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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Depression in the elderly should be viewed as a biological disorder, with multifactorial etiology, and not as a consequence of increasing social, physical, and material losses. Diagnosis is made basically on somatic symptoms, the most important ones being chronic fatigue, chronic pain, chronic sleep disorder, chronic gastrointestinal disturbance, and dysphoria. Other illnesses that might be present instead of or in addition to depression should be sought, both before depression therapy is started and also in the face of persistent symptoms after treatment is started. Basic treatment is with antidepressant medications, with careful attention to selection of drug and dosage, and careful monitoring for adverse effects. Antidepressant therapy and any other applicable forms of therapy are not mutually exclusive, and any other means of improving the patient's overall situation should be vigorously sought.
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PMID:Geriatric depression: avoiding the pitfalls of primary care. 355 33

A longitudinal study, based on interviews with 308 middle-class, preponderantly white mothers, provided an opportunity to evaluate the continuity, predictive factors, and behavioral correlates of sleep problems in young children. When their children were 8 months old, 10% of the mothers reported that their babies woke three or more times per night, 8% reported that the babies took an hour or more to settle after waking, 5% complained that their own sleep was severely disrupted by the child, and 18% reported at least one of these problems. At 3 years of age, 29% of the children had difficulty getting to bed and/or falling asleep or staying asleep. Of children with a sleep problem at 8 months of age, 41% still had a problem at 3 years of age, whereas only 26% of children without a problem at 8 months of age had a problem at 3 years of age (P less than .001). Among children with sleep problems at 8 months of age, mothers' depressed feelings were the only measured demographic or psychosocial factor associated with persistent sleep problems (P = .02). A separate analysis indicated that these depressed feelings did not appear to be a consequence of the child's sleep problem. Future studies should evaluate how maternal depression interacts with other factors to result in persistent sleep problems. Children with persistent sleep problems were more likely to have behavior problems, especially tantrums (P less than .02) and behavior management problems (P less than .01), than were children without persistent sleep problems (P less than .02).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Sleep problems in early childhood: continuities, predictive factors, and behavioral correlates. 367 Sep 67

The publication of a new nosology of sleep and arousal disorders in 1979 established the need for differential diagnosis of sleep disorders based on polysomnographic evaluations as well as medical history and physical examination. This review of recent developments in diagnosing and treating sleep disorders covers such topics as prevalence, findings related to sleeping pills and insomnia, effects of depression on sleep, and managing the elderly patient with disturbed sleep. The authors caution against misuse of hypnotic drug therapy for treatment of insomnia and encourage physicians to inquire about sleep patterns even when a patient is presenting a seemingly unrelated problem.
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PMID:Recent developments in the diagnosis and treatment of sleep disorders. 390 66

Brain function can be affected by the availability of dietary precursors of neurotransmitters. This occurs because the rate-limiting synthetic enzymes are not "saturated" with substrate under normal circumstances. Tyrosine affects catecholaminergic neurons that fire rapidly, whether in the brain stem to decrease blood pressure in hypertension or in the adrenal gland to increase blood pressure in hypotension, and has been used in the treatment of Parkinson's disease and depression. Choline forms acetylcholine and has been used successfully in the treatment of tardive dyskinesia and memory disorders. Tryptophan, which forms serotonin, has been used for chronic pain therapy, sleep disorders, depression, and appetite control. Although these substances may lack the potency of traditionally used agonists, they offer an increase in specificity because the enzymes necessary to convert them to neurotransmitters are found only in neurons. Precursors are also "physiological"; they are consumed as foods and, therefore, should be relatively safe therapeutic agents.
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PMID:Neurotransmitter precursors and brain function. 612 95

The aim of this study was to evaluate the safety of zimeldine, a 5-HT reuptake inhibitor, in the long-term treatment of depressive disorders. The study was an open label, multicentre investigation involving 147 patients who were suffering from depressive illness and who needed long-term anti-depressant treatment. Sixty-five patients completed the intended treatment period of 1 year, 75 terminated prematurely, and 7 are still in the programme. The reasons for termination were mainly ineffectiveness of the drug and adverse reactions. During the long-term treatment the most common emergent symptoms were, in order of decreasing frequency, dizziness, dry mouth, sleep disorders, sweating, tremor, nausea and headache. The side-effects were, however, mild and they generally decreased during the treatment period. No new adverse symptoms were reported. In the long-term treatment group, body weight showed a slight mean decrease. Clinical chemistry and cardiovascular investigations were judged to show no changes of clinical importance. It is concluded that zimeldine was shown to be a safe drug in this 1-year treatment programme of depression.
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PMID:The safety of zimeldine in long-term use in depressive illness. 623 Aug 89

