ABSTRACT
The entire range of clinical symptoms of early onset depression also occurs in the elderly. Historical notions of a unique presentation of late life depression -the hypochondriacal depressive or the neurovegetative depressive – are largely discounted today. However, recognizing depression in the elderly can require special skills and experience. In particular, differentiating the psychological sequelae of physical disorder from depressive illness, and the somatic symptoms of depression from the effects of systemic disease can be difficult. The particular challenge for old age psychiatry is that all can occur together in a single individual (Table 4). Diagnosis of depression, adapted from ICD-10 and DSM IV.
ICD-10
Common symptoms of depression
Depressed mood
Loss of interest
Loss of energy
Other symptoms of depression
Reduced concentration
Reduced self esteem
Guilt feelings
Pessimism regarding the future
Self harm or suicidal ideas
Altered sleep
Decreased appetite
Mild depression
At least two common and two other symptoms
Patient may be distressed but can function well
Moderate depression
At least two common and three or four other symptoms
Duration is at least two weeks and function is impaired
Severe depression
All three common and at least four other symptoms
Symptoms are severe in intensity and function is profoundly affected
23 DWM-IV (Major Depression)
Five or more of the following symptoms have been present during the same two week period nearly every day. At least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Depressed mood most of the day
Markedly diminished interest or pleasure in normal activities
Significant weight loss or weight gain
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or excessive guilt
Reduced ability to concentrate
Recurrent thoughts of death, suicidal thoughts or attempts
There must be clinically significant distress or impairment in functioning. The symptoms must not be due to the effects of a general medical condition or to the effects of a substance (e.g. drug abuse or medication)
