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Psychiatric comorbidity and depression in older adults

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Abstract

Late-life depression rarely occurs in isolation. Thus, screening for and assessment of late-life depression should always involve screening for other psychiatric disorders, including anxiety, personality disorders, and alcohol misuse. Comorbidity often makes treatment to relieve depressive symptoms more complicated, more comprehensive, and longer. Current late-life depression research indicates the strongest support for antidepressant medication and/or cognitive-behavioral therapy for comorbid anxiety, antidepressants and dialectical behavior therapy for comorbid personality disorders, and antidepressants and counseling for alcohol abuse that incorporates specific coping skills training for mood management, based on cognitive-behavioral principles. The clinician should provide sufficient psychoeducation for the older client and involve the client in treatment planning and progress evaluation. Very little research has specifically focused on treating depression and psychiatric comorbidity simultaneously, so additional research in this area is needed.

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References and Recommended Reading

  1. Murphy CF, Alexopoulos GS: Cognition and late-life depression. Prim Psychiatry 2004, 11:54–58.

    Google Scholar 

  2. Teri L, McKenzie G, LaFazia D: Psychosocial treatment of depression in older adults with dementia. Clin Psychol Sci Pract 2005, 12:303–316.

    Article  Google Scholar 

  3. Devanand DP: Comorbid psychiatric disorders in late life depression. Biol Psychiatry 2002, 52:236–242.

    Article  PubMed  CAS  Google Scholar 

  4. Schoevers RA, Beekman AT, Deeg DJ, et al.: Comorbidity and risk-patterns of depression, generalised anxiety disorder and mixed anxiety-depression in later life: results from the AMSTEL study. Int J Geriatr Psychiatry 2003, 18:994–1001.

    Article  PubMed  CAS  Google Scholar 

  5. Lenze EJ, Mulsant BH, Shear MK, et al.: Comorbid anxiety disorders in depressed elderly patients. Am J Psychiatry 2000, 157:722–728.

    Article  PubMed  CAS  Google Scholar 

  6. Steffens DC, McQuoid DR: Impact of symptoms of generalized anxiety disorder on the course of late-life depression. Am J Geriatr Psychiatry 2005, 13:40–47.

    Article  PubMed  Google Scholar 

  7. Flint AJ: Generalised anxiety disorder in elderly patients: epidemiology, diagnosis and treatment options. Drugs Aging 2005, 22:101–114.

    Article  PubMed  Google Scholar 

  8. Cook JM, Orvaschel H, Simco E, et al.: A test of the tripartite model of depression and anxiety in older adult psychiatric outpatients. Psychol Aging 2004, 19:444–451.

    Article  PubMed  Google Scholar 

  9. Meeks S, Woodruff-Borden J, Depp CA: Structural differentiation of self-reported depression and anxiety in late life. J Anxiety Disord 2003, 17:627–646.

    Article  PubMed  Google Scholar 

  10. Teachman BA, Siedlecki KL, Magee JC: Aging and symptoms of anxiety and depression: structural invariance of the tripartite model. Psychol Aging 2007, 22:160–170.

    Article  PubMed  Google Scholar 

  11. Wetherell JL, Gatz M, Pedersen NL: A longitudinal analysis of anxiety and depressive symptoms. Psychol Aging 2001, 16:187–195.

    Article  PubMed  CAS  Google Scholar 

  12. Devanand DP, Adorno E, Cheng J, et al.: Late onset dysthymic disorder and major depression differ from early onset dysthymic disorder and major depression in elderly outpatients. J Affect Disord 2004, 78:259–267.

    Article  PubMed  CAS  Google Scholar 

  13. Jeste ND, Hays JC, Steffens DC: Clinical correlates of anxious depression among elderly patients with depression. J Affect Disord 2006, 90:37–41.

    Article  PubMed  Google Scholar 

  14. Schoevers RA, Deeg DJ, van Tilburg W, et al.: Depression and generalized anxiety disorder: co-occurrence and longitudinal patterns in elderly patients. Am J Geriatr Psychiatry 2005, 13:31–39.

    Article  PubMed  Google Scholar 

  15. Lenze EJ, Mulsant BH, Mohlman J, et al.: Generalized anxiety disorder in late life: lifetime course and comorbidity with major depressive disorder. Am J Geriatr Psychiatry 2005, 13:77–80.

    Article  PubMed  Google Scholar 

  16. Belzer K, Schneier FR: Comorbidity of anxiety and depressive disorders: issues in conceptualization, assessment, and treatment. J Psychiatr Pract 2004, 10:296–306.

