Center for Epidemiological Studies – Depression Scale
The Geriatric Mental State Schedule (GMSS)
For depression in the presence of dementia or significant cognitive difficulties
The Cornell Scale for Depression in Dementia (http://www.emoryhealthcare.org/departments/fuqua/CornellScale.pdf )
3. DIAGNOSTIC CRITERIA
National Guidelines for Seniors Mental Health: Part 2: 2.2
DIAGNOSTIC CRITERIA FOR DEPRESSION - DSM IV
A cluster of symptoms present on most days, most of the time, for at least 2 weeks
Depressed mood
Loss of interest or pleasure in normal, previously enjoyed activities
Decreased energy and increased fatigue
Sleep disturbance
Inappropriate feelings of guilt
Diminished ability to think or concentrate
Appetite change (i.e., usually loss of appetite in the elderly)
Psychomotor agitation or retardation
Suicidal ideation or recurrent thoughts of death
DSM IV-TR CLASSIFICATION (APA, 2000)
Make a clear DSM-IV diagnosis & document
Different types of depressive disorders
Major depressive episodes (i.e., part of unipolar, bipolar mood disorder or secondary to a medical condition)
Dysthymic disorder
Depressive disorders not otherwise specified: A group of disorders including minor depressive disorder, post psychotic depressive disorder of schizophrenia and depressive disorders of unclear etiology (e.g., may be primary or secondary to medical condition or substance induced)
4. WHEN TO TREAT
National Guidelines for Seniors Mental Health: Part 2: 2.1.1
Following a positive screen for depression a complete bio-psycho-social assessment should be conducted including:
A review of diagnostic criteria in the DSM IV-TR or ICD 10 manuals
An estimate of severity, including presence of psychotic or catatonic symptoms
Risk of suicide, by directly asking patients about suicidal ideation, intent and plan
Personal or family history of mood disorder
Medication use and substance abuse
Review of current stressors and life situation
Level of functioning/disability
Family situation, social integration/support
Mental status exam, plus assessment of cognitive function
Physical exam and lab tests to determine if medical issues contribute or mimic depressive symptoms
Treatment can be divided into 3 main phases
Acute treatment phase: to achieve remission of symptoms
Continuation phase: to prevent recurrence or relapse of same episode of illness
Maintenance or prophylaxis phase: to prevent future episodes or recurrence
5. GUIDELINES FOR TREATMENT
National Guidelines for Seniors Mental Health: Part 4 & 5
Psychotherapies & Psychosocial Interventions
Supportive care should be offered to all patients who are depressed
Psychotherapy is a first line of treatment or in combination with antidepressant medication
Based on type of depression, coping style, level of cognitive functioning
Psychotherapy – provided by trained mental health professionals
Pharmacological Treatment
Medications are used in combination with psycho social or psychotherapy treatments
Part of overall treatment of depressed older adults
See table for commonly used antidepressants
See full guideline for details of prescribing and monitoring
6. WHEN TO REFER
National Guidelines for Seniors Mental Health: Part 3: 3.5
Recommendations for clinicians to refer for Psychiatric Care at Time of Diagnosis
Psychotic depression
Bipolar disorder
Depression with suicidal ideation
7. MONITORING AND LONG TERM TREATEMENT
National Guidelines for Seniors Mental Health: Part 6: 3
Health care providers should monitor the older adult for re-occurrence of depression for the first 2 years after treatment
Ongoing monitoring should focus on depressive symptoms present during initial episode Older adults in remission of their first episode should be treated for a minimum of one year and up to 2 years from time of improvement
Older adults with recurrent episodes should receive indefinite maintenance therapy
In LTC homes, response to therapy should be evaluated monthly after initial improvement and then every three months, as well as annual
Disclaimer: This tool is intended for information purposes only and is not intended to be interpreted or used as a standard of medical/health practice.
Based on: National Guidelines for Seniors’ Mental Health: the Assessment and Treatment of Depression Available on line: https://ccsmh.ca/
National Initiative for the Care of the Elderly (NICE) 246 Bloor Street West, Room 234 Toronto, Ontario M5S 1V4, Canada