Depression is a significant problem in the elderly population and is often accompanied by cognitive changes and agitation. Hypothalamic-pituitary axis dysfunction may occur in some depressed elderly patients and represent a non-specific physiological hyperarousal state. Moreover, recent evidence confirms that antidepressants down-regulate beta-adrenergic receptors in the central nervous system. These findings provide the background for proposing that depression may result from an age-specific, stress-induced dysfunction of the beta-adrenergic receptor system in a subgroup of the geriatric population. A bio-psycho-social model for understanding and developing innovative treatment strategies for depression in the elderly is presented.
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References
1.
KandelE. R.Psychotherapy and the Single Synapse, New England Journal of Medicine, 301, pp. 1028–1037, 1979.
2.
OuslanderJ. G.Drug Therapy in the Elderly, Annals of Internal Medicine, 95, pp. 711–722, 1981.
3.
EisdorferC., and KeckichW., The Normal Psychopathology of Aging, in Psychopathology in the Aged, ColeJ. O., and BarrettJ. E., (eds.), Raven Press, New York, pp. 167–179, 1980.
4.
LeighH., and ReiserM. F., The Patient: Biological, Psychological, and Social Dimensions of Medical Practice, Plenum Medical Book Co., New York, pp. 39–69, 1980.
5.
CarrollB. J., Neuroendocrine Aspects of Depression: Theoretical and Practical Significance, in The Psychobiology of Affective Disorders, MendelsJ. and AmsterdamJ. D., (eds.), Pfizer Pharmaceuticals, New York, New York, pp. 99–107, 1980.
6.
BrownW. A.Effect of Age on DST Results, American Journal of Psychiatry, 139, pp. 1376–1377, 1982.
7.
CohenR. M.CampbellI. C.CohenM. R.TorderT.Presynaptic Noradrenergic Regulation during Depression and Antidepressant Drug Treatment, Psychiatry Research, 3, pp. 93–105, 1980.
8.
SamorajskiT., and HartfordJ., Brain Physiology and Aging, in Handbook of Geratric Psychiatry, BusseE. W., and BlazerD. G., (eds), Van Nostrand Reinhold Co., New York, pp. 46–82, 1980.
9.
FinchC. E.Catecholamine Metabolism in the Brains of Aging Male Mice, Brain Research, 52, pp. 261–276, 1973.
10.
LehmannH. E., Epidemiology of Depressive Disorders, in Depression in the 1970's, FieveR. R., (ed), Exerpta Medica, The Hague, pp. 21–30, 1971.
11.
Diagnostic and Statistical Manual of Mental Disorders, Third Edition, American Psychiatric Association, pp. 205–224, 1980.
12.
WeinbergJ., Geriatric Psychiatry, in Comprehensive Textbook of Psychiatry/II, FreedmanA. M., and SadockB. J., (eds), Third Edition, Volume III, William and Wilkins, Baltimore, p. 3038, 1980.
13.
GernerR.EstabrookW.SteuerJ.WaltuchL., A Placebo-Controlled Double-Blind Study of Imipramine and Trazodone in Geriatric Depression, in Psychopathology in the Aged, ColeJ. O., and BarrettJ. E., (eds), Raven Press, New York, pp. 167–179, 1980.
14.
GoodwinD. W., and GuzeS. B., Psychiatric Diagnosis, Oxford University Press, New York, pp. 3–27, 1979.
15.
NelsonJ. C., and CharneyD. S.Primary Affective Disorder Criteria and the Endogenous-Reactive Distinction, Archives of General Psychiatry, 37, pp. 787–793, 1980.
16.
ReisineT.Adaptive Changes in Catecholamine Receptors in the Central Nervous System, Neuroscience, 6, pp. 1471–1502, 1981.
17.
ConwayJ.GreenwoodD. T., and MiddlemissD. N.Central Nervous Actions of Beta-Adrenoreceptor Antagonists, Clinical Science and Molecular Medicine, 54, pp. 119–124, 1978.
18.
EisdorferC.NowlinJ., and WilkieF.Improvement of Learning in the Aged by Modification of Autonomic Nervous System Activity, Science, 170, pp. 1327–1329, 1970.
19.
KalayamB., and ShamoianC. A.Propranolol, Psychoneuroendocrine Changes, and Depression, American Journal of Psychiatry, 139, pp. 1374–1375, 1982.
20.
FolsteinM. F., and McHughP. R., Dementia Syndrome of Depression, Alzheimer's Disease: Senile Dementia and Related Disorders, in Aging, KatzmanR.TerryR. D., and BickK. L., (eds), Raven Press, New York, Volume 7, pp. 87–96, 1978.
21.
WinokarG.BelarD., and SchlesserM., Clinical and Biological Aspects of Depression in the Elderly, in Psychopathology in the Aged, ColeJ. O., and BarrettJ. E., (eds), Raven Press, New York, pp. 145–155, 1980.
22.
Task Force on Late Neurological Effects of Antipsychotic Drugs: Tardive Dyskinesia: Summary of a Task Force Report of the American Psychiatric Association.American Journal of Psychiatry, 137, pp. 1163–1172, 1980.
