AGS 2009:年紀增長會增加未緩和憂鬱的風險


  May 4, 2009(伊利諾州芝加哥) —根據美國老年協會(AGS)科學年會中發表的一篇研究指出,有憂鬱的中年人比較可能在晚年持續憂鬱,特別是把自己視為病患者。
  
  這項研究的主要作者、華盛頓大學老年精神科專家Stephen Thielke醫師在Medscape Internal Medicine訪問中表示,希望聽眾記住的是,憂鬱不會自己緩解,特別是病患。
  
  該研究回溯分析「Cardiovascular Health Study」這項研究在1990至1999年間調查的縱向資料,包括了四個美國社區共將近5,900名Medicare保險對象,病患回答單一問題,以對其整體健康排序,「生活困擾量表」評分10分以上者確認為憂鬱症狀。
  
  研究者報告指出,超過70%的研究對象自認為生病,在一開始就認為有憂鬱,且在一年後評估時仍然有憂鬱症狀;但是即使在自我報告為健康者之中,超過50%有憂鬱者在一年後依舊有憂鬱症狀。
  
  作者發現,自認為生病的老年人中,年齡增長與變得憂鬱無關,但是在自認健康者之中,年齡因素則有相關。
  
  Thielke醫師向Medscape Internal Medicine表示,雖然研究者探究憂鬱與特定疾病之間的關聯,但一般人的自我報告健康狀態比特定疾病更能作為憂鬱的預測因子。
  
  他們並未研究何以年長者的憂鬱比較無法緩和,但Thielke醫師推測,理由之一是,除了健康不佳,社交狀況不佳也是原因之一。
  
  Thielke醫師表示,我們不應放棄這些受憂鬱症之苦的病患;有許多有效的老年憂鬱治療方式。
  
  未參與本研究的紐約市Mount Sinai醫學院老人部副主任Rosanne Leipzig教授表示,老年人的憂鬱治療不是只有給藥,有些老年人對於抗憂鬱藥物沒有耐受性,或者因為其他原因而不願意服用藥物。
  
  她表示,證據顯示,包括社會支持、會談治療以及合併藥物的系統性照護,比較能夠改善病患的憂鬱症狀。
  
  Leipzig教授提到本研究的一個缺點,就是未報告病患是否有接受任何憂鬱治療,也不清楚病患實際上是否繼續憂鬱或者改善,之後是否在再度評估前復發等。
  
  Leipzig教授表示,其他研究顯示,年長者比年輕人更容易憂鬱復發。
  
  Hartford基金會透過其Geriatric Health Outcomes Award獎項支持本研究 。Thielke醫師以及 Leipzig教授宣告沒有相關財務關係。
  
  美國老年協會(ASG) 2009:摘要A40。發表於2009年4月30日。
  

AGS 2009: Advancing Age Increases Risk for Nonremitting Depression

By Kathleen Louden
Medscape Medical News

May 4, 2009 (Chicago, Illinois) — Older adults who are depressed are more likely to stay depressed as they age, especially those who rate themselves as sick, a study presented here at the American Geriatrics Society Annual Scientific Meeting found.

"The take-home message is: depression is not going to resolve on its own, especially among sick patients," said Stephen Thielke, MD, a geriatric psychiatrist at the University of Washington, in Seattle, and the study's lead author in an interview with Medscape Internal Medicine.

The study was a retrospective analysis of longitudinal data from the Cardiovascular Health Study and involved nearly 5900 Medicare recipients in 4 American communities who were surveyed between 1990 and 1999. Patients answered a single question to rate their overall health, and depressive symptoms were determined by a score of 10 or more on the Center for Epidemiologic Studies Depression Scale.

More than 70% of subjects with self-rated sickness who were initially depressed still had symptoms of depression when they were evaluated 1 year later, the investigators reported. But even among individuals who reported themselves as healthy, more than 50% who had depressive symptoms were still depressed a year later.

Advancing age was not associated with becoming depressed in older adults with self-rated sickness, but it was in those with self-rated health, the authors found.

Although the researchers looked at the relation between depression and specific illnesses, Dr. Thielke told Medscape Internal Medicine that self-rated health in general was a better predictor of depression than specific illness.

They did not study why depression was unlikely to remit in older adults, but Dr. Thielke speculated that one reason, besides poor health, could be an inadequate social network.

"We should not give up on these patients who get stuck in depression," Dr. Thielke said. "There are very effective treatments of depression in older adults."

Treatment of depression in older adults is not as simple as just giving medication, said Rosanne Leipzig, MD, PhD, professor and vice chair of the Department of Geriatrics, Mount Sinai School of Medicine, in New York City. Dr. Leipzig, who was not involved with the study, said that some older adults might not tolerate the effects of antidepressant medication, or they might be unwilling to take medication for other reasons.

"Evidence shows you're more likely to improve a patient's depression with a system of care, including social support, such as talk therapy, combined with medication," she said.

Dr. Leipzig said a drawback of the current study is that it did not report whether patients received any therapy for depression. It also is not clear whether patients actually stayed depressed or improved and then suffered a recurrent episode of depression before re-evaluation, she said.

"Other studies show that older people are more likely than younger people to suffer recurrent depression," Dr. Leipzig said.

The Hartford Foundation supported this study through its Geriatric Health Outcomes Award. Dr. Thielke and Dr. Leipzig have disclosed no relevant financial relationships.

American Geriatrics Society (AGS) 2009 Annual Scientific Meeting: Abstract A40. Presented April 30, 2009.

    
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