1. GERIATRIC EDUCATION SERIES Presented in partnership by Funded in part by a grant from the EJC Foundation

2. dhs.unr.edu/aging ECHO Geriatric Series Depression: An Extremely Complex Disease Steven L. Phillips, MD Medical Director Sanford Center for Aging

3. Depression is an extremely complex disease. It occurs for a variety of reasons. Some people experience depression during a serious illness. Others may have depression with life changes such as a move or the death of a loved one. Still others have a family history of depression. Those who do may experience depression and feel overwhelmed with sadness and loneliness for no known reason.

4. Course Objectives Objective 1: Define main cause of depression. Objective 2: Describe the impact of depression on commonly treated medical conditions. Objective 3: Review options for the treatment of depression.

5. Main Causes of Depression Past Abuse Conflict Death or a Loss Genetics Substance Abuse Major Events Social Isolation Rejection Medications Chronic Illness

6. Chronic illness is an illness that lasts for a very long time (> 6 months) and usually cannot be cured completely. However, chronic illnesses can often be controlled through diet, exercise, lifestyle habits and certain medications.

7. Chronic Illnesses That May Cause Depression Diabetes Mellitus COPD/Emphysema HIV/AIDS Multiple Sclerosis Cancer Heart Disease Arthritis Systemic Lupus Hypothyroidism CVA/Stroke

8. Impact of Depression Social Isolation Functional Decline Loss of Productivity Self Neglect Danger to Self or Others Increase Office Visits Increase ER Visits Increase Hospitalizations Increase Readmissions Increase Mortality

9. Symptoms of Depression Sadness or Depressed Mood Physical Restlessness Worthlessness Impaired Decision Making Major Weight Change Excessive Sleep Loss of Enjoyment Insomnia Fatigue Hopelessness Excessive Guilt Thoughts of Death

10. Patient Health Questionnaire (PHQ-9) Over the last 2 weeks, how often have you been bothered by any of the following problems (circle your answer): Not at all Several More than Nearly days half days every day 0 1 2 3 Little interest in doing things 0 1 2 3 Feeling down, depressed or hopeless 0 1 2 3 Trouble falling or staying asleep or sleeping too much 0 1 2 3 Feeling tired or having little energy 0 1 2 3 Poor appetite or overeating 0 1 2 3 Feeling bad about yourself-or that you are a failure or have let yourself or your family down 0 1 2 3 Trouble concentrating on things, such as reading the newspaper or watching television 0 1 2 3 Moving or speaking so slowly that other people could have noticed? Or the opposite-being so fidgety or restless that you have been moving around a lot more than usual 0 1 2 3 Thoughts that you would be better off dead or hurting yourself in some way If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?  Not difficult at all  Somewhat difficult  Very difficult  Extremely difficult

11. Treatment Options for Depression Routine Exercise Antidepressant Social Engagement Medication Discontinuation Psychotherapy Brain Stimulation (ECT)

12. Sanford Center for Aging Geriatric Specialty Clinic Steven L. Phillips, MD slphillips@unr.edu (775) 784-1808