Geriatric Depression (also known as Late-Life Depression, or LLD) is a subtype of depression characterized by changes in mood, lack of pleasure, and often somatic symptoms in older adults. It is one of the major geriatric giants. It is most commonly defined as depression occurring in adults age 60 and over.[1]
A complete assessment for late-life depression requires:
Name | Rater | Description | Download |
---|---|---|---|
Geriatric Depression Scale (GDS) | Clinician/Patient | 30-question (15-questions for the short version) from a clinician scoring or self-report assessment with “yes” or “no” answers. 1 point assigned to each positive answer (See author's website for more details). | • Short-form (15 questions) • Long-form (30 questions) |
Delirium | Dementia | Depression | |
---|---|---|---|
Cardinal feature | Confusion and Inattention | Memory loss | Sadness, anhedonia |
Onset | Acute or subacute | Insidious | Slow |
Course | Fluctuating, often worse at night | Chronic, progressive (but stable over the course of a day) | Single or recurrent episodes; can be chronic |
Duration | Hours to months | Months to years | Weeks to years |
Level of Conciousness (LOC) | Impaired, fluctuates | Normal in early stages | Normal |
Attention (i.e. - able to focus on tasks) | Poor | Normal (except in late stages) | May be impaired |
Orientation (i.e. - date, location) | Fluctuates | Poor | Normal |
Memory (i.e. - short-term memory) | Poor | Poor | May be impaired |
Hallucinations | Common (visual) | Rare, except in late stages (and depends on type of dementia) | Not usually (only if psychotic depression) |
Delusions | Fleeting, non-systematized | Often absent | Not usually (only if psychotic depression) |
Psychomotor | Increased (hyperactive) or reduced (hypoactive) | No | Yes |
Reversibility | Yes | Rarely | Yes |
EEG Findings | Moderate to severe background slowing | Normal or mild diffuse slowing | Normal (usually) |
1st Step (use one or more agents in sequence) | Monotherapy: duloxetine, mirtazapine, sertraline, venlafaxine, vortioxetine, citalopram, desvenlafaxine, escitalopram |
2nd Step (if multiple 1st-step treatments are not effective or not indicated) | Switch to: nortriptyline, fluoxetine, moclobemide, paroxetine, phenelzine, quetiapine, trazodone, bupropion Or combine with: aripiprazole (2.5 to 15 mg)[23], methylphenidate, lithium |
3rd Step (if multiple 1st- and 2nd-step treatments are not effective or not indicated) | Switch to: amitriptyline, imipramine Or combine with: an SSRI or SNRI with bupropion |
Guideline | Location | Year | Website | |
---|---|---|---|---|
Canadian Network for Mood and Anxiety Treatments (CANMAT) | Canada | 2016 | - | • Original: Link • Correction: Link |
Canadian Coalition for Seniors' Mental Health (CCSMH) | Canada | 2021 | Link | CCSMH Depression |