By Melissa Hutsell
For the nearly six million elderly Americans suffering from depression in the United States, warning signs often go unnoticed. This is because aging adults display symptoms differently, and these symptoms can be confused with side effects of medications. For this reason and many more, only 10 percent of aging adults receive treatment for depression. Depression can have devastating consequences including serious health concerns like untreated medical problems, increased pain perception, deconditioning, and suicide. In fact, white males over the age of 85 have the highest suicide rate in the entire Unite States, according to the National Institute of Mental Health. It is important to know the signs and symptoms, and the ways in which they present themselves.
Criteria
Depressed mood most of the day
Decreased interest in activities
Weight loss or loss of appetite
Difficulty sleeping
Loss of energy
Cognitive slowing (dementia of depression)
Difficulty concentrating, thinking and remembering
Feeling worthless or guilty
Dr. Schonze Del Pozo, Geriatric Specialist with UC Davis and Doctor’s Hospital of Manteca, says that older adults are often confronted with recurrent loss of function, independence, family and friends, health, and assets. Grief and depression aren’t synonymous. “While sadness with these events is common, clinical depression should be addressed. Family members and friends play an important role in bringing concerns to light.” Dr. Del Pozo recommends taking initiative by having a conversation, or “screening” the elder, by asking these two questions: During the past month, have you been bothered by feeling down, depressed, or hopeless? During the past month, have you been bothered by little interest or pleasure in doing things?
When it comes to treatment, Dr. Del Pozo recommends the elder be fully evaluated by a physician to rule out other causes for symptoms. “Any illnesses should be addressed first before simply adding on an anti-depressant,” she adds, risk factors (see table) should be managed as best as possible. It is important to remember that exercise, diet and optimizing sleep are all key to a healthy mood and energy level. In some cases, these have proven just as effective as anti-depressants.
Risk Factors
Widowed or divorced status
Multiple chronic illnesses (diabetes, heart disease, stroke)
Alcohol use
Multiple medications
Financial difficulties
Lack of social support or physical activity
Recent changes in life (move, loss)
While geriatricians recommend lifestyle changes prior to addition of drugs, medications may be necessary for a time. “All medications have side effects and therefore the physician can chose the one with least interaction to other drugs as well as less side effects,” says Del Pozo, “Lexapro and Zoloft are often chosen for this reason. Remeron is also being used more commonly as it can be helpful for sleep as well as appetite.” Read more here: my-depression-treatment.com
However, Del Pozo urges that psychotherapy should always be used to support the elder, alongside medications, because therapy helps to address the underlining cause for depression, not just the symptoms. “Cognitive-behavioral therapy has been shown to be highly effective in treatment of depression of the elderly. Yet, this is a generation of people that were taught not to discuss problems or emotions openly, and even less so to strangers. Depression or sadness has often been seen a as weakness by our ‘baby boomers,’ who were born at a time when hard work, persistence and conviction were what made you survive,” she adds, “Physicians and family members have to break this perception, as denial of the depression will only lead to further isolation and feelings of worthlessness. While sad, it is important to note that suicide is attempted less by elderly patients, but is more successful compared to younger patients. Therefore, awareness of Geriatric Depression needs to be widespread.”
Regardless of age, offering emotional support and recognizing the signs is vital.