Geriatric Depression?
Q.Nutrtional defeciencies of B6, B12 and folate can also cause depression. Before getting a physchiatrist to look at your mother, I would suggest that you try to find a M.D. or D.O. who specializes in Geriatric Medicine and who is familiar with the diet and drug causes of depression in the elderly. You might want to show your mother's doctor my response to your question. If he wants more information of the role of diet and/or drugs in causing depression in the elderly, have him call the American Society for Clinical Nutrition, Inc.(301) 530-7111. They have a hot line to help physicians deal with the rapidly growing knowledge of the etiology of depression in the elderly and they will also send him the manual that I refered to above.
A.There are many studies documenting the fact that elderly people can be successfully treated for depression. Many studies. The recent studies compare the pros and cons of various treatment strategies - comparing the efficacy of various drugs, drugs vs ECT, etc. Counseling or psychotherapy alone is not adequate treatment for a depression of more than moderate severity, imho. Elderly people get depressed and anxious and psychotic just like the rest of us. Depression in elderly people is often complicated by acute or chronic physical illness and its treatment, but the causes of depression in the elderly are not different than the causes in younger people. While severe vitamin deficiencies can cause psychiatric symptoms, vitamins and dietary precursors are not generally accepted treatments for depressive disorders. Wellbutrin is sometimes considered a drug of choice for elderly depressives since it has essentially zero cardiovascular effects and may be as effective as the tricyclics for severe depression; however, it may lower the seizure threshold somewhat more and this may be a relative contraindication after stroke. Among the tricyclics, nortriptyline is widely used for elderly people because it is somewhat less side effect prone than certain other drugs of the group. The SSRIs (Prozac, Zoloft, Paxil) can be effective and are usually very well tolerated in elderly people; Prozac may be less preferrable for elderly folk because its active metabolite has such a very long half life. Electroconvulsive therapy (ECT) - much refined in the last 20 years - is sometimes particulary good for elderly depressives, since it often works more quickly than antidepressant medications. Medication and ECT have been quite effective in the patients I've seen. Counselling seems to be of limited benefit. Vitamin therapy for depression is quackish.
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