Elderly people depression

The author cites the example of untreated depression in elderly people (lines 35-38) in order to... 

It is known that our sense of smell can have a major effect on the way we feel. Elderly people who have lost their ability to smell are more prone to suffer from psychiatric problems such as anxiety and depression. Therefore, the continued development of this field of alternative medicine should not escape our notice. 

Because suicide is one of the leading causes of death in elderly people and in other populations, rapid and effective treatment of depression is warranted. Current therapies include the use of electroconvulsive (shock) therapy, psychiatric intervention, and antidepressant drugs such as tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and serotonin-selective reuptake inhibitors (SSRIs). Recently, in the U.S., the use of St. John s wort (Hypericum perforatum) has become more prevalent, especially in the treatment of depression. 

Brown SL, Salive ME, Harris TB, Simonsick EM, Guralnik JM, Kohout FJ. Low cholesterol concentrations and severe depressive symptoms in elder people. BMJ 1994 308 1328-1332. 

Livingston, G., Blizard, B. and Mann, A. Does sleep disturbance predict depression in elderly people A study in inner London. Br.. Gen. Pract. 43 (1993) 445-448. Robertson, D. R. Drug therapy for Parkinson s disease in the elderly. Br. Med. Bull. 46 (1998) 124-136. 

Some authors claim that liposaccharides can depress the content of TNF-a and increase the activity of superoxide dismutase (SOD) and catalase, thus—via mediators—they can affect the immune system (Can et al. 2003). It has been demonstrated that the NF-p transcription factor, (highly sensitive to the redox potential in its environment), which regulates synthesis of many mediators—cytokines, associated with inflammatory condition and the phenomenon of adhesion of cells— becomes deregulated in old age. Defense functions in such cases (and primarily in arthritis and arthritis-related conditions) are said to be performed by antioxidants (including a-lipoic acid), which can modulate the activity of monocytes and inhibit changes caused by deregulating of the transcription factor NF-kB under the influence of redox conditions in elderly people (Lee and Hughes 2002). 

Diazepam produces less sedation in cigarette smokers, and higher (not lower, as stated in SEDA-20) doses may be required for the same sedative or anxiolytic effect. Owing in part to its continued widespread use, several unusual adverse effects of diazepam continue to be reported. These include cases of urinary retention and compartment syndrome, which are not explicable by its pharmacology. On the other hand, accumulation of diazepam and attendant complications of obtundation and respiratory depression may be understood in terms of its long half-life, particularly in elderly people and medically ill patients. Caution about the intravenous use of diazepam comes from a study that showed cardiac dysrhythmias (mainly ventricular extra beats) in a quarter of oral surgery patients midazolam and lorazepam were much safer (1). 

Prolonged use of glucocorticoids in elderly people can exacerbate diabetes, hjrpertension, congestive heart failure, and osteoporosis, or cause depression. In a retrospective,... 

Elderly people have high rates of depression but tend to be excluded from randomized trials of antidepressant... 

Elderly people living at home were found to consume approximately 145 xg of folate daily compared with 223 p.g consumed by healthy young controls. The serum folate concentrations in the two groups were similar (H30). Nevertheless, the lower intake in the elderly is likely to make them more susceptible to stress. Some old people living at home have been found to have a diet which consisted mainly of tea and biscuits or one or two slices of bread daily. Some are mentally disturbed and others may have been recently bereaved and are seriously depressed. These people may present for the first time with a profound megaloblastic anemia. 

Folacin deficiency may lead to glossitis, diarrhoea, depression and confusion. Deficiency anaemia may develop especially in pregnancy and in elderly people. Symptoms of deficiency are similar to symptoms of cobalamine deficiency (known as macrocytic anaemia). Megaloblastic anaemia, the most common cause of macrocytic anaemia, is due to a deficiency of either cobalamine or folic acid (or both). Deficiency in the early stages of pregnancy can lead to developmental defects of the foetus (spinal cord defects and incomplete development of the brain). Women who are at increased risk will need increased daily intake of folic acid. 

Several studies conducted in experimental animals have demonstrated that diets deficient in protein exacerbate the oral toxicity of endosulfan (Boyd 1972 Boyd et al. 1970 Das and Garg 1981). These results suggest that people who consume low-protein diets, such as chronic alcoholics, dieters, food faddists, various cults, some ethnic groups, the elderly, and some people living in depressed areas or underdeveloped countries, may be more susceptible to the toxic effects of endosulfan. 

Benzodiazepines are most commonly prescribed for women and elderly patients. This may be partially due to the fact that women, in general, seem to be more willing to seek psychological help than men. In addition, four out of five people who experience panic attacks are women. Elderly patients are commonly afflicted with other conditions, such as insomnia and depression, which respond well to treatment with benzodiazepines. 

Insomnia is a common complaint in the elderly. As people age they require less sleep, and a variety of physical ailments to which the elderly are subject can cause a change in the sleep pattern (e.g. cerebral atherosclerosis, heart disease, decreased pulmonary function), as can depression. Providing sedative hypnotics are warranted, the judicious use of short half-life benzodiazepines such as temazepam, triazolam, oxazepam and alprazolam for a period not exceeding 1-2 months may be appropriate. Because of their side effects, there would appear to be little merit in using chloral hydrate or related drugs in the treatment of insomnia in the elderly. It should be noted that even benzodiazepines which have a relatively short half-life are likely to cause excessive day-time sedation. The side effects and dependence potential of the anxiolytics and sedative hypnotics have been covered elsewhere in this volume (Chapter 9). 

---