Depression across the Lifespan

Depression is the most common mental disorder, not only for adults, but for children and teenagers as well. The DSM-IV classifies depression as a mood disorder. It states that an individual has suffered a “major depressive episode” if certain symptoms persist for at least two weeks, including a loss of enjoyment in previously pleasurable activities, a sad or irritable mood, a significant change in weight or appetite, problems sleeping or concentrating, and feelings of worthlessness. These symptoms of depression fall into four categories: mood, cognitive, behavioral, and physical. Depression affects how individuals feel, think, behave, and how their bodies work. People with depression may experience symptoms in any or all of the categories, depending on personal characteristics and the severity of the depression. Although depression is usually first noticed during the teen or early adult years, a person can have an episode of depression at any age. Major depressive disorder (MDD) is estimated to be 2% in children and 6% in adolescents and up to 25% of adults age >60 experience MDD, dysthymic disorder, or “minor” depression. Although diagnosis and treatment of major depressive disorder is similar among all patients, its symptoms and course may be atypical in children, adolescents, and older adults. Awareness of these varying clinical manifestations can facilitate early recognition and treatment. Although diagnosis and treatment of depression is similar regardless of a patient’s age, younger and older patients may not exhibit typical depressive symptoms.

Children usually display anxiety, irritability, temper tantrums, and somatic complaints before verbally expressing depressive feelings. Children and adolescents may be more likely to have symptoms like unexplained aches and pains and social withdrawal. Depression in children may co-occur with anxiety, disruptive behavior disorders or attention deficit disorder. Psychotic depression in children manifests more often as auditory hallucinations than delusions.

Younger vs middle-age adults Researchers found that the presentation of depressive symptoms in young adult patients (age 18 to 35) differed from those of middle-age (age 36 to 50) patients.Younger patients were more likely to be irritable, complain of weight gain and hyper somnia, and have a negative view of life and the future. They also were more likely to report previous suicide attempts and endorse symptoms consistent with generalized anxiety disorder, social phobia, panic disorder, and drug abuse. Middle-age patients had more depressive episodes, deceased libido, and middle insomnia, and more frequently reported gastrointestinal symptoms such as diarrhea or constipation. ypical MDD mood symptoms often are absent in older patients. Frequently, somatic complaints, motor restlessness, or psycho motor retardation are seen; these symptoms may be attributable to a concurrent medical illness. This in turn may worsen the physical illness, leading to social isolation and considerable medical morbidity. Pain plays an important role in depression, particularly in older adults. Chronic pain affects up to 65% of older adults who live in the community and up to 80% of those who are institutionalized.The most common causes of pain in these patients are osteoarthritis, osteoporosis, fibromyalgia, degenerative disk disease, lumbar spinal stenosis, and scoliosis. In addition, neuropathic pain, such as post-herpetic neuralgia and peripheral neuropathy and injuries resulting from falls often cause long-lasting pain.

The presence of pain tends to negatively affect recognizing and treating depression. Regardless of their age, when a patient presents with pain or depression, investi-gate and consider treating both conditions. Memory decline is likely to be depressed older adults’ chief complaint, and when objectively tested these patients often show cognitive impairment.Whether depressive symptoms in this age group are a...