We present the duke somatic treatment algorithm for geriatric depression staged. Clinical practice guidelines for treatment of depression. Pharmacologic treatment of depression in the elderly. Sequential drug treatment algorithm for agitation and. Guidelines for adolescent depression in primary care glad.
The work group on major depressive disorder reports the following potentially competing interests for the pe riod from may 2005 to may 2010. Despite ects efficacy and safety record in older adults, many misconceptions still persist among both patients and health care professionals. However, most published rcts of the pharmacotherapy of geriatric depression assess only one treatment step, typically the first, or, more rarely, the second. Thus, given our current state of knowledge, treatment algorithms for the pharmacotherapy of geriatric depression can be informed by evidence, but are not yet truly evidencebased. As reported in jama in 2002, collaborative care more than doubled the effectiveness of depression treatment for older adults in primary care settings. Treatment of depression and anxiety in the geriatric patient.
Although the appraisal of guidelines for research and evaluation agree instrument described in chapter 1 of the original guideline document, evidencebased geriatric nursing protocols for best. Adult depression in primary care 2016 national institute for health and care excellence nice. New research may affect the interpretation and application of this material. Comprehensive geriatric assessment cga is defined as a multidisciplinary diagnostic and treatment process that identifies medical, psychosocial, and functional limitations of a frail older person in order. The work group on major depressive disorder reports.
The 2006 canadian coalition for seniors mental health ccsmh guideline on the assessment and treatment of depression 1 was used as a primary source. Elderly patients are at high risk for depression and cognitive disorders, the latter of which can be chronic as in dementia or acute as in delirium. Duke somatic treatment algorithm for geriatric depression was based on treatment guidelines for geriatric patients in the duke mood disorders program and was developed by duke clinicians. Guidelines for initiating antidepressant therapy mild. The treatment of depression in older adults samhsa publications.
Prospect prevention of suicide in primary care elderly. Geriatric depression british columbia medical journal. The original geriatric depression scale gds was a 30item questionnaire timeconsuming and challenging for some patients and staff. Later versions retain only the most discriminating questions. Patient health questionnaire2 phq 2 1 question number over the. After diagnosis, regular followup and active medication management are crucial to maximize treatment and remission. This document was prepared for the substance abuse and mental health services. To discuss pharmacologic treatment of depression in the elderly, including choice of antidepressants, titration of dose, monitoring of response and side effects, and treatment of unresponsive cases. Depression affects 15 out of every 100 adults over age 65 geriatric mental health foundation, 2011.
Two trials found no significant difference in efficacy between tcas. Geriatric depression scale long form patients name. Practice guideline for the treatment of patients with major depressive disorder, third edition. Rates of depression in the community range from 1%. Clinical practice guideline on the management of depression in adults. Although there have been previously published algorithms for the treatment of depression, few have been rigorously studied in terms of outcome. In this second part of the updated guidelines, we address. Differentiating among depression, delirium, and dementia. Algorithm for clinical practice guidelines for depression in adults in the primary care setting. Clinical practice guidelines for depression in adults in. For screening and diagnosis, selfrating forms are helpful, but clinical. Treatment of patients with bipolar disorder 7 introduction this practice guideline summarizes data on the specific somatic and psychosocial interventions that have been studied in the treatment of. Transcranial magnetic stimulation in the treatment of depression. Earlier diagnosis and effective treatment of depression in old age can lead to significant reduction in morbidity, mortality due to suicide and medical illnesses and health care costs.
This process is experimental and the keywords may be updated as the learning algorithm improves. Vadod major depressive disorder clinical practice guideline. A sequential drug treatment algorithm has been applied specifically to geriatric patients with depressive disorders mulsant et al. Major depressive disorder depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure in regular activities, decreased energy, feelings of guilt or low self. Ect can be safe and highly effective for severe, treatment. Clinical practice guidelines for management of depression in elderly. A geriatric psychiatrist treating the participant using a standardized pharmacologic treatment algorithm evaluated the participant at baseline and 3month followup, completing a madrs. Va dod depression practice guideline provider care. Adult depression clinical practice guidelines kaiser permanente. Therefore, it taps the affective and behavioral symptoms of depression and excludes. Recent bereavement, stress, or medical illness may contribute. What are the apa guidelines for treatment selection for. Depression and bipolar disorder american family physician. In updating their algorithm for treatment of geriatric depression, mulsant et al.
