DEPRESSÃO EM IDOSOS: FISIOPATOLOGIA, FATORES DE RISCO E ABORDAGENS TERAPÊUTICAS
Resumo
O envelhecimento populacional tem contribuído para o aumento da depressão em idosos, condição prevalente, frequentemente subdiagnosticada e com impacto relevante na qualidade de vida. Este estudo teve como objetivo analisar a fisiopatologia, os fatores de risco e as abordagens terapêuticas da depressão nessa população. Trata-se de uma revisão integrativa da literatura, de abordagem qualitativa, realizada nas bases Literatura Latino-Americana e do Caribe em Ciências da Saúde e PubMed/Medline, incluindo publicações entre 2016 e 2026, totalizando 29 estudos. Os achados indicam que a depressão em idosos possui etiologia multifatorial, envolvendo alterações neurobiológicas e fatores psicossociais. Fatores como idade avançada, comorbidades, isolamento social e polifarmácia aumentam a vulnerabilidade. Evidências sugerem maior efetividade da combinação entre intervenções farmacológicas e não farmacológicas. Conclui-se que a depressão em idosos demanda manejo interdisciplinar e individualizado. Destaca-se a importância da identificação precoce dos fatores de risco e da integração de estratégias terapêuticas baseadas em evidências, visando à promoção da qualidade de vida e ao envelhecimento saudável.
Biografia do Autor
Estudante de Medicina do 9° período da Faculdade de Medicina de Marília (FAMEMA).
Estudante de Medicina do 9° período da Faculdade de Medicina de Marília (FAMEMA).
Estudante de Medicina do 9° período da Faculdade de Medicina de Marília (FAMEMA).
Graduando(a) de medicina da Faculdade de Medicina de Marília (FAMEMA).
Referências
1. Tan JDL, Maneze D, Montayre J, Ramjan LM, Wang D, Salamonson Y. Family visits and depression among residential aged care residents: an integrative review. International Journal of Nursing Studies. 2023;146:104568. DOI: https://doi.org/10.1016/j.ijnurstu.2023.104568
2. Brender R, Mulsant BH, Blumberger DM. An update on antidepressant pharmacotherapy in late-life depression. Expert Opinion on Pharmacotherapy. 2021;22(14):1909–1917. DOI: https://doi.org/10.1080/14656566.2021.1921736
3. Brouwer J, Van Den Berg F, Knooihuizen R, Loerts H, Keijzer M. Exploring language learning as a potential tool against cognitive impairment in late-life depression: two meta-analyses and suggestions for future research. Behavioral Sciences. 2020;10(9):132. DOI: https://doi.org/10.3390/bs10090132
4. Zhang Y, Jiang X. The effects of physical activity and exercise therapy on depression in frail older adults: a narrative review. Medicine. 2023;102(34):e34908. DOI: https://doi.org/10.1097/MD.0000000000034908
5. Beard JR, Officer A, de Carvalho IA, Sadana R, Pot AM, Michel JP, et al. The World report on ageing and health: a policy framework for healthy ageing. The Lancet. 2016;387(10033):2145–2154. DOI: https://doi.org/10.1016/S0140-6736(15)00516-4
6. Feng L, Li J, Yap KB, Kua EH, Ng TP. Depressive symptoms and quality of life among older adults: a population-based study. Journal of Affective Disorders. 2016;189:131–136.
7. Kok RM, Reynolds CF. Management of depression in older adults: a review. JAMA. 2017;317(20):2114–2122. DOI: https://doi.org/10.1001/jama.2017.5706
8. Read JR, Sharpe L, Modini M, Dear BF. Multimorbidity and depression: a systematic review and meta-analysis. Journal of Affective Disorders. 2017;221:36–46.
