Depression In Older Persons
Clinical depression is a biologically-based brain disorder that affects
one's thoughts, feelings, behavior, and physical health. It is an
"affective disorder," which means that changes in mood occur in the
depressed person. Clinical depression does not discriminate -- it can
develop in anyone at any age. Depression is a serious medical illness
that affects more than 11.6 million Americans, including older persons,
in any given year. Of these people, less than one third actually seek
treatment for their illness.
Why does depression in the older population go untreated?
As the population grows older, untreated depression among senior
citizens is becoming a more widespread problem. The depressed older
person often mistakes his or her feelings of symptoms for dementia or
the normal aging process. Many older people and their families don't
recognize the symptoms of depression, aren't aware that it is a medical
illness, and don't know how it is treated. Also, many older people think
that depression is a character flaw and are worried about being
stigmatized, so they blame themselves for their illness and are too
ashamed to get help. Others worry that treatment would be too costly. It
should be noted, too, that depression is also a side effect of some
medications commonly prescribed to older persons, such as medications to
treat hypertension.
What are the symptoms of depression in older people?
Symptoms in older persons may differ somewhat from symptoms in other
populations. Depression in older people is often characterized by memory
problems, confusion, social withdrawal, loss of appetite, inability to
sleep, irritability, and, in some cases, delusions and hallucinations.
Older depressed individuals often have severe feelings of sadness, but
these feelings are not acknowledged or openly shown. Thinking that
depression is an inevitable sign of aging, many older individuals ignore
or deny their symptoms. The commonly believed myth that depression comes
naturally with old age is not true. Clinical depression is an illness
that needs medical attention just like any other illness.
How can clinical depression be distinguished from normal sadness and
grief?
It's natural to feel grief in the face of major life changes like those
so many older people experience, such as leaving a home of many years or
losing a loved one. Sadness and grief are perfectly normal temporary
reactions to the inevitable losses and hardships of life. Unlike normal
sadness, however, clinical depression doesn't go away by itself. It
needs to be treated professionally. Any unresolved depression can affect
the immune system, which makes the depressed individual more susceptible
to other illnesses. This complication is often found in older
individuals.
What causes depression in older people?
Although there is no single, definitive answer to the question of cause,
many factors -- psychological, biological, environmental and genetic --
likely contribute to the development of depression. Scientists think
that some people inherit a biological make-up that makes them more prone
to depression. Certain brain chemicals called neurotransmitters -- like
norepinephrine, serotonin, and dopamine -- are probably involved in
major depression.
While some people become depressed for no easily identified reason,
depression tends to run in families, and the vulnerability is often
passed from parents to children. When such a genetic vulnerability
exists, other factors like prolonged stress, loss, or a major life
change can trigger the depression. For older people, the loss of a
spouse or a friend, retirement, moving out of the family home, or some
other stressful event may bring about the onset of a depressive episode.
Who among the older population are at the highest risk for depression?
Older women are at the greatest risk because women in general are twice
as likely as men to become seriously depressed. Biological factors, like
hormonal changes, may make women more vulnerable. The stresses of
maintaining relationships or caring for an ill loved one and children
also fall more heavily on women, which could contribute to higher rates
of depression. Unmarried and widowed individuals as well as those who
lack a supportive social network also have elevated rates of depression.
Can depression in older persons be treated?
Fortunately, the prognosis is good. Once diagnosed, 80 percent of
clinically depressed individuals, including older persons, can be
effectively treated by medication, psychotherapy, electroconvulsive
therapy (ECT) or any combination of the three.
Four groups of antidepressant medications have been used to effectively
treat depressive illness:
* Tricyclics
* Monoamine oxidase inhibitors (MAOIs)
* Selective serotonin reuptake inhibitors (SSRI's)
* Norepinephrine and serotonin reuptake inhibitors (NSRIs)