UWL: Evaluation and Treatment of Depression 2009
Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.
UWL: Evaluation and Treatment of Depression
The registered dietitian (RD) should collaborate with other healthcare professionals to consider evaluation and treatment of depression for patients who are undernourished or at risk of undernutrition when medical nutrition therapy (MNT) interventions have not resulted in improved nutrient intake or stabilization of weight. Research reports an association between depression and weight loss or poor nutritional status.
Risks/Harms of Implementing This Recommendation
Conditions of Application
This recommendation applies when medical nutrition therapy (MNT) interventions have not resulted in improved nutrient intake or stabilization of weight.
Potential Costs Associated with Application
There are costs associated with evaluation and treatment for depression.
- 12 studies were evaluated regarding the association between underweight or weight loss and depression in adults over age 65
- Four studies report an association between weight loss or poor nutritional status and depression (Thomas et al, 2002; Callen and Wells, 2005; Chen et al, 2005; Woods et al, 2005), while two studies report no association between low BMI and depression (Crogan and Pasvogel, 2003; Shum et al, 2005)
- Additional studies report that weight loss may be common in depressed individuals with Alzheimer's disease (Purandare et al, 2001; Starkstein et al, 2005), individuals who are recently widowed (Schulz et al, 2001; Shahar et al, 2001), demented individuals (Thomas et al, 2003) and individuals on antidepressant therapies (Rigler et al, 2001). Further research is needed in these areas.
Recommendation Strength Rationale
Conclusion statement in support of this recommendation received Grade II.
- Risks/Harms of Implementing This Recommendation
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
Callen BL, Wells TJ. Screening for nutritional risk in community-dwelling old-old. Public Health Nurs. 2005;22(2):138-146.
Chen CC, Chang CK, Chyun DA, McCorkle R. Dynamics of nutritional health in a community sample of American elders: A multidimensional approach using Roy Adaptation Model. ANS Adv Nurs Sci. 2005; 28 (4): 376-389.
Crogan NL, Pasvogel A. The influence of protein-calorie malnutrition on quality of life in nursing homes. J Gerontol A Biol Sci Med Sci. 2003; 58 (2): 159-164.
Purandare N, Burns A, Craig S, Faragher B, Scott K. Depressive symptoms in patients with Alzheimer's disease. Int J Geriatr Psychiatry. 2001; 16 (10): 960-964.
Rigler SK, Webb MJ, Redford L, Brown EF, Zhou J, Wallace D. Weight outcomes among antidepressant users in nursing facilities. J Am Geriatr Soc. 2001; 49(1): 49-55.
Schulz R, Beach SR, Lind B, Martire LM, Zdaniuk B, Hirsch C, Jackson S, Burton L. Involvement in caregiving and adjustment to death of a spouse: Findings from the Caregiver Health Effects Study. JAMA. 2001; 285(24): 3,123-3,129.
Shahar DR, Schultz R, Shahar A, Wing RR. The effect of widowhood on weight change, dietary intake, and eating behavior in the elderly population. J Aging Health. 2001; 13 (2): 189-199.
Shum NC, Hui WW, Chu FC, Chai J, Chow TW. Prevalence of malnutrition and risk factors in geriatric patients of a convalescent and rehabilitation hospital. Hong Kong Med J. 2005; 11(4): 234-242.
Starkstein SE, Jorge R, Mizrahi R, Robinson RG. The construct of minor and major depression in Alzheimer's disease. Am J Psychiatry. 2005; 162 (11): 2,086-2,093.
Thomas P, Hazif-Thomas C, Clement JP. Influence of antidepressant therapies on weight and appetite in the elderly. J Nutr Health Aging. 2003; 7(3): 166-170.
Thomas DR, Zdrowski CD, Wilson MM, Conright KC, Lewis C, Tariq S, Morley JE. Malnutrition in subacute-care. Am J Clin Nutr. 2002; 75: 308-313.
Woods NF, LaCroix AZ, Gray SL, Aragaki AA, Cochrane BB, Brunner RL, Masaki K, Murray A, Newman AB. Frailty: Emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study. J Am Geriatr Soc. 2005; 53 (8): 1,321-1,330.