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We close with a deep dive into late-life depression, where we explore why growing older can sometimes mean growing sadder. Dr. Handratta and Dr. Amayo uncover the four key culprits: executive dysfunction (DED, not a good acronym!), vascular woes, inflammatory fires, and amyloid beta blues. We’ll discuss why SSRIs might not be the golden ticket and what alternatives, like dopamine agonists, rTMS, and even ECT, can brighten those grey years. Plus, we'll ponder if your patient is depressed, or if their brain is just throwing a vascular tantrum. Tune in for insights that are as informative as they are, well, hopefully not too depressing.
Four Key Theories:
Depression Executive Dysfunction Syndrome (DED): Frontal-striatal white matter tract issues, poor SSRI response, dopamine agonist consideration.
Vascular Causes: Hypertension, diabetes, multi-infarct dementia, rTMS, ARBs, Calcium channel blockers.
Inflammation: Indoleamine 2 3-dioxygenase, tryptophan depletion, CRP levels, TNF alpha antagonist.
Amyloid Beta Deposits: Hippocampal involvement, Alzheimer's risk, cholinesterase inhibitors.
Treatment Options: SSRIs (often with augmentation), pramipexole, rTMS, ECT (highly effective), and addressing underlying medical conditions.
Differentiating Diagnoses: Differentiating between depression, vascular dementia, and other neurocognitive disorders.
ECT: Most effective treatment for late life depression.
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