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B   Obtain history of the patient and family

Based on DSM-IV criteria, a major depressive disorder must consist of at least five of the following symptoms and they must have lasted for at least 2 weeks. These are: depressed mood, decreased interest or pleasure in previous activities, insomnia, or hypersomnia, psychomotor retardation or agitation; fatigue, loss of energy; feelings of worthlessness; poor concentration, and recurrent thoughts of suicide or suicidal ideation. At least one of the above symptoms must be depressed mood or loss of interest. And for a differential diagnosis, this depressed mood can not be attributable to a general medical condition or bereavement.

Overall, the risk factors for a major depressive episode include the following: female, especially post partum, a history of depression, first degree relatives with a history of depression, prior suicide attempts, over age 40, medical problems, decreased social supports, stress, and current substance or alcohol abuse.

Obtaining a history of the patient and family is extremely crucial in the treatment of mood disorders. Often, there seems to be a genetic link. History must be taken before any treatment begins. It is very important to find out both from the family and patient if there has ever been any history of prior episodes of depression and the level of recovery; any history of mania, any other psychiatric problems, any hospitalizations, or suicide attempts. Often geriatric patients are reluctant to discuss their mental health problems, and therefore, you must obtain an accurate history from the immediate family.

Depression may present with similar or the same symptoms as dementias, but are due to other medical or neurological diseases such as head trauma, Parkinson's disease, Picks disease, Huntington's disease, HIV disease, multiple sclerosis, a lateral sclerosis, vitamin deficiencies, and numerous other medical conditions.

Some patients with loss of memory and other cognitive deficits have a major depression or other mood disorder which is causing their memory loss or cognitive deficits and this is said to be the false or pseudodementia. Many elderly patients suffer from a major depression, which may even present itself with some of the same symptoms as dementia of the Alzheimer's type or even multiinfarct dementia. These symptoms include short term or recent memory loss, fatigue, insomnia or hypersomnia, low appetite, weight loss, overeating, and an inability of handling activities of daily living.

Substance induced depression includes cognitive and emotional effects caused by inhalants, sedative drugs, hypnotic drugs, prescription side effects, overdoses of prescription drugs, or other substances. This is common in the elderly.

Bi-polar affective disorders also exist in geriatric patients but usually began in their earlier life. The symptoms of bi-polar disorder consist of the following: grandiosity, decreased need for sleep, pressured speech, racing thoughts or flight of ideas, psychomotor agitation, excessive involvement of pleasurable activities such as spending, sex, trips, loss of control, and substance abuse.

Supportive based therapy on an individual basis has proven to be more successful with the geriatric population rather than family therapy or group therapy.

Also, it is very crucial to have lab testing and a complete examination of the older patient before beginning any course of treatment. Psychotherapy plus antidepressant therapy combined has proven to be the most successful in treatment of geriatric patients. But before beginning any antidepressant medication it is very crucial to have an EEG AND AN EKG to rule out any superimposed brain diseases or cardiac problems.

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