Guest Blog: Late Life Depression in the midst of Covid-19 Pandemic, a Preliminary Report

*This piece is a re-print from the Central California Psychiatric Society’ 2022 Quarterly Update from December 2022.

As part of our ongoing commitment to behavioral health, PRMS is pleased to feature geriatric psychiatry specialist, Dr. Rossano Bangasan, MD, DFAPA, Central California Psychiatric Society (CCPS) member, and Chair of the Geriatric Committee at CCPS, as one of the guest bloggers this month. Dr. Bangasan shares more about depression, its different types, and its effect later in life.

What is depression and why is it important to know what it is? A lot of my patients would come to my office and start their story during the interview as feeling sad or lonely, or sometimes, from the very start, they may interchangeably use feeling down or depressed on their mood, and not sure if this is the real deal. To begin with, I would tell them, feeling sad or lonely is a natural emotion, it’s normal, depending on the situation like you didn’t do well on the exam, you lost your favorite bag, and things like that. On the other hand, depression is not a normal feeling, it’s an illness that can potentially kill a person. It could be feeling sad, lonely, or down on your mood, but it’s incorporated with several other symptoms, and these constellations of symptoms last at least two weeks or more.

In medical school, we learned about Sig: e caps (prescribe energy caps) - our acronym for Major Depressive Disorder (or MDD). We were taught that if a person is depressed, he should have at least five out of the following nine criteria in a period of two weeks – Sig e caps stands for Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidality.

Compare this with the DSM-5 TR criteria for MDD: Criteria A – Depressed mood and/or Anhedonia PLUS Sig E Caps; Criteria B – symptoms bring about significant impairment in social, occupational or other areas of functioning; Criteria C - the symptoms are not direct physiological effect of a substance of a GMC; Criteria D - not better accounted for by other dx like schizoaffective disorder, schizophrenia; Criteria E – no manic or hypomanic episode.

Why is it important to know Major Depressive Disorder (MDD) per se? It is very disabling, based on WHO classification. MDD is the 2nd cause of disability and because of that, it increases health care costs by as much as 50-100%, MDD is very common in the sense that as much as 10-15% of patients seen in primary care settings suffer from it, and it is deadly, as severe MDD accounts for over 35,000 suicides per year. All of these worsened when we were hit by the Covid-19 pandemic.

Who are considered older adult, senior citizen, or elderly? Older individuals could be between the ages of 55 and 70, when changes in their functionality are becoming noticeable. Among different counties here in California, elderly are individuals 60 years old and above, whereas in the Penal Code, they are still the 65-year-old and above individuals.

Is there any difference between Early-Onset and Late-Life Depression (LLD)? Basically, the presentation of early- and late-life depression is almost the same except that patients with LLD have less frequent family history of mood disorders, higher prevalence of dementing disorders, present to be more impaired during neuropsychological testing, have higher rate of dementia development on follow-up, and have more neurosensory hearing impairment.

Why were PCPs unable to screen those presenting with LLD? Failure to discuss a highly stigmatized mental illness, believing that depression is common and normal in occurrence among elderly individuals, missing the diagnosis because of medical comorbidity, unfamiliarity in prescribing antidepressants, and time constraints involved.

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