When to Refer Depressed Elderly Patients To a Geriatric Psychiatrist
Recommendations for Primary Care Physicians
These guidelines were developed by the Clinical Practice Committee of the American Association for Geriatric Psychiatry (AAGP) and approved by the board of directors, March 1997. The situations below indicate when to refer a patient for consultation or treatment by a geriatric psychiatrist.
Diagnostic Uncertainty
- Symptoms of known medical illness mimic, overlap, mask, or distort symptoms of depression.
- The differential diagnosis of depression and neurologic disorders such as dementia, delirium, Parkinson’s disease or stroke is unclear.
- When depressive symptoms occur in the context of late-life losses, declining health, or disability, a geriatric psychiatrist can determine whether psychotherapy is indicated as the treatment of choice or an adjunct to antidepressant medication.
Severe or Urgent/Emergent Situations
- The patient is suicidal or homicidal.
- The patient has delusions or hallucinations.
- The patient is disabled by severe depression, and may be refusing to eat or drink.
- The patient needs evaluations for electroconvulsive therapy.
Complicated Treatment
- The primary care physician (PCP) is uncertain about antidepressant selection.
- The patient has failed to respond to one or two adequate trials (8 to 12 weeks at a therapeutic dose) of antidepressants with which the PCP is comfortable, or gets worse during treatment.
- Antidepressant side effects or drug interactions limit effective therapy.
- The patient and/or caregivers are noncompliant with treatment.
- Difficult, demanding or unreasonable behavior of the patient or caregiver undermines treatment.
- When staff in a geriatric care facility seems to have difficulty working effectively with depressed patients, a geriatric psychiatrist may be able to provide formal or informal staff consultation and education.
Maintenance Management
- When the risks and benefits of continuing maintenance antidepressants are uncertain.
- A patient on a maintenance regimen experiences an exacerbation of depression or other worsening of mental status.
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