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If You're Over 65 and Feeling Depressed: Treatment Brings New Hope
From the National Institute of Mental Health
DEPRESSION IS A WHOLE BODY DISORDER
Depression. The darkest moods. Feeling down, empty. Difficulty
remembering. Many things just don't interest you any more. Aches and
pains that keep coming back. Depression that goes on and on and on
for weeks and months is called clinical depression.
Most people think of depression only as sadness and low mood, but
clinical depression is far more than the ordinary "down" moods
everyone experiences now and then, and which pass after a visit
with a friend or a good movie.
Depression is also more than a feeling of grief after losing
someone you love. Following such a loss, for many people, a depressed
mood is a normal reaction to grief. And these people may find it helpful
to join a mutual support group, such as widowed-persons, to talk with
others experiencing similar feelings.
However, when a depressed mood continues for some time, whether
following a particular event or for no apparent reason, the person may
be suffering from clinical depression--an illness that can be treated
effectively.
Clinical depression is a whole body disorder. It can affect the way
you think and the way you feel, both physically and emotionally.
It isn't "normal" to feel depressed all the time when you get older;
in fact, most older people feel satisfied with their lives.
Nonetheless, among people 65 and over, as many as 3 out of 100 suffer
from clinical depression. It can be serious and can even lead to
suicide.
But there is good news. Nearly 80 percent of people with clinical
depression can be treated successfully with medications,
psychotherapy, or a combination of both. Even the most serious
depressions usually respond rapidly to the right treatment. But
first, depression has to be recognized.
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Ann's daughter thought her 73-year-old widowed mother was
getting senile because she was so confused and forgetful.
Ann had seemed to recover well from the death of her husband 3
years before, but lately she cried about him almost every day.
Her daughter arranged for Ann to see a geriatric specialist who
diagnosed Ann's condition as depression, not senility. He
put her on medication and suggested that she join a widow-to-widow
support group. Before long, Ann's memory improved along with her mood.
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TYPES OF CLINICAL DEPRESSION
Two serious types of clinical depression are major depression and
bipolar disorder.
Major Depression:
Major depression makes it almost impossible to carry on usual activities,
sleep, eat, or enjoy life. Pleasure seems a thing of the past. This
type of depression can occur once in a lifetime or, for many people,
it can recur several times. People with a major depression need
professional treatment.
Bipolar Disorder (Manic-Depressive Illness):
Another type of depression, bipolar disorder--or manic-depressive illness--leads
to severe mood swings, from extreme "lows" to excessive "highs." These
states of extreme elation and unbounded energy are called mania. This
disorder usually starts when people are in their early twenties.
Though unusual for this type of depression to start for the first time
in later life, it requires medical treatment, whatever the person's age.
A DEPRESSION SYMPTOM CHECKLIST
Have you experienced any of these symptoms for more than 2 weeks? If you answer "yes" to 4 or
more of the symptoms for depression or mania, a physical
and psychological evaluation by a physician and/or mental health
specialist should be sought.
Symptoms of Depression:
- A persistent sad, anxious or "empty" mood
- Loss of interest or pleasure in ordinary activities, including sex
- Decreased energy, fatigue, feeling "slowed down"
- Sleep problems (insomnia, oversleeping, early-morning waking)
- Eating problems (loss of appetite or weight, weight gain)
- Difficulty concentrating, remembering, or making decisions
- Feelings of hopelessness or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Thoughts of death or suicide; a suicide attempt
- Irritability
- Excessive crying
- Recurring aches and pains that don't respond to treatment
If someone has recently experienced a loss, these feelings may be part
of a normal grief reaction. But, if the feelings persist with no
lifting mood, the person may need professional treatment.
Symptoms of Mania:
These symptoms may range from moderate to severe. When mania is
moderate, only people close to the affected person may be able to
spot the symptoms.
