Seniors and depression.

While you may be aware of the classic symptoms of depression, you may not know that it may actually appear quite differently in seniors.
While you may be aware of the classic symptoms of depression, you may not know that it may actually appear quite differently in seniors.

Between the loss of family, friends and/or health, it’s understandable that you or a loved one might experience periods of sadness as you age. However, we want you to know that “having the blues” on occasion while grieving a loss is different than suffering from lingering depression—which interferes with the ability to function for a prolonged period of time.

Unfortunately, depression is estimated to affect some 6 million Americans over age 65, making it all too common. That doesn’t mean that it’s considered to be a normal part of aging. In fact, The National Institute of Mental Health considers depression in people age 65 and older to be a major public health problem.

While you may be aware of the classic symptoms of depression, you may not know that it may actually appear quite differently in seniors. In fact, many seniors suffering from depression can honestly claim to not actually feel sad at all. Instead, they may complain of a lack of energy, low motivation or have physical complaints without an underlying cause—which makes depression in seniors all the more difficult to recognize and treat.

What’s more, both patient and physicians can confuse depression with the side effects of other illnesses, the medicines used to treat them or other a normal reaction to life’s events.

Illnesses that may cause depression include:

  • Cancer
  • Parkinson’s Disease
  • Heart Disease
  • Stroke
  • Dementia and Alzheimer’s Disease
  • Lupus
  • Multiple Sclerosis
  • Thyroid disorders
  • Vitamin B12 deficiency

Medications that may cause depression include:

  • Cardiovascular drugs
  • Chemotherapeutics
  • Antipsychotic drugs
  • Anti-anxiety medications and sedatives
  • Anticonvulsants
  • Anti-inflammatory/anti-infective agents
  • Stimulants
  • Hormones

There is also a higher risk for depression if you:

  • Are female
  • Have one or more chronic medical illnesses, such as cancer, diabetes or heart disease or are caring for someone who does
  • Have a disability
  • Sleep poorly or have insomnia
  • Are lonely or social isolated
  • Have a personal or family history of depression
  • Use certain medication
  • Suffer from a brain disease
  • Misuse of alcohol or drugs
  • Have experienced a stressful life event such as the loss of a loved one
  • Have poor nutrition

Depression can be treated

Once recognized, depression is a treatable medical condition, much the same as heart disease or diabetes. However, between misdiagnosis and the hesitancy to speak out and ask for help, it’s estimated that only 10% of seniors with depression receive any medical treatment.

In fact, it’s estimated the primary care physician accurately recognize less than one-half of patients with depression, resulting in potentially decreased function and increased length of hospitalization. As a result, older patients with symptoms of depression have roughly 50% higher healthcare costs than non-depressed seniors.

Most importantly, 80% of those seniors could completely recover with proper diagnosis and treatment. If left untreated, the impact of depression in seniors has an even greater impact on physical health, as well.

Left untreated, depression can:

  • Worsen symptoms of other illnesses such a heart disease
  • Suppress the immune system, raising the risk of infection
  • Reduces the ability to rehabilitate
  • Lead to disability
  • Lead to premature death
  • Result in suicide

How do I know if I have depression?

As opposed to “the blues” which may last a day or two, you may have depression if any of the following symptoms most of the day, nearly every day for at least two weeks:

  • Memory problems
  • Social withdrawal
  • Persistent sad, anxious or “empty” mood
  • Feelings of hopelessness and/or pessimism
  • Feelings of guilt, worthlessness and/or helplessness
  • Irritability, restlessness
  • Loss of interest in activities or hobbies once pleasurable
  • Fatigue and decreased energy
  • Difficulty concentrating, remembering details and making decisions
  • Insomnia, early–morning wakefulness, or excessive sleeping
  • Overeating or appetite loss
  • Thoughts of death or suicide, suicide attempts
  • Persistent aches or pains, headaches, cramps, or digestive problems without a clear physical cause that do not get better, even with treatment
  • Neglecting personal care such as skipping meals, forgetting to take medications and neglecting personal hygiene
  • Delusions or hallucinations

The difference between depression and dementia in seniors

As depression and dementia have a number of symptoms in common, this can easily lead to an incorrect assumption or even medical diagnosis of an otherwise easily treated medical condition. What’s more, the issue is further confused by the fact that research indicates that both depression can lead to dementia and that dementia can lead to depression.

While there is no single test to differentiate between depression and dementia, a consultation with a geriatric psychiatrist would be in order if you have concerns. They would conduct a thorough interview and consider the following symptoms:

If it’s Depression . . .

  • Mental decline is rapid
  • Patients can state the correct date and time and know who they’re speaking with
  • Patients have difficulty concentrating
  • Language and motor skills are slow but normal
  • Patients notice and worry about memory problems and confusion
  • Individuals with depression put a negative spin on things
  • There is no difficulty in using everyday items
  • There are persistent thoughts of suicide or suicide attempts

If it’s Dementia . . .