Ortho tm is an evidencebased geriatricsorthopedics comanagement model that can be implemented. Clinical practice guidelines for treatment of depression in elderly. Treating geriatric depression in primary care springerlink. Detailed information on the specific application of these treatment modalities in the perinatal period is in the 1 best practices guidelines relating to reproductive mental health,and 2 selfcare program for. At its core, such a systematic approach requires a treatment algorithm. All depressed individuals were treated according to a modified version of the duke somatic algorithm treatment for geriatric depression 36 over 24 weeks in a prospective cohort design with a. Depression, a significant problem among older adults, is most commonly reported in the primary care setting. The purpose of these guidelines is to present a framework for the evaluation, treatment, and follow up of geriatric patient, who present with depression.
Geriatric depression scale an overview sciencedirect. At 12 months, about half of the patients receiving. All classes have proven efficacy in elderly patients. The duke somatic treatment algorithm for geriatric depression staged was designed for geriatric depression 59 and all drugs in the staged are now readily accessible in china. Greenberg, phd, rn, gnpbc, hartford institute for geriatric nursing, new york university rory meyers college of nursing why. The assessment and treatment of depression pdf ccsmh. The ags cocare programs provide you with tools, resources, education, and support.
To offer the treatments for depression preferred by many older. Apa guideline for the treatment of depression i clinical practice guideline for the treatment of depression across three age cohorts american psychological association. The treatment for adolescents with depression study tads. Risk factors include prior depression and a family history of depression. The guideline recommends interventions for the treatment of depression in children and adolescents, adults, and older adults.
Previously, depression screening for adults was done by a standalone phq9 tool with additional depression questions on the back page. It has been designed for the assessment of depressive symptomatology in. Transcranial magnetic stimulation as adjunctive treatment for resistant depression 8. The american psychological association apa developed this clinical practice guideline to provide recommendations for the treatment of depressive disorders. Referral to a behavioral health provider communication between pcp and. Patients with severe major depressive disorder require antidepressant therapy, with or without psychological counseling or supporting counseling. The patient health questionnaire phq is designed to facilitate the recognition and diagnosis of depressive disorders in primary care patients. A systematic approach to the pharmacotherapy of geriatric major. A systematic approach to the pharmacotherapy of geriatric. Choose the best answer for how you felt over the past week. The intervention components are 1 recognition of depression and suicidal ideation by primary care physicians, 2 application of a treatment algorithm for geriatric depression in the primary care setting. To update clinical practice guidelines to assist primary care pc in the screening and assessment of depression.
Vadod clinical practice guideline for the management of major depressive disorder. Remission depression scale score below a threshold that demonstrates relative absence of symptomsdepressed mood goal of treatment continuation therapy relapse remission greater than 6 months recovery maintenance therapy recurrence wilkinson p and izmeth z. Answers indicating depression are in bold and italicized. The ccsmh gratefully acknowledges unrestricted educational grant support for the dissemination of the national guidelines for seniors mental health from. While assessing depression among elderly, it is important to remember that although many elderly have depressive symptoms, they do not fulfil the criteria of.
Following a systematic approach to their use can improve these outcomes. Practice guideline for the treatment of patients with. Validation of a treatment algorithm for major depression. This collection features the best content from afp, as identified by the afp editors, on depression and bipolar disorder and related issues, including antidepressants, major depressive disorder, mental health, postpartum depression, and psychiatric medications. Finally, we propose an updated algorithm based on the authors interpretation of the available evidence. Apa guideline for the treatment of depression ii abstract the american psychological association developed this clinical practice guideline to provide recommendations for the treatment of depressive disorders including major depression, subsyndromal depression, and persistent depressive disorder. However, most published rcts of the pharmacotherapy of. Continuation and maintenance treatment for depression in older people. If biological intervention is required, psychopharmacological therapy is.
The gds short form 15 questions has been derived from the 30 question version. The geriatric depression scale gds was designed specifically to screen for depression in geriatric populations. The purpose of these guidelines is to present a framework for the evaluation, treatment, and followup of geriatric patient, who present with depression. Adult and adoelscent depression screening, diagnosis, and. Yet, some evidence exists that antidepressants are less helpful in those over 75. Some patients have both affective mood and cognitive. Prefrontal neuropsychological predictors of treatment.
332 585 1294 998 582 1238 63 1051 1051 924 1199 1462 1220 785 326 1202 1297 212 640 807 748 1066 1168 1166 187 1122 264 1363 1055 1021