노인 우울증의 임상적 치료 지침

Abstract

Depression in older patients contributes to personal suffering and family disruption and increases disability, medical morbidity, mortality, suicide risk, and healthcare utilization. Older patients often have serious coexisting medical conditions that may contribute to the depression and complicate the choice of treatment. Older adults metabolize medication slowly and more sensitive to side effects than younger patients. Because of these complexities, we should be careful in prescribing antidepressants at depressive disorders in older patients.For unipolar nonpsychotic major depression, the preferred strategy is an antidepressants(SSPI or venlafaxine XR preferred) plus psychotherapy. For unipolar psychotic depression, the treatment of choice is an antidepressant(SSRI or venlafaxine XR) plus one of the newer atypical antipsychotics. Electroconvulsive therapy is also first line. For dysthymic disorder or persistent milder depression, combination of antidepressant(SSRI preferred) and psychotherapy is recommend.If the patient has a comorbid medical condition(e.g., hypothyroidism) that is contributing to the depression, treating both the depression and the medical condition from the outset is recommended. The SSRIs were the top-rated antidepressants for all type of depression. The preferred psychotherapy techniques for treating depression in older patients are cognitive-behavioral therapy, supportive psychotherapy, problem-solving psychotherapy, and interpersonal psychotherapy. Also, appropriate psychosocial interventions(e.g., psychoeducation, family counseling, visiting nurse services) are needed in treatment program. Continuing treatment with antidepressants for at least 1 year is recommended if a patient has had a single episode of severe unipolar major depression, for 1-3 year for a patient who has 2 such episodes, and for longer than 3 years if there is a history of 3 or more episodes.