There is a need for disease management protocols that are based upon a solid foundation of research in latelife depression/Ill ere is a dearth of practical inpatient and outpatient guidelines and treatment recommendations that take into account the wide interpatient variation
and concomitant medications, or contain clinically meaningful definitions for depression and treatment response. In conclusion, new approaches to clinical research are needed. The AHCPR guidelines, NTH Consensus Conference, and NIH Update on treating “geriatric depression” all stress that the efficacy of the various treatments for depression Inhibitors,research,lifescience,medical in the elderly is, by and large, equivalent to that found in adults in general. Differences, however, in dealing with the elderly involve the recognition of depression, Inhibitors,research,lifescience,medical overcoming barriers to care, and the particular practical problems discussed above. For example, the consequences of unrecognized and untreated depression in the elderly include increased health services utilization, longer hospital stays, poor treatment compliance, and increased morbidity and mortality from medical illness and suicide. The costs of treatment are relatively modest and can be minimized by careful monitoring of the patient’s clinical status. Other points to Inhibitors,research,lifescience,medical be made include: (i) major depressive disorder in late life is a treatable illness;
(ii) evidence for the specific efficacy of www.selleckchem.com/products/CHIR-258.html medication is based on randomized placebo-controlled trials; (iii) evidence exists for the efficacy of psychotherapy alone as a treatment for less severely ill, nonpsychotic outpatients, though this area remains understudied; (iv) electroconvulsive therapy appears to be effective in geriatric patients with severe or psychotic major depressive; (v) evidence Inhibitors,research,lifescience,medical for or against the efficacy of combined acute phase treatment with both psychotherapy and medication is generally
lacking in geriatric patients, but combined therapy is clearly a clinical advantage; and (vi) the utility of maintenance phase medication is suggested by a few studies.
Characterizing patients’ affect is an important component of the diagnosis of depression Inhibitors,research,lifescience,medical and assessing changes over time is important in evaluating ever treatment outcomes. Therefore, evaluating affect and following the course of affect throughout treatment is a major component of the clinical process. The purpose of this paper is to demonstrate the pertinence of measuring both positive affect (PA) and negative affect (NA) when assessing depression, and not to focus only on depression, anxiety, and other forms of negative affect. As has been demonstrated by research findings and postulated by various circumplex models of emotion, positive and negative affective states are neither polar opposites (r=-1.00) nor totally unrelated (r=0.00).1 In other words, one should not assume that a report of high NA means that the respondent is also experiencing low PA. Measuring both is necessary.