Zusammenfassung
Depressive Störungen im Alter sind häufig und können entweder erstmals im früheren Erwachsenenalter auftreten und bis ins höhere Alter rezidivieren (ICD 10: F 33.*) oder jenseits des 60. Lebensjahres erstmals beginnen. Diese spät beginnenden Depressionen chronifizieren häufiger und beinhalten ein erhöhtes Risiko, insbesondere in eine vaskuläre Demenz zu münden. Die multifaktorielle Genese der Depression infolge psychosozialer Belastungen im Alter bei modulierenden genetischen, vaskulären und metabolischen Faktoren verlangt eine multimodale Therapie auf biologischer und psychosozialer Ebene, was inzwischen auch zunehmend empirisch belegt ist. Prognostisch und therapeutisch bedeutsam ist die Unterscheidung von depressiven Störungen mit ausgeprägten exekutiven Störungen und kognitiven Defiziten. Bei depressiven Verstimmungen unter akuten Belastungen (z. B. Verlusterlebnisse, schwere Erkrankungen, Konflikte usw.) kann zunächst ein „watchful waiting“ erfolgen. Nach 2 bis 4 Wochen sollte bei Persistenz eine pharmakologische antidepressive Therapie, zumindest ab mittelschwerer Episode, erfolgen. Darüber hinaus wird in der neuen nationalen Versorgungsleitlinie für depressive Störungen auch bei älteren Menschen explizit als Alternative oder Ergänzung eine Psychotherapie empfohlen. Hier sind die kognitive Verhaltenstherapie, die interpersonelle Therapie und v. a. das Problemlösetraining hervorzuheben, da Letzteres auch von anderen Berufsgruppen durchgeführt werden kann und somit die Versorgungslücke bei den ärztlichen und den psychologischen Psychotherapeuten gemildert wird. Zusammenfassend sollte eine depressive Störung im Alter keinen therapeutischen Nihilismus induzieren: Nach einer gestuften Diagnostik folgen individuell an körperliche, kognitive und soziale Ressourcen angepasste Therapiebausteine.
Abstract
Depressive disorders in elderly persons are frequent and can either first be manifested at a younger age and show a recurrent pattern during later life (ICD 10, F33.*) or have an onset beyond 60 years, which is termed late onset depression (LOD). This LOD has a higher tendency to chronification and implies an increased risk of progression, especially to vascular dementia. The multifactorial genesis of depression in old age includes psychosocial, vascular and metabolic factors and requires multimodal therapy modules at the biological and psychosocial level, which is now increasingly being empirically proven. Depressive disorders with executive and cognitive deficits have to be considered a defined entity with respect to prognosis and treatment. As a first step of treatment watchful waiting is appropriate, especially in depressive adjustment disorders triggered by acute psychosocial stressors (e.g. loss of relatives and conflicts). After 2–4 weeks pharmacological antidepressant therapy should be initiated, at least in a moderate depressive episode. Furthermore, the revised national guidelines for depressive disorders also explicitly recommend psychotherapy as an alternative or supplement to pharmacotherapy in the elderly. Several forms of psychotherapy are emphasized: cognitive behavioral therapy, interpersonal therapy and in particular problem solving, as this is a form of treatment that can also be carried out by other professional groups, thus alleviating the treatment gap caused by the lack of psychotherapists. In summary, a depressive disorder in old age should not induce therapeutic nihilism: after stepped diagnostic assessments, multimodal therapies are individually adapted to the physical, cognitive and social resources of the patients.
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Eschweiler, G.W. Diagnostik und multimodale Therapie der Altersdepression. Z Gerontol Geriat 50, 99–105 (2017). https://doi.org/10.1007/s00391-016-1174-2
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DOI: https://doi.org/10.1007/s00391-016-1174-2