    Article  PubMed  Google Scholar 

  17. Whyte EM, Dew MA, Gildengers A, et al.: Time course of response to antidepressants in late-life major depression: therapeutic implications. Drugs Aging 2004, 21:531–554.

    Article  PubMed  CAS  Google Scholar 

  18. Flint AJ, Rifat SL: Two-year outcome of elderly patients with anxious depression. Psychiatry Res 1997, 66:23–31.

    Article  PubMed  CAS  Google Scholar 

  19. Lenze EJ, Mulsant BH, Dew MA, et al.: Good treatment outcomes in late-life depression with comorbid anxiety. J Affect Disord 2003, 77:247–254.

    Article  PubMed  Google Scholar 

  20. Cassidy EL, Lauderdale S, Sheikh JI: Mixed anxiety and depression in older adults: clinical characteristics and management. J Geriatr Psychiatry Neurol 2005, 18:83–88.

    Article  PubMed  Google Scholar 

  21. Mohamed S, Osatuke K, Aslam M, et al.: Escitalopram for comorbid depression and anxiety in elderly patients: a 12-week, open-label, flexible-dose, pilot trial. Am J Geriatr Pharmacother 2006, 4:201–209.

    Article  PubMed  CAS  Google Scholar 

  22. Areán PA, Cook BL: Psychotherapy and combined psychotherapy/pharmacotherapy for late life depression. Biol Psychiatry 2002, 52:293–303.

    Article  PubMed  Google Scholar 

  23. Wetherell JL, Lenze EJ, Stanley MA: Evidence-based treatment of geriatric anxiety disorders. Psychiatr Clin North Am 2005, 28:871–896.

    Article  PubMed  Google Scholar 

  24. Barrowclough C, King P, Colville J, et al.: A randomized trial of the effectiveness of cognitive-behavioral therapy and supportive counseling for anxiety symptoms in older adults. J Consult Clin Psychol 2001, 69:756–762.

    Article  PubMed  CAS  Google Scholar 

  25. Mohlman J, Gorenstein EE, Kleber M, et al.: Standard and enhanced cognitive-behavior therapy for late-life generalized anxiety disorder: two pilot investigations. Am J Geriatr Psychiatry 2003, 11:24–32.

    Article  PubMed  Google Scholar 

  26. Alexopoulos GS, Katz IR, Bruce ML, et al.: Remission in depressed geriatric primary care patients: a report from the PROSPECT study. Am J Psychiatry 2005, 162:718–724.

    Article  PubMed  Google Scholar 

  27. Hegel MT, Unützer J, Tang L, et al.: Impact of comorbid panic and posttraumatic stress disorder on outcomes of collaborative care for late-life depression in primary care. Am J Geriatr Psychiatry 2005, 13:48–58.

    Article  PubMed  Google Scholar 

  28. Gum AM, Areán PA, Bostrom A: Low-income depressed older adults with psychiatric comorbidity: secondary analyses of response to psychotherapy and case management. Int J Geriatr Psychiatry 2007, 22:124–130.

    Article  PubMed  Google Scholar 

  29. Kunik ME, Benoit MH, Rifai AH, et al.: Diagnostic rate of co-morbid personality disorder in elderly psychiatric inpatients. Am J Psychiatry 1994, 151:603–605.

    PubMed  CAS  Google Scholar 

  30. Molinari V, Marmion J: Relationship between affective disorders and Axis II diagnoses in geropsychiatric patients. J Geriatr Psychiatry Neurol 1995, 8:61–64.

    PubMed  CAS  Google Scholar 

  31. Devanand D, Turret N, Moody BJ, et al.: Personality disorders in elderly patients with dysthymic disorder. Am J Geriatr Psychiatry 2000, 8:188–195.

    Article  PubMed  CAS  Google Scholar 

  32. Balsis S, Gleason ME, Woods CM, et al.: An item response theory analysis of DSM-IV personality disorder criteria across younger and older age groups. Psychol Aging 2007, 22:171–185.

    Article  PubMed  Google Scholar 

  33. Balsis S, Woods CM, Gleason ME, et al.: Overdiagnosis and underdiagnosis of personality disorders in older adults. Am J Geriatr Psychiatry 2007, 15:742–753.

    Article  PubMed  Google Scholar 

  34. Morse JQ, Pilkonis PA, Houck PR, et al.: Impact of cluster C personality disorders on outcomes of acute and maintenance treatment in late-life depression. Am J Geriatr Psychiatry 2005, 13:808–814.

