Depression in the Elderly. Consensus Statement of the Spanish Psychogeriatric Association

Abstract

Discussion and Conclusions: Consensus was reached for a high number of items as well as for the management of depression in the context of comorbid conditions and in resistant cases. In the current absence of sufficient evidence-based information, our results can be used to inform medical doctors about clinical recommendations that might reduce uncertainty in the diagnosis and treatment of elderly patients with depressive disorders.

Focus on Depression in Parkinson’s Disease: A Delphi Consensus of Experts in Psychiatry, Neurology, and Geriatrics

“…In order to establish consensus, experts were queried on a broad range of treatment approaches for depression in PD. About tricyclic antidepressants (TCAs), there are some evidence for treatment with amitriptyline, nortriptyline, and desipramine in PD [ 6 , 7 , 11 , 40 – 43 ]. However, according to the literature and the expert panel opinion, their prescription within the scope of PD is questionable due to their anticholinergic adverse effects such as (cognitive impairment, orthostatic hypotension, increased risk of falls, constipation, and urinary retention) ( Table 4 ; S26) [ 5 , 29 , 30 , 40 , 44 ].…”

“…Last year, the International Parkinson Disease and Movement Disorder Society (IPMDS) identified some SSRIs (sertraline, citalopram, paroxetine, and fluoxetine) and a SNRI (venlafaxine) as possibly or clinically useful for depression in PD [ 6 ]. Other consensus recommendations on the administration of SNRIs in the elderly [ 11 , 53 , 54 ] and in PD patients are found elsewhere [ 42 , 44 ]. There are no studies assessing the benefits and safety profile of desvenlafaxine or the newly commercialized vortioxetine in depression and PD comorbidities, yet a very recent postmarketing study with a WHO pharmacovigilance database has documented some harmful associations between movement disorders and a plethora of old and new generation antidepressants.…”

“…Following efficacy and tolerability criteria (especially regarding the absence or a minimal increase in motor symptoms), other supported drugs for PD and depression comorbidities were bupropion (NE-DA reuptake inhibitor; Table 4 ; S33 and S45), mirtazapine (NEergic and specific serotonergic antidepressant; Table 4 ; S31 and S44), and tianeptine (glutamatergic modulator; Table 4 ; S35 and S48). Bupropion may be an ideal candidate given its dopaminergic action, lack of serotonergic activity, and subsequent low risk of Parkinsonism but may also induce psychotic symptoms [ 11 , 42 , 44 ]. A part from the revision from Costa and colleagues, no other specific studies addressing mirtazapine in PD patients have been found, but its extended use in psychogeriatric population is well known, which may be due to a higher antidepressant response of multitarget drugs such as mirtazapine and dual-action agents in neurodegenerative conditions [ 42 , 54 ].…”

“…Nonetheless, there is considerable amount of reported experience on electroconvulsive therapy (ECT) by psychiatrists and, to a lesser extent, neurologists and geriatrists (data not shown). ECT is specifically used in patients with drug-refractory and life-threatening affective disorders ( Table 4 ; S41) [ 5 , 11 , 63 ].…”

“…This study uses the modified Delphi method [ 8 – 10 ] as in Agüera-Ortiz et al and Luquin et al [ 11 , 12 ]. A two-round closed-ended questionnaire included 49 items revisiting some fundamental clinical aspects of depression in PD: aetiology and risk factors (10), clinical presentation (10), diagnosis (5), and treatment (24).…”