9. Lund C, Brooke-Sumner C, Baingana F, Baron EC, Breuer E, Chandra P, et al. Social determinants of mental disorders and the Sustainable Development Goals. The Lancet Psychiatry. 2018;5(4):357–369. DOI: https://doi.org/10.1016/S2215-0366(18)30060-9
10. Santomauro DF, Mantilla Herrera AM, Shadid J, Zheng P, Ashbaugh C, Pigott DM, et al. Global prevalence and burden of depressive and anxiety disorders in 2020 due to the COVID-19 pandemic. The Lancet. 2021;398(10312):1700–1712. DOI: https://doi.org/10.1016/S0140-6736(21)02143-7
11. Alexopoulos GS. Mechanisms and treatment of late-life depression. Translational Psychiatry. 2019;9(1):188. DOI: https://doi.org/10.1038/s41398-019-0514-6
12. Zhao Y, Wu X, Tang M, Shi L, Gong S, Mei X, et al. Late-life depression: epidemiology, phenotype, pathogenesis and treatment before and during the COVID-19 pandemic. Frontiers in Psychiatry. 2023;14:1017203. DOI: https://doi.org/10.3389/fpsyt.2023.1017203
13. Reynolds CF, Cuijpers P, Patel V, Cohen A, Dias A, Chowdhary N, et al. Early intervention to reduce the global health and economic burden of major depression in older adults. Annual Review of Public Health. 2022;43:123–142.
14. Park M, Unützer J. Geriatric depression in primary care. Clinics in Geriatric Medicine. 2022;38(2):201–216.
15. Beekman ATF, Penninx BWJH, Deeg DJH, Ormel J, Braam AW, Van Tilburg W. Depression and physical health in later life: results from the Longitudinal Aging Study Amsterdam. Journal of Affective Disorders. 2020;263:126–133.
16. Read JR, Sharpe L, Modini M, Dear BF. Multimorbidity and depression: a systematic review and meta-analysis. Journal of Affective Disorders. 2022;296:36–48. DOI: https://doi.org/10.1016/j.jad.2017.06.009
17. Soysal P, Veronese N, Thompson T, Kahl KG, Fernandes BS, Prina AM, et al. Relationship between depression and frailty in older adults: a systematic review and meta-analysis. Ageing Research Reviews. 2022;74:101492.
18. Ismail Z, Gatchel J, Bateman DR, Barcelos-Ferreira R, Cantillon M, Jaeger J, et al. Affective and emotional dysregulation as pre-dementia risk markers: exploring the mild behavioral impairment syndrome. Alzheimer’s & Dementia. 2022;18(2):260–271.
19. Santini ZI, Koyanagi A, Tyrovolas S, Mason C, Haro JM. The association between social relationships and depression: a systematic review. Journal of Affective Disorders. 2023;323:372–381.
20. Park M, Unützer J. Geriatric depression in primary care. Psychiatric Clinics of North America. 2023;46(2):237–252.
21. Penninx BWJH. Depression and cardiovascular disease: epidemiological evidence on their linking mechanisms. Neuroscience & Biobehavioral Reviews. 2023;149:105152.
22. Sukhera J. Narrative reviews in medical education: key steps for researchers. Journal of Graduate Medical Education. 2022;14(4):418–419. DOI: https://doi.org/10.4300/JGME-D-22-00481.1
23. Gunning FM, Oberlin LE, Schier M, Victoria LW. Brain-based mechanisms of late-life depression: implications for novel interventions. Seminars in Cell & Developmental Biology. 2021;116:169–179. DOI: https://doi.org/10.1016/j.semcdb.2021.05.002
24. Dotson VM, Gradone AM, Bogoian HR, Minto LR, Taiwo Z, Salling ZN. Be fit, be sharp, be well: the case for exercise as a treatment for cognitive impairment in late-life depression. Journal of the International Neuropsychological Society. 2021;27(8):776–789. DOI: https://doi.org/10.1017/S1355617721000710
25. Triolo F, Harber-Aschan L, Belvederi Murri M, Calderón-Larrañaga A, Vetrano DL, Sjöberg L, et al. The complex interplay between depression and multimorbidity in late life: risks and pathways. Mechanisms of Ageing and Development. 2020;192:111383. DOI: https://doi.org/10.1016/j.mad.2020.111383
26. Lee SH, Lee H, Yu S. Effectiveness of social support for community-dwelling older adults with depression: a systematic review and meta-analysis. Healthcare. 2022;10(9):1598. DOI: https://doi.org/10.3390/healthcare10091598
27. Jellinger KA. The heterogeneity of late-life depression and its pathobiology: a brain network dysfunction disorder. Journal of Neural Transmission. 2023;130(5):709–726. DOI: https://doi.org/10.1007/s00702-023-02648-z
28. Kuo CY, Lin CH, Lane HY. Molecular basis of late-life depression. International Journal of Molecular Sciences. 2021;22(14):7421. DOI: https://doi.org/10.3390/ijms22147421
29. Klimova B, Novotny M, Valis M. The impact of nutrition and intestinal microbiome on depression in older adults: a systematic review. Nutrients. 2020;12(3):710. DOI: https://doi.org/10.3390/nu12030710
30. Li XL, Wei J, Zhang X, Meng Z, Zhu W. Relationship between night sleep duration and risk of depression among middle-aged and older adults: a dose–response meta-analysis. Frontiers in Physiology. 2023;14. DOI: https://doi.org/10.3389/fphys.2023.1085091
31. Andreescu C, Ajilore O, Aizenstein HJ, Albert K, Butters MA, Landman BA, et al. Disruption of neural homeostasis as a model of relapse and recurrence in late-life depression. The American Journal of Geriatric Psychiatry. 2019;27(12):1316–1330. DOI: https://doi.org/10.1016/j.jagp.2019.07.016
32. Taylor WD, Zald DH, Felger JC, Christman S, Claassen DO, Horga G, et al. Influences of dopaminergic system dysfunction on late-life depression. Molecular Psychiatry. 2021;26(6):1808–1823.