- Excessively "high" mood
- Irritability
- Decreased need for sleep
- Increased energy
- Increased talking, moving, and sexual activity
- Racing thoughts
- Disturbed ability to make decisions
- Grandiose notions
- Being easily distracted
DEPRESSION SHARES SYMPTOMS WITH OTHER MEDICAL CONDITIONS
Some symptoms of depression also occur in other medical conditions. For example, weight loss, sleep disturbance, and low energy also occur in diabetes and heart disease; apathy, poor concentration, and memory loss are also found in Parkinson's and Alzheimer's diseases; and achiness or fatigue
may be present in many other conditions. To determine the proper diagnosis, a physician must conduct a thorough evaluation, keeping in mind that depressed older people are more likely to complain of such physical problems rather than expressing sad, anxious, or hopeless feelings.
In addition, fatigue, high or low mood, sedation, and difficulty with memory or concentration can be depressive symptoms but can also occur as side effects of medication. The current medications taken by an individual should also be evaluated in determining the diagnosis.
Depression Can Co-Occur with Other Illnesses
Depression often co-occurs with medical, psychiatric, and substance abuse disorders, though it is frequently unrecognized and untreated. This can lead to unnecessary suffering since depression is usually treatable, even when it co-occurs with other disorders.
Medical Illnesses
Depression occurs at higher than average rates in heart attack and cancer patients, persons with diabetes, and post-stroke patients. Untreated depression can interfere with the patient's ability to follow the necessary treatment regimen or to participate in a
rehabilitation program. It may also increase impairment from the medical disorder and impede its improvment.
Psychiatric Illnesses
Depression also occurs more frequently in persons with other psychiatric disorders, especially anxiety disorders. In such cases, detection of depression can result in more effective treatment and a better outcome for the patient.
Substance Abuse Disorders
Substance abuse disorders (including alcohol and prescription drugs) frequently co-exist with depression. Substance use must be discontinued in order to clarify the diagnosis and maximize the effectiveness of psychiatric interventions. Additional treatment is necessary if the depression remains after the substance use and withdrawal effects have ended.
Individuals or family members with concerns about the co-occurence of depression with another illness should discuss these issues with the physician.
CAUSES OF DEPRESSION
Many factors can contribute to depression. Some people become depressed for
a combination of reasons. For others, a single cause appears to
trigger depression. Some become depressed for no apparent reason.
Regardless of the cause, depression needs to be diagnosed and treated.
Some contributing factors that are particularly important, especially among older people are:
Other Illnesses
Long-term or sudden illnesses can bring on or aggravate depression.
Strokes, certain types of cancer, diabetes, Parkinson's disease, and
hormonal disorders are examples of illnesses that may be related to
depressive disorders.
Medications
Some medicines cause depressive symptoms as side effects. Certain
drugs used to treat high blood pressure and arthritis fall in this
category. In addition, different drugs can interact in unforeseen
ways when taken together. It is important that each doctor know all
the different types and dosages of medicine being taken and discuss
them with the patient.
Genetics and Family History
Depression often runs in families. Children of depressed parents have a
higher risk of being depressed themselves. Some people probably have
a biological make-up that makes them particularly vulnerable.
Personality
Certain personalities--people with low self-esteem or who are very
dependent on others--seem to be vulnerable to depression.
Life Events
The death of a loved one, divorce, moving to a new place, money
problems, or any sort of loss can contribute to depression.
People without relatives or friends to help may have even more
difficulty coping with stress. Sadness and grief are normal
responses to loss, but if they linger or are severe,
professional help should be sought.
HELP FOR DEPRESSION
One of the biggest obstacles to getting help for clinical depression
can be a person's attitude. Many people think that depression will go
away by itself, or that they're too old to get help, or that getting
help is a sign of weakness or moral failing. Such views are simply wrong.
With treatment, even the most seriously depressed
person can start to feel better, often in a matter of weeks, and
return to a happier and more fulfilling life. Such an outcome is a
common story, even when a person felt hopeless and helpless.
