Depression in older adults

Depression in older adults are overlooked as depressed older adults are less likely to endorse affective symptoms and more likely to display cognitive changes, somatic symptoms and loss of interest than younger adults. The common sign and symptoms of depressive disorders in older adults include reduced energy and concentration, insomnia, decreased appetite and somatic complains. In older adults, there is an increased emphasis on somatic complains so the presenting symptoms for depression go underdiagnosed and inadequately treated. According to DSM-5 criteria for depression includes at least one of the symptoms of depressed mood or loss of interest or pleasure, weight loss without trying, insomnia or hypersomnia, feelings of worthlessness, fatigue during the same 2week period APA, 2013).The symptom is not attributable to the physiological effects of substance use or to another medical condition. 

Evidence based treatments

While prescribing antidepressants to older adults it is important to be aware of other medical comorbidities with older adults such as cardiovascular problems, dementia, diabetes, Parkinson disease. Certain antidepressants can cause cardiac abnormalities and hypotension. Antidepressants is the effective treatment for depression in older adults and the selection of antidepressants should be based on the lowest side effect and drug to drug interaction.  SSRIs and SNRIs are relatively safe in the elderly compared to tricyclic antidepressants. SSRIs has lower anticholinergic effects than older antidepressants and thus well tolerated by patients with cardiovascular disease. Tricyclic antidepressants are no longer first line agents for older adults because of lethal in higher dose and can cause cardiac arrhythmia. The best SSRIs for elderly are citalopram, escitalopram, sertraline. They have low drug to drug interaction due to cytochrome P-450 interactions. Venlafaxine, Remeron and Wellbutrin are considered safe due to good safety profile in terms of drug to drug interactions. 

FDA approved drug for depression 

Bupropion is FDA approved drug for MDD for adults. Results showed that there is reduction in the risk of suicidality with bupropion in older adult age 65 and older (Stahl’s 2017). It may also improve cognitive slowing or pseudodementia. It is not sedative and weight gain is rare. Bupropion is generally well tolerated by older adults with few withdrawal symptoms and adverse events (Hewett k., et al., 2016). The risk factors associated with bupropion is the side effects that is caused by the actions of norepinephrine and dopamine in brain areas with undesired effects such as tremor, headache, dizziness and agitation.

Nonpharmacological therapy

 Bright light therapy is the effective treatment for depression in older adult. In Bright light therapy, patient suite themselves near a light box fitted with fluorescent tubes and the session typically takes place in the morning for a prescribed duration of time. The leading hypothesis of the light therapy is that it corrects phased-delayed circadian rhythms by activation suprachiasmatic nucleus through ocular receptor (Gilens D., et al., 2021). 

Off level drug for depression in elderly 

Buspirone is an anxiolytic, serotonin 1 A partial agonist, serotonin stabilizer and FDA approved for the management of anxiety disorders. It can be used off level for the depression and as adjunctive specially for the treatment resistant depression. Buspirone does not cause dependence, shows no withdrawal symptoms, safety profile and shows effect in 4 weeks (Fava M., 2017). There is rare risk of cardiac symptoms, no weight gain and minority sedation. The risk factors associated with buspirone is dizziness, headache, nausea, restlessness and sedation. 

APA Clinical guidelines

APA clinical guidelines for the treatment of depression in older adults recommends combined pharmacotherapy (second generation antidepressants, SSRIs, SNRIs or NDRIs) and interpersonal psychotherapy over psychotherapy alone (APA, 2021).In older adults, a comprehensive assessment of depression which include detailed history including assessment for the presence of physical comorbidity, physical examination and mental state examination to evaluate the risk factors , comorbidity, self-harm and level of dysfunction.


American Psychological Association (2021). Decision making within evidence practice in

      psychology-using the APA clinical practice guidelines for the treatment of depression in

      older adults. Retrieved from

Avasthi A., Grover S., (2018). Clinical practice guidelines for management of depression in

     elderly. Indian Journal of psychiatry. 60(3). 341-362. CINAHL plus. 

Fava M., (2017). The combination of bupropion and bupropion in the treatment of depression.

     Psychotherapy and psychosomatics. 76(5). 311-312. CINAHL Plus.

Hewett K., Chrzanowski W., Jokinen R., Felgentreff R., Shrivastava Rk., Wightman D., Modell

       J. G., (2016). Double-blind, placebo -controlled evaluation of extended -release bupropion in

       elderly patients with major depressive disorder. Journal of psychopharmacology. 24(4). 521-

        529. MEDLINE with full text.

Holvast F., Massoudi B., Voshaar R., Verhaak P, (2017). Non-pharmacological treatment for

        depressed older patients in primary care: a systematic review and meta – analysis. Plos One.

        12(9). 22-31. CINAHL plus.

Gilens D., K., Hoss M., Lyon C., (2021). Does light therapy decrease depression in older adults?

      American Family Physician. 104(4).417-418. CINAHL Plus.

Place your order
(550 words)

Approximate price: $22

Calculate the price of your order

550 words
We'll send you the first draft for approval by September 11, 2018 at 10:52 AM
Total price:
The price is based on these factors:
Academic level
Number of pages
Basic features
  • Free title page and bibliography
  • Unlimited revisions
  • Plagiarism-free guarantee
  • Money-back guarantee
  • 24/7 support
On-demand options
  • Writer’s samples
  • Part-by-part delivery
  • Overnight delivery
  • Copies of used sources
  • Expert Proofreading
Paper format
  • 275 words per page
  • 12 pt Arial/Times New Roman
  • Double line spacing
  • Any citation style (APA, MLA, Chicago/Turabian, Harvard)

Our Guarantees

Money-back Guarantee

You have to be 100% sure of the quality of your product to give a money-back guarantee. This describes us perfectly. Make sure that this guarantee is totally transparent.

Read more

Zero-plagiarism Guarantee

Each paper is composed from scratch, according to your instructions. It is then checked by our plagiarism-detection software. There is no gap where plagiarism could squeeze in.

Read more

Free-revision Policy

Thanks to our free revisions, there is no way for you to be unsatisfied. We will work on your paper until you are completely happy with the result.

Read more

Privacy Policy

Your email is safe, as we store it according to international data protection rules. Your bank details are secure, as we use only reliable payment systems.

Read more

4-hour deadlines

Your urgent tasks will be completed within 4 hours. Your discussion responses and late orders will be will be handled fast and we still maintain our quality.

Read more