Structural brain changes, seen on MRI and thought to be secondary to vascular insufficiency, are associated with depression in late life. Such cases are referred to as vascular depression. The clinical manifestations of depression in the elderly are listed in Table 33-3. The symptoms may have no clear cause and may resolve spontaneously, and episodes may occur in increasingly rapid cycles. Adjusting to a severe or ultimately fatal chronic illness and losing a spouse or partner are common causes of such symptoms.
Affected persons recover with time or when the stressor resolves.
Symptoms must persist for at least 2 years but are not severe enough to constitute a major depressive episode. Sometimes major depression is characterized predominantly by psychotic features, especially delusions of illness or guilt about past actions, thoughts, or events. Psychotic depression is more prevalent in late life than in midlife. Generally, psychotic symptoms are similar among elderly and younger patients, although elderly patients usually have more of them and are less likely to experience self-deprecation and guilt. Bipolar I disorder is characterized by one or more manic episodes, with or without episodes of depression.