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Yıl:2016; Cilt: 9; Sayı: 4>> Özet
Türkiye Klinikleri Psikiyatri Özel Dergisi; 2016;9(4):1-8
Yaşlılıkta Depresyon ve Tedavisi
B Duman, ETÖ Kızıl
Ankara Üniversitesi, Ankara
Depresyon, yaşlı bireylerde en sık gözlenen psikiyatrik rahatsızlıktır. Genetik faktörlerin rolü ileri yaş depresyonlarında azdır. Fiziksel hastalıklar ve ilaçlar depresyonu tetikleyebilir ya da iyileşmesine engel olabilir. Gençlerle kıyaslandığında yaşlılarda depresyonun klinik görünümü farklıdır, örneğin somatik belirtiler ve bilişsel kusurlar daha belirgindir. Geriatrik depresyon hastalarında, intihar oranları yüksek olduğu için intihar düşünceleri dikkatlice ele alınmalıdır. Depresif belirtilere neden olabilecek organik tabloları dışlamak için, hastalar fiziksel bir hastalığın varlığı yönünden de değerlendirilmelidir. Yaşlı depresyon hastalarının tedavisi, polifarmasinin sık olması, yaşla ilişkili farmakodinamik ve farmakokinetik değişikliklerin varlığı, antidepresanların yan etkilerine artmış duyarlılık, fiziksel ve bilişsel eş tanılar gibi çok sayıda zorluk içermektedir. Tedavi yanıtlarının yavaş ve tedavi oranlarının düşük olmasına karşın, seçici serotonin geri alım inhibitörleri gibi antidepresanlar ve psikoterapiler etkili ilk sıra tedavi seçenekleridir. Yaşlı bireyler, ilaca bağlı hiponatremi gibi ilaç yan etkilerine daha yatkındır. Hastaların yaklaşık üçte biri antidepresan monoterapisine yanıt vermemektedir dolayısıyla tedaviye direnç, geriatrik depresyon tedavisinde önemli bir sorundur.
Geriatric Depression and its Treatment
Depression is the most frequent mental disorder in older people. The genetic contribution to depression decreases with age. Physical illnes and medications are associated with precipitating or perpetuating depression. Clinical presentation is different; older patients showed distinct clinical features when compared to younger patients like more somatic symptoms and prominent cognitive impairment. Older depressed patients have high suicide rates therefore suicidal thoughts should be explored carefully. Physical examination of the patient is important in order to rule out an organic condition contributing to depressive symptoms. The treatment of older patients present more difficulties such as greater likelihood of polypharmacy, age-related pharmacodynamic and pharmacokinetic changes, susceptibility to antidepressants side effects, physical and cognitive comorbidities. Although, their response speed is slower and response rate is lower; antidepressant drugs like selective serotonine reuptake inhibitors (SSRI) and psychoterapies are efficient first-line treatment options. Elderly individuals are more prone to side effects of medications like drug induced-hyponatremia. Treatment resistance is an important problem in the management of geriatric depression, at least a third of patients don't respond to antidepressant monotherapy

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