    Article  PubMed  Google Scholar 

  35. Lynch TR, Cheavens JS, Cukrowicz KC, et al.: Treatment of older adults with co-morbid personality disorder and depression: a dialectical behavior therapy approach. Int J Geriatr Psychiatry 2007, 22:131–143.

    Article  PubMed  Google Scholar 

  36. Rao R: Does personality disorder influence the likelihood of in-patient admission in late-life depression? Int J Geriatr Psychiatry 2003, 18:960–961.

    Article  PubMed  Google Scholar 

  37. Abrams RC, Spielman LA, Alexopoulos GS, et al.: Personality disorder symptoms and functioning in elderly depressed patients. Am J Geriatr Psychiatry 1998, 6:24–30.

    PubMed  CAS  Google Scholar 

  38. Abrams RC, Alexopoulos GS, Spielman LA, et al.: Personality disorder symptoms predict declines in global functioning and quality of life in elderly depressed patients. Am J Geriatr Psychiatry 2001, 9:67–71.

    Article  PubMed  CAS  Google Scholar 

  39. Cheavens JS, Lynch TR: Dialectical behavior therapy for personality disorders in older adults. In Handbook of Behavioral and Cognitive Therapies with Older Adults. Edited by Gallagher-Thompson D, Steffens A, Thompson LW. New York: Springer; 2007:187–199.

    Google Scholar 

  40. Markowitz JC, Bleiberg K, Pessin H, et al.: Adapting interpersonal psychotherapy for borderline personality disorder. J Ment Health 2007, 24:219–222.

    Google Scholar 

  41. Reifman A, Welte JW: Depressive symptoms in the elderly: differences by adult drinking history. J Appl Gerontol 2001, 20:322–337.

    Article  Google Scholar 

  42. Schonfeld L, Dupree LW: Antecedents of drinking for early-and late-onset elderly alcohol abusers. J Stud Alcohol 1991, 52:587–592.

    PubMed  CAS  Google Scholar 

  43. Center for Substance Abuse Treatment: Substance Abuse Among Older Adults. Treatment Improvement Protocol (TIP) Series 26. Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration; 1998. [DHHS publication no. (SMA) 01-3496.]

    Google Scholar 

  44. Fischer LR, Wei F, Solberg LI, et al.: Treatment of elderly and other adult patients for depression in primary care. J Am Geriatr Soc 2003, 51:1554–1562.

    Article  PubMed  Google Scholar 

  45. Center for Substance Abuse Treatment: Substance Abuse Relapse Prevention: A Group Treatment Approach for Older Adults. Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration; 2005.

    Google Scholar 

  46. Oslin DW, Katz IR, Edell WS, et al.: Effects of alcohol consumption on the treatment of depression among elderly patients. Am J Geriatr Psychiatry 2000, 8:215–220.

    Article  PubMed  CAS  Google Scholar 

  47. Oslin DW: Treatment of late-life depression complicated by alcohol dependence. Am J Geriatr Psychiatry 2005, 13:491–500.

    Article  PubMed  Google Scholar 

  48. Clark LA: Temperament as a unifying basis for personality and psychopathology. J Abnorm Psychol 2005, 114:505–521.

    Article  PubMed  Google Scholar 

  49. Watson D, Clark LA: Clinical diagnosis at the crossroads. Clin Psychol Sci Pract 2006, 13:210–215.

    Article  Google Scholar 

  50. Flint AJ, Rifat SL: Anxious depression in elderly patients. Response to antidepressant treatment. Am J Geriatr Psychiatry 1997, 5:107–115.

    PubMed  CAS  Google Scholar 

  51. Gum AM, Arean PA, Bostrom A: Low-income depressed older adults with psychiatric comorbidity: secondary analyses of response to psychotherapy and case management. Int J Geriatr Psychiatry 2007, 22:124–130.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Aging and Mental Health, Florida Mental Health Institute, University of South Florida, 13301 Bruce B. Downs Boulevard, MHC 1400, Tampa, FL, 33612, USA

    Amber M. Gum

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  1. Amber M. Gum
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  2. Jennifer S. Cheavens
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Correspondence to Amber M. Gum.

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Gum, A.M., Cheavens, J.S. Psychiatric comorbidity and depression in older adults. Curr Psychiatry Rep 10, 23–29 (2008). https://doi.org/10.1007/s11920-008-0006-5

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  • DOI: https://doi.org/10.1007/s11920-008-0006-5

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