There are three major types of treatment for clinical depression:
psychotherapy, medication, and, in some cases, other biological
treatments. At times, these treatments may be used in
combination.
Individuals respond differently to treatments. If after several weeks
symptoms have not improved, the treatment plan should be reevaluated.
Also, the procedures and possible side effects of all treatments
should be fully discussed with the doctor.
Some people may find that mutual support groups are helpful when combined
with other treatments.
Medication
There are many very effective medications, but the three types of
drugs most often used in the past to treat depression are tricyclic
antidepressants, monoamine oxidase inhibitors (MAOIs), and lithium. Now, selective serotonin reuptake inhibitors (SSRIs) are also widely used.
Lithium is very effective in the treatment of bipolar disorder and is
also sometimes used to treat major depression.
- All medications alter the action of brain chemicals to
improve mood, sleep, appetite, energy levels, and concentration.
- Different people may need different medications, and sometimes more than one medication is needed to treat clinical depression.
- Improvement usually occurs within weeks.
Psychotherapy
Talking with a trained therapist can also be effective in treating
certain depressions, particularly those that are less severe.
Short-term therapies (usually 12-20 sessions) developed to treat
depression focus on the specific symptoms of depression.
- Cognitive therapy aims to help the patient recognize and change negative thinking patterns that contribute to depression.
- Interpersonal therapy focuses on dealing more effectively with other people; improved relationships can reduce depressive symptoms.
Biological Treatments
Some depressions may respond best to electroconvulsive therapy.
ECT is an effective treatment that is used in extremely severe cases
of major depression when very rapid improvement is necessary, or
when medications cannot be used or have not worked. Improved
procedures make this treatment much safer than in previous years. During
treatment, anesthesia and a muscle relaxant protect patients from
physical harm and pain.
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For years, Tom had been looking forward to his retirement--with
more time to fish. But after the first few months, not only had
he stopped going fishing with his friends, he often did not go
out of the house for days. Tom also complained to his wife
about not sleeping well and about different aches and pains each
day. Fortunately, his wife took him to a doctor who recognized
Tom was depressed. After a few weeks of treatment, Tom
began to enjoy his retirement as much as he had expected.
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WHERE TO GET HELP
Trained professionals in numerous settings diagnose and treat
clinical depression:
Family physicians, clinics, and health maintenance organizations
can provide treatment or make referrals to mental health specialists.
Mental health specialists include psychiatrists, psychologists,
family therapists, social workers, mental health counselors, and psychiatric nurses. Psychiatrists can
prescribe antidepressant drugs because they are physicians.
Other mental health specialists, however, often work with
physicians to ensure that their patients receive the medications
they need.
Community mental health centers, which often provide treatment
based on the patient's ability to pay, usually have a variety of
mental health specialists.
Hospitals and university medical schools may have research
centers that study and treat depression.
ADVOCACY ORGANIZATIONS
National advocacy or consumer organizations provide information about
depression, sources of treatment, and local community support groups:
National Alliance for the Mentally Ill (NAMI)
Colonial Place Three
2107 Wilson Blvd., Suite 300
Arlington, VA 22201
Phone: 1-800-950-NAMI (6264) or (703) 524-7600
Internet: http://www.nami.org
Depression & Bipolar Support Alliance (DBSA)
730 N. Franklin St. - #501
Chicago, IL 60610-7224
(312) 988-1150
Fax: (312) 642-7243
Internet: www.DBSAlliance.org
National Foundation for Depressive Illness, Inc.
P.O. Box 2257
New York, NY 10016
1-212-268-4260; 1-800-239-1265
Website:Ê http://www.depression.org
National Mental Health Association (NMHA)
2001 N. Beauregard Street, 12th Floor
Alexandria, VA 22311
Phone: 1-800-969-6942 or (703) 684-7722
TTY-800-443-5959
Internet: http://www.nmha.org
Source: The National Institute of Mental Health, NIH Publication No. 95-4033, September 23, 2002
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