In the past, it was believed that elderly depression was mainly mild, and psychological treatment could achieve ideal results. The results of a two-year study give new recommendations-patients with depression are best to take medication for a long time, if possible, take medication for life.
”Patients with depression are best to take medication indefinitely, just like drugs for high blood pressure or diabetes.” Research leader Dr. Charles, a psychiatrist at the University of Pittsburgh, said that continuous medication can treat depression and prevent depression. relapse. According to statistics, 3% to 5% of the elderly will experience depression, and more than 50% of them will relapse within 3 years. It was previously believed that psychotherapy (such as exercise and social interaction) could change the behavior of the elderly and was used as a long-term treatment measure, but in this study it is considered to have little effect. Researchers believe that elderly patients have brain changes and loss of some mental functions due to aging, resulting in obvious effects of drugs, but poor psychological treatment.
At present, the types of antidepressants used to treat depression in the elderly are the same as those in younger patients, but the dosage must be adjusted based on the slower metabolic rate of the elderly. Due to the proven efficacy and the relatively low risk of side effects, selective 5-HT reuptake inhibitors (SSRIs) and other second-generation antidepressants (SNRI, NaSSA, NDRI, etc.) are the first-line treatments for depression in the elderly.
SSRIs were developed and marketed abroad after the 1980s. Their mechanism of action is to inhibit the reuptake of 5-HT in the presynaptic membrane, increase the concentration of 5-HT in the synaptic cleft, and increase the conduction of 5-HT nerves. , So as to play an antidepressant effect. Now there are more than 30 kinds of drugs of this kind, and the most used ones are: fluoxetine hydrochloride, paroxetine hydrochloride, sertraline hydrochloride, citalopram hydrobromide, fluvoxamine maleate, escitalop Pulan is called “6 Golden Flowers” by the psychiatric community. However, these drugs have relatively large side effects, and it is necessary to pay close attention to adverse events during medication: such as hyponatremia, changes in QT interval, gastrointestinal bleeding, and falls. Regular electrocardiogram and laboratory examinations can help prevent and identify the above risks early. For elderly depressed patients with comorbid coronary artery disease, SSRIs are safer.
Commonly used SNRI drugs include duloxetine, venlafaxine, milnacipran, etc. These drugs have low side effects, are easy to tolerate and safe, and are more suitable for use by the elderly. Among them, milnacipran is considered to be the SNRI drug with the most balanced inhibitory effect on the reabsorption of two neurotransmitters. The inhibitory effect on serotonin and norepinephrine reabsorption is close to 1:1, and the lowest dose is 25mg. It can open the dual-channel effect (while regulating serotonin, but also regulating norepinephrine), and does not affect the patient’s blood pressure, sexual function and weight.
In the process of medication treatment for elderly patients with depression, the following matters should be noted:
1. Individualized medication. Need to have a professional doctor to guide, strictly follow the doctor’s prescription. Elderly patients are often accompanied by some chronic diseases, such as Parkinson’s disease, heart disease, hypertension, diabetes, etc. These conditions should be informed to the doctor in detail, who will analyze the interaction between the drugs, weigh the pros and cons, and formulate the best Medication plan.
2. Start with a small dose. The liver and kidney functions of elderly patients gradually decline, and the metabolism of the drug is slow, so the medication should start with a small dose.
3. Foot treatment. It takes longer for individuals over 65 years of age to respond to antidepressant treatment than young people, so patients have to wait patiently for 3 weeks to observe and evaluate the effect; after that, the effect of antidepressants is also slower than that of young people. It is very important for elderly depression patients to maintain medication for treatment. They must be taken for a full course of treatment and must not be stopped midway due to drug side effects. If after 6 to 8 weeks of adequate treatment, the patient has no or only a partial response, it is recommended to switch to another type of antidepressant. If depressive symptoms persist after the second treatment attempt, referral to geriatric psychiatry or enhanced therapy is recommended.
4. In addition to drug treatment, psychological treatment, physical therapy and other methods should also be used. Physiotherapy methods include electroconvulsive therapy, acupuncture, yoga, hypnosis, massage, etc. Electroconvulsive therapy is to stimulate the patient’s brain with electric current to stimulate the central nervous system to effectively inhibit the generation of negative emotions, and its effective rate can reach 80%.
