Depression in seniors can pose challenges in diagnosis and treatment.
For example, depression impacts older people differently than younger people and can occur with other illnesses which mask its severity. Depression also lasts longer in seniors and takes longer to treat.
The American Association for Geriatric Psychiatry (AAGP) this year celebrates its 40th anniversary. There have been many advances in geriatric depression treatment since its founding, including pharmacogenomics.
Pharmacogenomics a Key Step Forward
Pharmacogenomic tools (like the GeneSight test) use a patient’s DNA to determine which medication may work well for them.
AAGP’s American Journal of Geriatric Psychiatry supports the use of testing in depression treatment. It recently published a critical analysis of peer-reviewed literature, concluding:
“Clinicians still employ a ‘trial-and-error’ approach to optimizing treatment regimens for late-life depression (LLD). With LLD affecting a significant and growing segment of the population, and with only about half of older adults responsive to antidepressant therapy, there is an urgent need for a better treatment paradigm. Pharmacogenetic decision support tools (DSTs), which are emerging technologies that aim to provide clinically actionable information based on a patient’s genetic profile, offer a promising solution.”
Testing can help with two of the biggest challenges for elderly patients:
- Comorbidity: When seniors are given sub-optimal antidepressant medications at incorrect doses, conditions like dementia, cardiovascular problems, diabetes and Parkinson disease can get worse.
- Polypharmacy: Many seniors take multiple medications for a variety of conditions. Mixing medications can cause unforeseen problems. GeneSight test results help doctors avoid negative drug-drug interactions.
40 Years in Depression Treatments Advancements for Seniors
Other methods of depression treatments for seniors have shown some success by themselves or in combination.
Ketamine was approved for use in 1970 as a medical anesthetic. Although not approved by the FDA as a depression treatment, there is a growing body of evidence supporting its use in difficult-to-treat cases.
For example, results of the first randomized control trial (RCT) evaluating the effects and safety of ketamine for elderly patients have been published in the American Journal of Geriatric Psychiatry. The trial evaluated dosage for each patient to maximize benefits and minimize side effects.
“… Ketamine well-tolerated by participants, with none experiencing severe or problematic side effects,” said lead author University of New South Wales Professor Colleen Loo.
- Electro Convulsive Therapy
Electro convulsive therapy (ECT) has evolved to use ultrabrief stimulation. ECT is considered for older adults who experience severe depression, debilitating side effects or drug interactions. According to medicinenet.com, “ECT is often a safe and effective treatment alternative.”
- Repetitive Transcranial Magnetic Stimulation
Doctors who use repetitive transcranial magnetic stimulation (rTMS) apply magnets to the scalp to stimulate the brain. rTMS is often seen as complementary to ECT due to the reported lack of cognitive side effects. The World Journal of Psychiatry recently published that “dose” is critical, with studies specific to senior populations show using a higher pulse level leads to good results.
While depression treatment for seniors has changed through the years, there is still much work to do – including testing and tailoring treatments specifically for seniors.
We congratulate the AAGP on 40 years of success. We look forward to working together to find effective ways to help seniors with depression.