Detecting Depression and Anxiety in Older Adults Dr Nick Woodthorpe Depression in Older Adults Introduction to Depression • 1 in 5 older people living in the community • 2 in 5 living in care homes Causes of Depression • Painful events • Past depression or family history • Personality • Physical illness • Medicines • Drugs and Alcohol • Loneliness Particular Issues in Depression • Physical symptoms, for example, thyroid problems, heart disease or arthritis. • Long-term illness • Confusion and memory problems • A new sense of loneliness/lack of purpose Depression - Symptoms • 2 weeks • No hypomania or mania • No psychoactive drugs • No organic mental disorder Depression - Symptoms • Feeling low or sad (they may not report this) • Loss of interest in life • Low energy and tired for no reason Depression - Symptoms • Change in appetite and weight • Restlessness or psychomotor retardation • Anxious • Avoidance • Irritable • Sleep disturbance • Loss of confidence and self-esteem Depression - Symptoms • Hopelessness and worthlessness • Poor concentration • Panicky • Loss of libido • Sense of guilt • Suicidal thoughts • Delusions or hallucinations Depression - Diagnostic Categories • Mild • Moderate • Severe with or without psychosis • Recurrent Anxiety in Later Life Everyone gets anxious sometimes Everyone gets anxious sometimes Fight or Flight Response Fight or Flight Response Causes of anxiety in later life • Painful events • Stress • Past experiences- upbringing/Childhood • Personality • Physical illness • Medicines • Diet - caffeine, excess sugar, poor diet • Loneliness/Loss of role • Vulnerability • Lack of activities/social isolation Anxiety - Symptoms Psychological: • Feeling worried • Tired • Restless and irritable • Experiencing feelings of dread • Reduced concentration Anxiety - Symptoms Physical: • Fast or irregular heart beats (palpitations) • Shortness of breath • Excessive sweating • Dry mouth • Trembling • Dizziness • Diarrhoea/Stomach ache • Headache • Sleep disturbances • Muscle tension or pains • Nausea Diagnostic Categories • Phobias • Generalised anxiety disorder • Panic disorder • Post traumatic stress disorder • Obsessive-compulsive disorder Depression and Anxiety Management • Bloods • Antidepressants • SSRI • Mirtazapine • Venlafaxine and Duloxetine • Anxiolytics • Talking therapy Depression and Anxiety Management • Refer to secondary care – Significant risks: suicide/self-harm, harm from others and self-neglect – Trial of two antidepressants has not worked • If in doubt telephone for advice, regarding management or referral Antidepressant Tips • Sertraline is most cardiac friendly • Fluoxetine can be more alerting in older adults • Mirtazapine - if poor sleep and low appetite dominate • Mirtazapine 15mg ON is more sedating • Citalopram max dose is 20mg OD in older adults • Duloxetine is good for neuropathic pain Antidepressants and Hyponatraemia Older adults are particularly prone <0.5% incidence Antidepressant Total Reports of Hyponatraemia Total ADRs Reported to CSM Nortriptyline 1 404 Tranylcypromine 1 379 Reboxetine 3 885 Phenelzine 3 544 Trazodone 16 1068 Mirtazapine 26 2936 0.5-1.0% incidence amitriptyline, clomipramine, dosulepin, doxepin, imipramine, lofepramine, moclobemide, paroxetine, venlafaxine >1.0% incidence citalopram, escitalopram, fluoxetine, sertraline Advice to give patients • Seek help and talk to someone • Keep active • Stay connected • Eat properly • Depression is an illness - not a sign of weakness • Monitor alcohol intake • Sleep pattern should improve • Be kind to yourself How can friends and family help? • Listen and encourage • Try not to blame and being patient • Provide support • Recognise achievements • Learning about condition and identifying signs of relapse Useful Links • https://www.england.nhs.uk/wp- content/uploads/2017/09/practice-primer.pdf • https://mindedforfamilies.org.uk/older- people/ Thank you! Any Questions? .