33. Vyas CM, Okereke OI. Late-life depression: a narrative review on risk factors and prevention. Harvard Review of Psychiatry. 2020;28(2):72–99. DOI: https://doi.org/10.1097/HRP.0000000000000240
34. Lima Júnior JDM, Soares PF, Carvalho WL, Mesquita LLS, Araújo MSM, et al. Fatores associados à ansiedade e depressão em idosos: uma revisão integrativa. Nursing (São Paulo). 2023;26(298):9495–9508. DOI: https://doi.org/10.36489/nursing.2023v26i298p9495-9508
35. Kurata VM, Carreira L. Influência da institucionalização no desenvolvimento de depressão em idosos: uma revisão integrativa. Ciência, Cuidado e Saúde. 2020;18(4):e50312. DOI: https://doi.org/10.4025/ciencuidsaude.v18i4.42392
36. Hernandez JA, Voser RD. Exercício físico regular e depressão em idosos. Estudos e Pesquisas em Psicologia. 2019;19(3):718–734. DOI: https://doi.org/10.12957/epp.2019.46912
37. Devita M, Salvo R, Ravelli A, Rui M, Coin A, Sergi G, et al. Recognizing depression in older adults: practical guidance and challenges for clinical management. Neuropsychiatric Disease and Treatment. 2022;18:2867–2880. DOI: https://doi.org/10.2147/NDT.S347356
38. Matison AP, Mather KA, Flood VM, Reppermund S. Associations between nutrition and the incidence of depression in middle-aged and older adults: a systematic review and meta-analysis. Ageing Research Reviews. 2021;70:101403. DOI: https://doi.org/10.1016/j.arr.2021.101403
39. Gutsmiedl K, Krause M, Bighelli I, Schneider-Thoma J, Leucht S. Response to antidepressants in older adults with major depressive disorder: a systematic review and meta-analysis. BMC Psychiatry. 2020;20(1):102. DOI: https://doi.org/10.1186/s12888-020-02514-2
40. Marshe VS, Islam F, Maciukiewicz M, Bousman C, Eyre HA, Lavretsky H, et al. Pharmacogenetic implications for antidepressant therapy in late-life depression: a systematic review. The American Journal of Geriatric Psychiatry. 2020;28(6):609–629. DOI: https://doi.org/10.1016/j.jagp.2020.01.007
41. Melrose S. Late-life depression: nursing actions that can help. Perspectives in Psychiatric Care. 2018;55(3):453–458. DOI: https://doi.org/10.1111/ppc.12341
42. Araújo BC, Silva AR, Souza GF, Santos LL, Almeida RS. Meditação/mindfulness para o tratamento de ansiedade e depressão em adultos e idosos [dissertação]. Brasília (DF): Universidade de Brasília; 2019.
43. Luquine Júnior CD, Silva AR, Souza GF, Santos LL, Almeida RS. Yoga para tratamento de ansiedade ou depressão em adultos e idosos [dissertação]. Brasília (DF): Universidade de Brasília; 2019.
44. Corrêa HP, Moura CD, Azevedo C, Bernardes MF, Mata LR, Chianca TC. Efeitos da auriculoterapia sobre estresse, ansiedade e depressão em adultos e idosos: revisão sistemática. Revista da Escola de Enfermagem da USP. 2020;54:e03546. DOI: https://doi.org/10.1590/s1980-220x2019006703626
