Depression is a mental disorder that predominantly affects the elderly population. Although depression may manifest across the lifespan regardless of age, its consequences in late adulthood have profound effects such as increased personal suffering, developing suicidal thoughts, inflicting a huge burden on caregivers, morbidity, and isolating self (Haigh et al., 2018). Moreover, depression among older adults increases the risk of developing other chronic illnesses such as diabetes, asthma, and arthritis. Geriatric depression is characterized by increased worry, anxiety, confusion, agitation, hopelessness, and memory loss (Haigh et al., 2018). According to DSM-IV, symptoms of depression include weight loss, increased fatigue, noticeable restlessness, extreme guilt, disturbed sleep, and attempts to commit suicide. Treatment of geriatric depression requires special care because it can worsen other underlying conditions. This discussion recommends one nonpharmacological intervention, one off-label drug, and one FDA-approved drug for treating geriatric depression.

FDA-approved drug

Sertraline is one of the Selective Serotonin Reuptake Inhibitors (SSRIs) offered to older adults with depression as an antidepressant. SSRIs are the first-line treatment for depression. Evidence from clinical tests provides that SSRIs are highly tolerable and efficacious. The common SSRIs approved by the FDA for patients with depression are sertraline, citalopram, and escitalopram. These drugs prevent serotonin reuptake in the brain (Borhannejad et al., 2020). In other words, it helps regulate the mood-enhancing chemical known as serotonin by preventing its reabsorption into the neurons. Using sertraline reduces symptoms such as irritability, anxiety, confusion, and insomnia (Borhannejad et al., 2020). However, an individual may not be prescribed sertraline if, in the last 14 days, the patient was using monoamine oxidase inhibitors (MAOIs) such as phenelzine, selegiline, and tranylcypromine. Also, the patient will be assessed on whether he/she is allergic to the medication. Using sertraline may pose a risk of developing a serotonin syndrome, especially when used alongside other antidepressants and medications such as triptans, dextromethorphan, and tramadol (Borhannejad et al., 2020). Other side effects of using sertraline include sweating, somnolence, dizziness, diarrhea, dry mouth, back pain, blurred vision

Off-label drug

Alprazolam, also known as Xanax, is one of the benzodiazepine drugs commonly given to the geriatric population to treat symptoms such as insomnia and anxiety. Alprazolam is an off-label drug given alongside other antidepressants, especially at the start of treatment. Usually, older patients exhibiting symptoms of anxiety caused by depression are prescribed alprazolam in the first few days of treatment (within 1-7 days of starting treatment) (Bushnell et al., 2017). This drug provides a calming effect on an individual’s brain or reduces excitement. The duration to be prescribed with Xanax is six months. However, some patients may have recurrent episodes of insomnia and anxiety, which would require an extended period of using Xanax (at least one year). Generally, alprazolam has fewer side effects when used within a short period, such as 6-months (Bushnell et al., 2017). However, prolonged use of this drug may result in drowsiness, blurred vision, muscle weakness, memory loss, slurred speech, and slow breathing. Another side effect of alprazolam is habit-forming or addiction, especially when used regularly and taken in large doses. Once withdrawn from use, it can induce a rebound that brings panic symptoms, insomnia, and anxiety.

Non-pharmacological intervention

Cognitive behavioral therapy (CBT) is a highly effective and established psychotherapy for managing the geriatric population with depression. However, it must be carried out in a way that meets the needs and issues of older adults, such as physical impairment, loneliness, retirement, loss of loved ones, financial restraints, etc. Besides, psychiatrists are aware of cognitive changes that come with aging, such as a decline in working memory, fluid intelligence, reduced cognitive speed, and selective attention (Chand & Grossberg, 2013). CBT follows the cognitive model focusing on the relationship between emotion, cognition, and behaviors. Usually, individual behavior and mood are influenced by the perceived thoughts and interpretation of events. These thoughts emerge from underlying schema or beliefs, making an individual feel sad, anxious, or hopeless. Often, individuals develop frequent thoughts from dysfunctional beliefs that generate automatic body responses, inhibiting the capacity to control their emotions and actions (Chand & Grossberg, 2013). Therefore, using CBT to modify an individual dysfunctional belief may help them recover from depression. CBT helps the patient become aware of his/her thoughts. Most essentially, it helps identify some of the things that make them feel distressed. The use of CBT to address the use of depression among older adults has been found to reduce symptoms such as anxiety, restlessness, confusion, and suicidal thoughts.

 In conclusion, depression is one of the leading mental illnesses affecting most aged persons. It is characterized by increased restlessness, anxiety, worry, insomnia, fatigue, and extreme guilt. Untreated depression can result in a stroke or increase the intensity of underlying conditions such as diabetes and hypertension, among others. In this regard, geriatric populations must receive proper care to avoid further complications. The recommended medication to treat elderly persons with depression is Sertraline Alprazolam. Sertraline is an FDA-approved drug in the class of SSRIs, whereas alprazolam is an off-label drug in the class of benzodiazepines. Both drugs prove to be effective in helping patients recover from depressive symptoms. However, precautions have to be taken before receiving these prescriptions. Also, the patient can be managed with CBT to control symptoms such as anxiety, suicidal thoughts, and restlessness, among others.

References

Borhannejad, F., Shariati, B., Naderi, S., Shalbafan, M., Mortezaei, A., Sahebolzamani, E., … & Akhondzadeh, S. (2020). Comparison of vortioxetine and sertraline for treating a major depressive disorder in elderly patients: A double‐blind, randomized trial. Journal of Clinical Pharmacy and Therapeutics, 45(4), 804-811. https://doi.org/10.1111/jcpt.13177

Bushnell, G. A., Stürmer, T., Gaynes, B. N., Pate, V., & Miller, M. (2017). Simultaneous antidepressant and benzodiazepine new use and subsequent long-term benzodiazepine use in adults with depression, United States, 2001-2014. JAMA psychiatry, 74(7), 747-755.  doi:10.1001/jamapsychiatry.2017.1273

Chand, S. P., & Grossberg, G. T. (2013). How to adapt cognitive-behavioral therapy for older adults. Current Psychiatry, 12(3), 10-15.

Haigh, E. A., Bogucki, O. E., Sigmon, S. T., & Blazer, D. G. (2018). Depression among older adults: a 20-year update on five common myths and misconceptions. The American Journal of Geriatric Psychiatry, 26(1), 107-122. https://doi.org/10.1016/j.jagp.2017.06.011