Depression treatment is as effective in older (over 65) as in younger adults

Depression in later life, traditionally defined as age older than 65, is associated with disability, increased mortality, and poorer outcomes.

Compared to younger adults with depression:

- cognitive and functional impairment and anxiety are more common in older adults

- older adults with depression are at increased risk of suicide

Depression is associated with cognitive impairment and an increased risk of dementia.

A selective serotonin reuptake inhibitor (SSRI) should be the first line pharmacological treatment for depression for most older adults.

Psychological and drug treatment is as effective in older as in younger adults

References:

Depression in older adults. Rodda et al. BMJ, 2011.

Image source: Vincent van Gogh's 1890 painting At Eternity's Gate. Wikipedia, public domain.

Battling depression with "battery-powered brains" - CNN report on deep brain stimulation (DBS)

CNN reports on treating severe depression with electrodes inside the brain:



The procedure -- called deep brain stimulation, or DBS -- targets a small brain structure known as Area 25, the "ringleader" for the brain circuits that control our moods.

Area 25 is relatively overactive in depressed patients. One hypothesis is that in patients who do not improve with treatments for depression, Area 25 is somehow stuck in overdrive.

DBS had been used since 1997 as a treatment for movement disorders, including essential tremor, Parkinson's disease and dystonia.

References:

Treating depression with electrodes inside the brain. CNN, 2012.

Depression affects up to 9% of U.S. population - how to do effective screening?

From American Family Physician:

Depression affects up to 9% of U.S. population.

The U.S. Preventive Services Task Force recommends screening in adolescents and adults but it does not recommend screening for depression in children 7-11 years of age, or screening for suicide risk in the general population.

The Patient Health Questionnaire (PHQ)-2 and PHQ-9 are commonly used and validated screening tools.

The PHQ-2 has a 97% sensitivity and 67% specificity in adults. The PHQ-2 inquires about the frequency of depressed mood and anhedonia over the past 2 weeks, scoring each as 0 ("not at all") to 3 ("nearly every day").

PHQ-9 has a 61% sensitivity and 94% specificity in adults. The PHQ-9 depression module scores each of the 9 DSM-IV criteria as “0” (not at all) to “3” (nearly every day).

If the PHQ-2 is positive for depression, the PHQ-9 should be administered.

In older adults, the 15-item Geriatric Depression Scale is an appropriate follow-up test.

If these screening tests are positive for depression, further evaluation is needed to confirm that the patient's symptoms meet the Diagnostic and Statistical Manual of Mental Disorders' (DSM) criteria for diagnosis.

Suicide is second to only accidental death as the leading cause of mortality in young men across the world. High-lethality methods of suicide are preferred by young men: hanging and firearms in high-income countries, pesticide poisoning in the Indian subcontinent, and charcoal-burning in east Asia (Lancet, 2012).

References:

Screening for depression. Maurer DM. Am Fam Physician. 2012 Jan 15;85(2):139-44.

Image source: Vincent van Gogh's 1890 painting At Eternity's Gate. Wikipedia, public domain.

Unipolar depression in adolescence is common worldwide but often unrecognized

Unipolar depressive disorder in adolescence is common worldwide but often unrecognised. The incidence, notably in girls, rises sharply after puberty and, by the end of adolescence, the 1 year prevalence rate exceeds 4%.

The burden of depression is highest in low-income and middle-income countries. Depression is associated with morbidity, and heightens suicide risk.

The strongest risk factors for depression in adolescents are:

- family history of depression
- exposure to psychosocial stress

Factors that interact to increase risk through hormonal and perturbed neural pathways include:

- inherited risks
- developmental factors
- sex hormones
- psychosocial adversity

References:

Depression in adolescence. Prof Anita Thapar et al. The Lancet, Volume 379, Issue 9820, Pages 1056 - 1067, 17 March 2012.

Image source: OpenClipArt.org

We Need To Talk | A Story of Loss and Hope - Johns Hopkins' video on depression

"Millions of people suffer from depression. Many suffer in silence. Effective treatments for depression exist, but only half of those who are depressed seek help. View this video, sponsored by the Healthy Community Partnership, to learn how important it is to start the conversation about mental illness. It could save a life."



Here is a related resource: Managing Your Depression: What You Can Do to Feel Better (A Johns Hopkins Press Health Book):

Using the Internet for health purposes was associated with increased depression

The rapid expansion of the Internet has increased the ease with which the public can obtain medical information. Most research on the utility of the Internet for health purposes has evaluated the quality of the information or examined its impact on clinical populations. Little is known about the consequences of its use by the general population.

Health-related Internet use was associated with small but reliable increases in depression (i.e., increasing use of the Internet for health purposes from 3 to 5 days per week to once a day was associated with 0.11 standard deviations more symptoms of depression, P = 0.002).

Using the Internet for health purposes was associated with increased depression. The increase may be due to increased rumination, unnecessary alarm, or over-attention to health problems.

In contrast, using the Internet to communicate with friends and family was associated with declines in depression.

References:

Effects of Internet Use on Health and Depression: A Longitudinal Study. J Med Internet Res 2010;12(1):e6.

Negative consequences from the use of internet for health information - CDC (PDF) http://goo.gl/Fgcq via http://goo.gl/947F

Image source: Wikipedia, public domain.

Updated: 08/12/2010

Excessive Internet use may be linked to depression

Excessive Internet use may be linked to depression. Spend a day offline and connect with friends and family.

Twitter comment by @MiriamETucker: But they're all online!

Your Internet use could be telling you something about your mental health. If you keep up with friends via Facebook or spend more time chatting online with strangers than with family, it might be time to disconnect the computer for awhile — and check in with yourself.

The researchers analyzed internet use and depression levels of 1,319 Britons aged between 16 and 51. An online questionnaire was used to measure participants' Internet use, the functions for which they used the Internet, and their depressive tendencies. Of these, 1.2 percent were "internet addicted."

"Excessive internet use is associated with depression, but what we don't know is which comes first -- are depressed people drawn to the internet or does the internet cause depression?"

Using the Web to replace your usual social circle could be a red flag. Instead of spending hours on message boards, pick up the phone and call someone.

Twitter comments:

@BiteTheDust (Robbo) re: internet and depression.... if you skype someone is that using the phone or using the internet? just asking :)

@amacdt Especially if you use video skype - it's a tough one. I find that I really enjoy talking to people with video

References:

The relationship between excessive Internet use and depression: a questionnaire-based study of 1,319 young people and adults. Morrison CM, Gore H. Psychopathology. 2010;43(2):121-6. Epub 2010 Jan 23.

Study links excessive Internet use to depression. Reuters.

http://www.360-5.com

Image source: Wikipedia, public domain.