalarda Iki uçlu Ve Tek uçlu Depresyon Tedavi yönetimi”. Journal of Mood Disorders 3/5 (Mayıs 2013).
JAMA Kulaksızoğlu IB. Geriatrik hastalarda iki uçlu ve tek uçlu depresyon tedavi yönetimi. Journal of Mood Disorders. 2013;3.
MLA Kulaksızoğlu, Işın Baral. “Geriatrik Hastalarda Iki uçlu Ve Tek uçlu Depresyon Tedavi yönetimi”. Journal of Mood Disorders, c. 3, sy. 5, 2013.
Vancouver Kulaksızoğlu IB. Geriatrik hastalarda iki uçlu ve tek uçlu depresyon tedavi yönetimi. Journal of Mood Disorders. 2013;3(5).