Depression is the most common emotional disorder of the elderly. The frequency of grief reaction and the confusion with dementia, hypochondriasis, and sleep disorders complicate both the diagnosis and treatment of depression in older patients. Further, these patients often take medications that can produce or aggravate depression. The choice of antidepressant is based largely on side effects. After evaluating the risk factors, the physician can select a drug on the basis of sedative, anticholinergic, or other side effects. Prior history of response to a particular drug and the physician's experience with particular drugs weight heavily in this decision. Lower initial doses of all medications should be used in the elderly, and dosage should be increased slowly, if possible. These guidelines, derived from clinical experience with tricyclic antidepressants, are presented as a foundation for selecting from the large number of "second generation" antidepressant drugs soon to be available.
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PMID:Depression and antidepressants and the elderly. 634 62

The use of tricyclic antidepressants as opposed to hypnotics in treating insomnia is reviewed. Available data indicate that TCAs alleviate sleep disturbances related to depression (often before antidepressant effects are seen) and, in selected cases, may prove effective in disturbed sleep related to sleep apnea, fibrositis, and sleep related bruxism, as well as in adults with childhood onset insomnia or a history of hyperkinesis. However, TCAs share many of the problems reported for hypnotics, as well as having some potentially serious side effects not present with benzodiazepines. The need for determination of the etiology of sleep disorders, and specific pharmacotherapy directed toward identified causes rather than the symptom of insomnia, is stressed.
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PMID:Tricyclic antidepressants in the treatment of insomnia. 635 74

In a Finnish general practice 120 patients with psychosomatic disorders, manifest as syndromes of tension headache, cardiac neurosis, dizziness or muscular tension, were randomly allocated to treatment over a 4-week period with either flupenthixol (1 to 2 mg per day) or diazepam (5 to 10 mg mg per day). The 4 syndromes and 12 associated symptoms (anxiety, fatigue, depression, pain, asthenia, muscle fatiguability, tension, dyspnoea, restlessness, palpitations, sleep disorders, and vertigo) were rated on a 4-point scale on entry, at 2 weeks and at 4 weeks. Both drugs reduced significantly the average total scores for syndromes and single symptoms after 2-weeks' treatment. Flupenthixol was the more effective in relieving fatigue and vertigo; diazepam in relieving headache, anxiety, tension, restlessness and sleep disturbance. Cardiac neurosis, palpitations and general muscular tension responded poorly to both drugs. After 4 weeks, relief of vertigo, pain and fatigue was more evident in the flupenthixol group, and of anxiety, tension and restlessness in the diazepam group. Side-effects were complained of at some stage by 17 patients in the flupenthixol group (9 of fatigue, 5 of sleep disturbance, 1 of constipation, 1 of extrapyramidal symptoms, and 1 of weight gain) and by 16 patients in the diazepam group (10 of fatigue, 4 of sleep problems and 2 of diarrhoea).
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PMID:Flupenthixol versus diazepam in the treatment of psychosomatic disorders: a double-blind, multi-centre trial in general practice. 637 78

Patients should be aware of alterations in sleep with age, and they should not have unrealistic expectations. Drinking or taking sleeping pills is not likely to be a long-term solution to a sleep problem. Chronic difficulty in sleeping raises the possibility of sleep apnea, nocturnal myoclonus or depression, all of which commonly appear after 40. In the absence of these and other, less common disorders, sleep can often be improved by exercise, regular habits and removal of any disturbing elements from the bedroom.
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PMID:Sleep after forty. 669 39

Sleep disorders are difficult to distinguish from changes in sleep typically occurring after age 60. Sleep laboratory evaluation is needed to differentiate normal sleep alterations from the similar but more severe symptoms of depression or organic brain syndrome, and to detect sleep apnea, the most common sleep disorder found in geriatric patients. This disorder may be fatal, especially if a hypnotic drug is prescribed. Since biologic rhythms are easily disturbed in the elderly, education about sleep habits may be the most helpful therapy.
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PMID:Sleep disorders in the elderly. 682 85


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