  • Mental decline is slow
  • Patients become confused and disoriented and may get lost, confuse dates, or wonder where they are
  • Patients struggle with short-term memory
  • Writing, speaking, and language skills are impaired
  • Patients don’t notice or seem to care about memory problems
  • People with dementia try to cover up their shortcomings
  • Individuals with dementia may not recall how to do things like pulling on a sweater
  • Patients with dementia don’t consider suicide as an option

Seniors and suicide

As with any major depressive disorder, there is always a risk of suicide, which is the 10th leading cause of death in the United States. This is particularly the case with seniors ages 85 or older who represent the second highest rate of suicide in the country (the highest rate being counted among adults between 45 and 54). This is more than six times the suicide rate of the general population. These figures don’t reflect suicide attempts, which go unreported and untreated.

If you or a loved one is in crisis, please reach out and call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) to speak with a trained crisis counselor or contact the Crisis Text Line by texting TALK to 741741.

What are the treatment options for depression?

While physicians and therapists will work to develop a personalized treatment plan for anyone suffering from depression, the primary treatment options include medication and/or therapy. It’s important to realize that no one single depression treatment works for every person.

Medication

One of the most common forms of treatment for depression is medication called antidepressants. Through their use, symptoms usually begin to improve within a week or two, although some forms may take several weeks to work fully.

As with any medication, seniors have to be particularly careful with their usage as they may have a higher risk of bad drug reactions, missing doses or overdosing. Seniors also tend to be more sensitive to medications, requiring lower or less frequent doses. Some medication used to treat depression also put seniors at greater risk for falling. That is why it is wise to make sure any physician visited is aware of every medication being taken.

If antidepressants are prescribed, it is important to not stop taking them without the help of a doctor. It isn’t possible to become addicted to them, but stopping them abruptly may cause unwanted side effects.

Psychotherapy

Psychotherapy (or “talk therapy”) can also be an effective treatment for depression that helps by teaching new ways of thinking and behaving and changing habits. Research shows that cognitive-behavioral therapy (CBT), including a version called problem-solving therapy, may be an especially useful type of psychotherapy for treating older adults and improving their quality of life.

Research also suggests that psychotherapy is just as likely to be an effective first treatment for depression for older adults as taking an antidepressant. This can also be preferable to adding to the list of medications that are already being taken for other conditions. However, if the depression is severe enough, medication or a combination of medications with psychotherapy may be a more effective approach.

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy (ECT) is sometimes used for severe depression that does not respond to medication or psychotherapy. ECT is a type of brain stimulation therapy that uses electricity, magnets, or implants. In use for almost 80 years, ECT remains the strongest and fastest-acting treatment for severe depression.

Despite ECT’s efficacy and safety record in older adults, many misconceptions still persist among both patients and health care professionals. Although ECT may cause side effects, such as confusion and memory loss, these side effects are usually short-term.

Eye Movement Therapy (EMDR)

Developed in the late 1980s as a treatment for post-traumatic stress disorder, EMDR has also been found to be helpful with depression in seniors ages 70-85—even with diminishing cognitive abilities.

This is particularly the case with seniors who may have recently experienced the death of a spouse or other loved one. This can sometimes reactivate traumatic experiences from their past, causing a “domino effect,” that can lead to anxiety and depression.

“When a traumatic event occurs, it can get frozen in the memory systems of the brain,” Ted Raddell, PhD explained. “This is why when a trauma gets triggered by everyday circumstances, the individual can experience tremendous anxiety, almost as if they are reliving the experience all over again. EMDR seems to unfreeze this stuck or stored material so the brain can integrate it and desensitization occurs.”

If you’re interested in trying EMDR, the EMDR Institute can help you find a therapist trained in this method.

Complementary Therapies

Examples of complementary therapies for depression include yoga, exercise, and certain dietary supplements. These therapies may offer some benefits for people with depression; however, they should not replace talking to your health care professional or continuing with the treatment plan determined with that doctor.

To ensure your safety, be sure to tell your health care professional about any complementary health approaches you or a loved one uses or plans to use. Physical activity is a helpful part of any treatment plan for depression and may become easier to add an antidepressant medication and/or therapy begin to work.

Talk to your health care professional about your options and/or visit the National Center for Complementary and Integrative Health to learn more about these types of therapies: www.nccih.nih.gov.

Beyond Treatment

Remember that if you or a loved one are taking medication for depression, it may take several weeks for it to start working. If the first medication does not work, be open to trying another. You may need to try a few different medications before finding one that works best. Sometimes, if an antidepressant medication is only partially effective, adding a second medication of a different type can be helpful.

Studies have shown that forcing oneself to do things were enjoyed before experiencing depression can help lift your spirits. Go easy on yourself. Other things that may help include:

  • Breaking up large tasks into small ones.
  • Spending time with other people and talking to friend or relatives about depression.
  • Sticking to a treatment plan. It will take time for treatment to work.
  • Avoiding important life decisions until the depression is resolved.

If you or a loved one is in crisis, please reach out and call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) to speak with a trained crisis counselor or contact the Crisis Text Line by texting TALK to 741741.

Summary

While you may be aware of the classic symptoms of depression, it can actually appear quite differently in seniors. By being proactive and learning more, you can reduce the risk of depression as you journey along the gray mile.

Tom Text

@TomJonesNBTX

4 thoughts on “Seniors and depression.

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