CGA issues: depression
Any co-existing physical health problems should be optimised. General advice should include good sleep hygiene, maintaining physical activity and limiting alcohol intake.
- For mild or subthreshold symptoms, psychosocial interventions such as increasing social contact and physical exercise may be sufficient. Medication should not be offered as a first-line treatment but reserved for those who do not respond to initial measures.
- When drug treatment is required, selective serotonin re-uptake inhibitor (SSRI) should be the first-line therapy. SSRIs may cause hyponatraemia, postural hypotension, and increase the risk of gastrointestinal bleeding.
- Tricyclic antidepressants have anti-cholinergic side effects and should be avoided in older people.
- Psychological therapies are effective in older people, and in combination with drug treatment is more effective than either therapy alone.
- Those with moderate to severe symptoms are likely to require referral for specialist support.
- People who have responded to medication should continue is for at least six months after recovery to reduce the risk of relapse.
Treating depression in adults generally: NICE CG 90.
Depression in older people: BMJ 2011: 343:d5219.