Depression, Anxiety, and Other Mood Disorders

Mood and anxiety disorders are common in the geriatric population and are becoming a significant burden on an already taxed healthcare and social service system. Often, these disorders co-occur with medical illnesses. These co-occurrences frequently result in an increased risk of morbidity and mortality, both in terms of mental health and physical health. Psychiatrists who are formally trained to manage psychiatric disorders in the geriatric population are not only sparsely located, but also scarce (the patient to clinician ratio is skewed by a magnitude of tens of thousands). A primary goal of this chapter will be to equip general medical providers with the knowledge and skills to evaluate, triage, and potentially treat these disorders in a primary care setting. The discussion will include a pathophysiologic perspective of depression, anxiety, and other mood disorders in the geriatric population; how they may present differently from the general adult population; and diagnostic risk factors. We will then shift the discussion to the management and treatment of these diagnoses. This will include considerations about psychosocial and environmental factors. Finally, we will outline several clinical pearls to keep in mind when treating geriatric patients and present a case study to demonstrate how to employ the knowledge and skills discussed for treating mood or anxiety disorders in older adults.