[Late-onset depression : Pathophysiology, diagnostics and treatment]

Nervenarzt. 2016 Sep;87(9):1017-29. doi: 10.1007/s00115-016-0193-y.
[Article in German]

Abstract

Late-onset depression (LOD) is defined as depression manifesting for the first time in later life. Up to now, there has been no exact definition of the lower age limit for LOD. Psychopathological symptoms of LOD do not fundamentally differ from depression in other phases of life; however, cognitive deficits are typically more pronounced. The LOD is associated with an increased risk of developing dementia. Imaging studies show reduction in gray matter volume and white matter lesions caused by vascular diseases. The occurrence of depression with vascular lesions of the brain is also referred to as "vascular depression". The diagnostic procedure includes a detailed medical history and the observation of psychopathological changes, physical examination, laboratory tests, electroencephalograph (EEG), electrocardiograph (ECG) and magnetic resonance imaging (MRI) of the head and neuropsychological tests to measure cognitive deficits. Psychotherapy is an effective treatment option. Selective serotonin reuptake inhibitors are the first-line pharmacological therapy.

Keywords: Dementia; Electroconvulsive therapy; Lithium; Treatment resistance; Vascular depression.

Publication types

  • Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Combined Modality Therapy / methods
  • Depression / diagnosis*
  • Depression / psychology
  • Depression / therapy*
  • Diagnostic Techniques, Neurological*
  • Female
  • Geriatric Assessment / methods*
  • Humans
  • Late Onset Disorders / diagnosis*
  • Late Onset Disorders / psychology
  • Late Onset Disorders / therapy*
  • Male
  • Middle Aged
  • Physical Examination / methods
  • Psychotherapy / methods
  • Selective Serotonin Reuptake Inhibitors / therapeutic use

Substances

  • Serotonin Uptake Inhibitors