Related topics: •  Illness: The Mind-Body Connection •  Seniors and Alcohol Use •  Seniors and Exercise

Depression is one of the most common psychiatric problems among older people, but it's not a natural or inescapable part of aging. "Grumpy old men" and "crotchety old ladies" don't necessarily come by their temperaments simply because of their age; they may be clinically depressed. And that may be misinterpreted by others -- as well as by the depressed older people themselves.

It's not that friends, family, and even doctors don't notice that the person feels blue, but that they don't consider the symptoms part of a bona fide, treatable illness. Doctors often confuse clinical depression with the symptoms of other acute and chronic illnesses, such as Parkinson's disease. And seniors themselves may decide that the way they feel is par for the course as they grow older.

Some 1 to 5 percent of older Americans suffer from depression, according to the National Institute of Mental Health (NIMH). And with the baby boomers reaching their sixties now, there's reason to believe these numbers will increase. In seniors, as in younger people, depression is by no means a benign disease -- it can lead to faster physical and mental decline in older people and even to death at an earlier age.

At meeting of the Gerontological Society of America, University of Michigan researchers reported that depressed seniors over 70 years old are more likely to develop other diseases after two years. An older person who's been depressed for at least six years is twice as likely to develop cancer, according to a study in the Journal of the National Cancer Institute. Other studies have found that isolation can be a result of depression, as well as one of its causes, as despondent older people cut themselves off from friends and family.

It's important to acknowledge that many older people have good reasons to feel sad. It is understandable for someone with cancer to be despondent over the illness, just as it's normal for someone to be devastated by chronic pain, the loss of a spouse, or the inability to do scores of things that used to be second nature. Doctors and family members need to keep a watchful eye for the difference between clinical depression and grief over painful losses.

Major depression is a despair and hopelessness so profound that the person may lose interest in life. He may be unable to get out of bed or eat for days at a time. Nothing seems pleasurable anymore. Mild depression, or dysthymia, involves a chronically dampened mood, poor self-esteem, and low-level symptoms of major depression. Some depressive symptoms can be traced to specific problems, as in the case of people who suffer from seasonal affective disorder (SAD) or "winter blues" -- thought to be a reaction to lack of sunlight. But very often, major depression has no precipitating event. Doctors generally consider a person clinically depressed when he has suffered at least two weeks of despair and at least four of the symptoms commonly associated with depression, which include hopelessness, apathy, and a loss of interest in most activities.

•Feelings of overwhelming sadness and frequent crying

•Hopelessness and pessimism

•Changes in eating habits with weight loss or weight gain

•Changes in sleeping habits, such as insomnia, waking in the wee hours of the morning, or sleeping all the time

•Indifference toward activities a person used to enjoy

•Sluggishness, fatigue, and a feeling of profound emptiness and flatness

•Trouble concentrating or thinking clearly

•Morbid or suicidal thoughts

•Medications. Some common drugs may cause symptoms of depression. These include blood-pressure medicines such as Catapres and Aldomet; Inderal for heart problems; drugs used to treat Parkinson's disease, such as L-dopa and bromocriptine; some arthritis medicines; and steroids, such as cortisone and prednisone.

•Illnesses. Any person with a chronic illness is susceptible. Those who've suffered heart attacks or strokes or have diabetes or cancer are more likely to be depressed, as are sufferers from Parkinson's disease or hormonal disorders. Seniors whose illnesses have left them unable to perform basic daily activities such as using the telephone or getting dressed are particularly at risk, according to a 1999 Johns Hopkins University study. Additionally, depression often accompanies other psychiatric disorders, particularly anxiety.

•Substance abuse disorders. Problems with alcohol and prescription drugs often result in despair for seniors.

•Genetics. Having relatives who suffered from depression increases your chance of developing depressive symptoms at some point in your life.

•Life events. People often go through an overwhelming amount of loss late in life, be it death of a spouse, of siblings, or of other loved ones. In addition, disabilities or illnesses often leave seniors housebound most of the time. All of these factors -- combined with the very nature of growing older -- can amount to a lonely and isolated life, the perfect breeding ground for depression.

