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Biological Risk Factors for Late-Life Depression

Context:

Late-life depression (LLD) is caused by multiple factors working together. It has three broad risk factors — biological, psychological, and social.

Relevance:

GS III: Science and Technology

Dimensions of the Article:

  1. Biological Risk Factors for Late-Life Depression
  2. Psychological Risk Factors for Late-Life Depression
  3. Social Risk Factors for Late-Life Depression
  4. Clinical Assessment of Depression
  5. Approaches to Treating Late-Life Depression

Biological Risk Factors for Late-Life Depression

Late-life depression (LLD) is a complex mental health disorder that affects many elderly people. Although the causes of LLD are not fully understood, research has identified several biological risk factors associated with the condition. Here are some of the key biological risk factors for LLD:

  • Lack of Candidate Biomarker: Scientists have not yet identified a candidate biomarker for LLD that could serve as a clear sign of the disease process.
  • Genetic Contribution: Studies have found some evidence of genetic contribution to LLD. Hypotheses involving the genes that code for serotonin synthesis, norepinephrine transporter, and the neurotrophic factor have been advanced, but require further testing.
  • Vascular Depression: A subset of LLD, called vascular depression, is associated with cerebrovascular lesions. This theory is based on the observation that depression is a frequent outcome in people who have had a stroke. Vascular depression is associated with brain lesions, which appear as bright spots on brain scans, called white matter hyperintensities, disrupting brain signalling and circuits.
  • Cortisol Secretion: Stress that accumulates over one’s life leads to a sustained secretion of cortisol, the hormone that regulates the body’s stress response. Increased cortisol levels lead to the loss of brain cells in the hippocampus, which is implicated in memory and learning.
  • Physical Illness: LLD is often associated with physical illnesses such as heart attacks, heart conditions, diabetes, and hip fractures. Depressive symptoms can also manifest if a person doesn’t optimally recover from physical illnesses.

Psychological Risk Factors for Late-Life Depression

  • Neuroticism: Neuroticism is a personality trait characterized by a tendency to experience negative emotions, anger, irritability, and emotional instability. Research has consistently implicated neuroticism in LLD, with some depressed individuals overreacting to life events or misinterpreting them.
  • Recent Adverse Life Events: Depressed elderly people often report recent adverse life events, such as job loss or bereavement, more frequently than non-depressed older adults.
  • Locus of Control: Locus of control refers to the degree to which an individual feels a sense of agency in their life. Individuals with an external locus of control tend to feel that external forces, such as random chance or the actions of others, are more responsible for the events that occur in their life. Research has found that having an external locus of control predicts the emergence and persistence of depressive symptoms in older adults.

Social Risk Factors for Late-Life Depression

  • Lower Socioeconomic Status: Research has found that individuals with lower socioeconomic status are more likely to experience depression across the life cycle, including in late-life.
  • Social Support: Social support includes the perception of support, the structure of the social network, and the tangible help and assistance available. Perceived social support has been found to be the most robust predictor of LLD symptoms. However, it is important to note that while older adults’ social networks may thin out over time, many new ones may emerge.

Other social risk factors for LLD include living alone, social isolation, and the loss of a spouse or partner. By understanding these social risk factors, healthcare professionals can develop more effective prevention and treatment strategies for older adults with LLD.

Clinical Assessment of Depression

Clinical assessment of depression involves evaluating various aspects of the patient’s medical history and current symptoms. Here are some key steps in the assessment process:

  • Evaluate Duration and Course of the Current Episode: This involves assessing the duration of the current depressive episode, screening for previous episodes, and evaluating the course of previous episodes.
  • Rule Out Substance Misuse: Substance misuse can lead to symptoms of depression. Therefore, it is important to rule out any substance misuse in the patient.
  • Evaluate Response to Previous Interventions: Assessing the patient’s response to previous interventions can inform the treatment plan going forward.
  • Assess Family History: Looking at the family history of depression and/or suicide can inform the diagnosis and treatment of the patient.
  • Evaluate Cognitive Status: Assessing the patient’s cognitive status is important in older patients with depression. Screening scales like the Mini Mental-State Examination can be helpful.
  • Thorough Physical Examination: A thorough physical examination of all systems is important in the assessment process.
  • Order Relevant Tests: This may include tests for thyroid and metabolic panel, vitamin B12, folate and vitamin D levels, and other biochemistries. Brain scans may also be ordered to rule out other pathologies.

By conducting a thorough clinical assessment, healthcare professionals can make an accurate diagnosis and develop an effective treatment plan for patients with depression.

Approaches to Treating Late-Life Depression

Psychotherapy: Cognitive behaviour therapy (CBT) helps identify maladaptive thought patterns and restructure them to help cope and feel better.

  • Therapists seek evidence in support of negative thoughts and offer alternative perspectives.
  • CBT sessions typically last 30-60 minutes, with six to 20 sessions.

Medications: Safe and effective drugs are available to treat geriatric depression. Antidepressants are often taken for six to nine months after the remission of a depressive episode.

  • Combining medication with talk therapy increases efficacy.
  • Prescribing medication to older adults starts low and goes slow.

Brain Stimulation: Electroconvulsive therapy (ECT) is used to treat severe depression, suicidality, and psychotic depression.

  • ECT is the most effective treatment for severe major depressive episodes.

Family Therapy: Working with families is critical for the successful outcome of treatment.

  • Educating family members about the depressive disorder and potential risks of geriatric depression is essential.
  • Family members can assist clinicians by observing behavioural changes, removing potential implements of suicide and administering medications to non-adherent individuals.
  • LLD is treatable, and taking care of the elderly is a shared responsibility.

-Source: The Hindu


March 2024
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