GERIATRIC EDUCATION SERIES

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Funded in part by a grant from the EJC Foundation

dhs.unr.edu/aging

ECHO Geriatric SeriesDepression: An Extremely Complex Disease

Steven L. Phillips, MDMedical Director

Sanford Center for Aging

Depression is an extremely complex disease. It occurs for a variety of reasons. Some people experience depression during a serious illness. Others may have depression with life changes such as a move or the death of a loved one. Still others have a family history of depression. Those who do may experience depression and feel overwhelmed with sadness and loneliness for no known reason.

Course Objectives

• Objective 1: Define main cause of depression.

• Objective 2: Describe the impact of depression on commonly treated medical conditions.

• Objective 3: Review options for the treatment of depression.

Main Causes of Depression

• Past Abuse

• Conflict• Death or a Loss

• Genetics• Substance Abuse

• Major Events

• Social Isolation• Rejection

• Medications• Chronic Illness

Chronic illness is an illness that lasts for a very long time (> 6 months) and usually cannot be cured completely. However, chronic illnesses can often be controlled through diet, exercise, lifestyle habits and certain medications.

Chronic Illnesses That May Cause Depression

• Diabetes Mellitus

• COPD/Emphysema• HIV/AIDS

• Multiple Sclerosis• Cancer

• Heart Disease• Arthritis• Systemic Lupus• Hypothyroidism• CVA/Stroke

Impact of Depression

• Social Isolation• Functional Decline• Loss of Productivity• Self Neglect• Danger to Self or Others

• Increase Office Visits• Increase ER Visits• Increase Hospitalizations• Increase Readmissions• Increase Mortality

Symptoms of Depression

• Sadness or Depressed Mood

• Physical Restlessness

• Worthlessness

• Impaired Decision Making

• Major Weight Change• Excessive Sleep

• Loss of Enjoyment• Insomnia• Fatigue• Hopelessness• Excessive Guilt• Thoughts of Death

Patient Health Questionnaire (PHQ-9)Over the last 2 weeks, how often have you been bothered by any of the following problems (circle your answer):

Not at all Several More than Nearly days half days every day

0 1 2 3 Little interest in doing things 0 1 2 3 Feeling down, depressed or hopeless 0 1 2 3 Trouble falling or staying asleep or sleeping too much 0 1 2 3 Feeling tired or having little energy 0 1 2 3 Poor appetite or overeating 0 1 2 3 Feeling bad about yourself-or that you are a failure or have let yourself or your family down 0 1 2 3 Trouble concentrating on things, such as reading the newspaper or watching television 0 1 2 3 Moving or speaking so slowly that other people could have noticed? Or the opposite-being so fidgety or restless that you have been moving around a lot more than usual 0 1 2 3 Thoughts that you would be better off dead or hurting yourself in some way

If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people? Not difficult at all Somewhat difficult Very difficult Extremely difficult

Treatment Options for Depression

• Routine Exercise• Antidepressant• Social Engagement

• Medication Discontinuation• Psychotherapy• Brain Stimulation (ECT)

Sanford Center for Aging Geriatric Specialty Clinic

Steven L. Phillips, MDslphillips@unr.edu

(775) 784-1808