The two are often confused. Because depression can cause concentration problems and trouble thinking clearly, it's often mistaken for Alzheimer's. Certainly, seniors suffering from Alzheimer's and dementia are more likely to become depressed. But many times the symptoms of depression are assumed to be part of Alzheimer's disease when in fact they are independent and treatable.

A controversial school of thought -- supported by a 1999 Swedish study -- contends that symptoms of depression such as low energy and concentration problems may often actually be early signs of Alzheimer's disease. Instead of becoming depressed because of failing memories and disorientation associated with Alzheimer's, the study suggests, the depression symptoms come first.

Older adults make up the highest risk group for suicide in the nation. Despite comprising just 12 percent of the population, seniors account for 16 percent of all suicides in the US, according to 2004 figures from the CDC. And white men over 85 are about six times as likely to commit suicide as individuals of all age groups.

Helping someone who's depressed can be tough, given that your loved one will likely withdraw from family and friends and resist assistance. But the best idea is to lend an understanding ear and tactfully -- without standing in judgment -- encourage her to consult a doctor or another healthcare professional. Primary physicians can help, but geriatricians, who specialize in elder care, are the best choice. In extreme cases -- if the person seems in danger of taking her own life -- urge her to call a suicide prevention hotline, or call one yourself.

One of the worst things you can do is try to talk someone out of a depression either by being overly cheerful or insisting your loved one "just get over it." Depression is a disease. It's biological, and it's not relieved by an act of will.

According to the NIMH, only about 10 percent of seniors suffering from depression receive psychotherapy or other treatment. But when treated, older patients respond well. A Pittsburgh Medical Center study found that 80 percent of seniors treated with medication and therapy over a three-year period didn't suffer recurrent bouts, while only 10 percent of those without treatment avoided relapse.

Older people with mild depression respond well to a class of drugs called selective serotonin reuptake inhibitors (SSRIs), according to a study by Dr. Carl Salzman of Harvard Medical School. Among antidepressants, SSRIs -- which include Prozac and Paxil -- cause fewer side effects and interact less with other medications, because they pinpoint only one area in the brain.

But these drugs also present complications for older people. A study in the New England Journal of Medicine found that elderly patients taking SSRIs had 80 percent more falls than patients not on antidepressants, and since seniors are often taking an array of prescription drugs, there is always an increased risk of dangerous interactions.

The Harvard study also emphasized using nonpharmacological approaches, such as psychotherapy, before turning to medication. Therapies that foster social activity for seniors seem to be particularly effective, says Salzman. According to Mary Pipher, PhD, author of Another Country: The Emotional Terrain of Our Elders, the elderly would benefit from a societywide reevaluation of attitudes toward aging. As adults we do pretty well at understanding teenagers, for example, because we were once young ourselves -- but we don't have the same empathy for elders if we haven't yet become senior citizens.

Volunteer programs are a great way for older adults to get involved in the community again. Getting a pet or taking up gardening are also potential lifestyle changes that can act as solutions to depression. At a time when a lot of things and people are disappearing from a person's life, it's sometimes necessary to add new things to love, according to Pipher.

Exercise is also a good nonchemical way to beat depression. A Duke University study found that among 156 men and women with major depression disorder, antidepressants were more effective early on, but that after 16 weeks, aerobic exercise proved to be equally effective in reducing depressive symptoms. (For good senior exercise routines, see Seniors and Exercise.)

-- Benj Vardigan is a senior editor for Consumer Health Interactive and the winner of an Outstanding Young Journalist award from the Northern California chapter of the Society of Professional Journalists.

Further Resources

Children of Aging Parents

800/227-7294 AARP

601 E St. NW

Washington, DC 20049

800/424-3410

http://www.aarp.org/

National Mental Health Association

1021 Prince Street

Alexandria, VA 22314-2971

703/684-7722

http://www.nmha.org/

National Institute of Mental Health

6001 Executive Boulevard, Rm. 8184, MSC 9663

Bethesda, MD 20892-9663

301/443-4513

http://www.nimh.nih.gov/

References

First published July 25, 2000
Last updated February 27, 2008
Copyright © 2000 Consumer Health Interactive

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