Depression in Late Life: Current Issues

老年憂鬱症：目前之議題

謝明鴻(Ming-Hong Hsieh) ； 賴德仁(Te-Jen Lai)

《台灣精神醫學》 19卷2期 (2005/06) Pp. 85-99

https://doi.org/10.29478/TJP.200506.0002

摘要

憂鬱是造成老年人痛苦的重要原因，但經常未被正確的診斷，也缺乏適當的治療。老年憂鬱症是由一群不同原因所造成情感困擾的疾病，並可表現出各種不同的特徵。本文將討論老年憂鬱症目前之議題。
達到臨床意義的憂鬱症狀在社區老人的盛行率大約爲8%至16%，而樣本取自社區的老年重度憂鬱症盛行率較低，大約爲1%至4%。愈來愈多的證據顯示腦部結構的改變，特別是血管性的原因，會使得有些人到老年時容易出現憂鬱。從長期研究憂鬱症的預後與生物、心理社會、及功能之相關性之結果，逐漸認爲輕微且未達診斷症候群之老年憂鬱症也是憂鬱疾病嚴重度的一部分。老年憂鬱症常併發基底核及前額葉的投射部分出現問題，而導致執行功能障礙。老年憂鬱症合併執行功能障礙則會提高未來出現失智症的危險性。重度憂鬱症是企圖自殺或自殺成功的老人最常被診斷的疾病。合併焦慮性疾病的老年憂鬱症常呈現較嚴重的憂鬱症狀、較高的自殺率，且療效較差。合併較多之身體疾病則是老年憂鬱症的特色。儘管藥物療效與年輕的憂鬱症相似，但是老年憂鬱症需要較長的時間才能獲得緩解且復發率也較高。加強基層醫療人員對老年憂鬱症的了解，可使得更多合併身體問題的老年憂鬱症患者成功地被辨識出來且接受適當的治療。

關鍵字

老年憂鬱症 ； 盛行率 ； 血管性憂鬱症 ； 自殺

並列摘要

Depression is one of the leading causes of suffering in the elderly, but it is often under-diagnosed and under-treated. Depression in late life represents a heterogeneous group of mood disturbances that may present with variable features. Current issues in depression in late life are discussed. The prevalence of ”clinically significant depressive symptoms” among community-dwelling older adults ranges from approximately 8% to 16%. The prevalence estimates of ”major depression” in community samples of elderly people have been quite low, ranging from 1% to 4%. There is increasing evidence that structural change, especially vascular in nature, renders some people in later life vulnerable to depression. Data regarding longitudinal outcomes and biological, psychosocial, and functional correlates increasingly support the notion that minor and subsyndromal depressions are part of a spectrum of depressive illness severity. Disorders of the basal ganglia and their prefrontal projections are often complicated by depression and result in executive dysfunction. These depressed patients with executive dysfunction appear at a higher risk of developing dementia later In later life, the most common diagnosis in those who attempt or complete suicide is major depression. Comorbidity with an anxiety disorder is associated with a more severe depression, a higher level of suicidality and poorer treatment outcomes. Increased medical comorbidity is characteristic in late-life depression. In spite of similar treatment responses, elderly patients spend longer time to remission, and have higher rate of relapse than do younger patients. By raising awareness and understanding of depression among primary healthcare, more depressed elderly with comorbid medical problems can be successfully identified and helped.

並列關鍵字

late life depression ； prevalence ； vascular depression ； suicide

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