HCCIntelligence™ Webinar Recording: Managing Depressive Disorders in Homebound Patients

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The HCCIntelligence Webinar held on December 18, 2019, presented by Dr. James M. Ellison, addressed the management of depressive disorders in homebound, elderly patients. Dr. Ellison, an expert in geriatric psychiatry, emphasized the varied presentations and assessment methods for geriatric depressive disorders and introduced strategies for effective treatment.<br /><br />Key points discussed included:<br /><br />1. **Prevalence and Risk Factors**: Late-life depression (LLD) is prevalent, with significant implications for physical health and overall quality of life. Risk factors for LLD include lack of social support, recent negative life events, low exercise levels, chronic medical illness, and sleep disturbances.<br /><br />2. **Adverse Outcomes**: Untreated LLD can lead to an increased use of health services, reduced adherence to medical treatments, and heightened risks for functional decline, increased medical morbidity and mortality, and suicide.<br /><br />3. **Assessment Tools**: Various tools for assessing depression in the elderly include the DSM-5 criteria for Major Depressive Disorder (MDD) and Persistent Depressive Disorder (Dysthymia), the Geriatric Depression Scale (GDS), and the Cornell Scale for Depression in Dementia.<br /><br />4. **Non-Pharmacological Treatments**: Effective non-drug strategies such as Cognitive Behavioral Therapy (CBT), Interpersonal Therapy, Problem Solving Therapy, and encouraging physical activity were highlighted for their benefits in treating LLD.<br /><br />5. **Pharmacologic Treatment**: Dr. Ellison discussed the efficacy of antidepressants including SSRIs (e.g., sertraline, citalopram) and SNRIs, noting that all FDA-approved antidepressants can treat LLD though side effects and drug interactions must be managed carefully. Alternatives like bupropion and mirtazapine were also mentioned.<br /><br />6. **Electroconvulsive Therapy (ECT)**: ECT was described as an underused but effective option for severe cases, especially when other treatments fail or are not tolerated.<br /><br />7. **Additional Therapies**: Exploration of newer therapies like ketamine and neurotherapies were noted, but these remain largely investigational.<br /><br />8. **Suicide Risk and Management**: The importance of recognizing and managing the high suicide risk in elderly patients with LLD was stressed, emphasizing the need for regular monitoring and maintenance treatment.<br /><br />The session concluded with a Q&A segment where attendees could interact live and obtain comprehensive insights into the discussed topics. Upcoming HCCI events and consulting services were also announced.

Keywords

geriatric psychiatry

late-life depression

depressive disorders

homebound elderly

risk factors

assessment tools

non-pharmacological treatments

pharmacologic treatment

electroconvulsive therapy

suicide risk