Sunday, February 17, 2002
Some common triggers of late life depression include:
health problems (onset of illness or worsening of existing illness)
loss of independence (no longer able to drive, care for self, etc.)
loss of a close relative or friend
admission to nursing home
Depression among the elderly can be hard to recognize. Often symptoms -- such as decreased appetite and insomnia -- are attributed to other health problems or aging in general. In fact, psychiatrists find that about 15 percent of people over the age of 65 are severely depressed. Sadly, there are probably many more cases that are unidentified and untreated. On the bright side, over 80% of elderly people who are treated for depression do recover.
Signs and Symptoms
Depression can include many of the following symptoms:
This may include a sad, cranky or irritable mood. Excessive physical complaints and apathy also define this symptom.
Loss of Interest in or Pleasure from Most Activities
This may take the form of "not caring anymore" or loss of interest in hobbies. For example, someone who loves golf may suddenly find excuses not to play. This may also show up as a decreased interest in sex. Your physician may call this lack of interest "anhedonia."
Indecisiveness or Diminished Ability to Concentrate
This may take the form of being easily distracted or having memory difficulties. Jobs that require concentration may become almost impossible to perform.
Recurrent Thoughts of Death
Thoughts of one's own death are common in depression. These can range from a general feeling that others would be better off if one were dead to making specific suicide plans and preparations. These feelings should always be treated as an emergency and require immediate medical attention.
Insomnia can mean difficulty falling asleep, waking and restlessness during the night, or waking up earlier than usual and not being able to fall back to sleep. Hypersomnia, or feeling sleepy and napping all the time, is less common but also occurs.
Fatigue or Loss of Energy
Minor physical activity (such as getting dressed) may feel like a huge exertion and may take much longer than normal.
Feelings of Worthlessness or Excessive Guilt
This symptom includes unrealistic negative self-evaluations, unrealistic self-blame, or very low self-esteem. Sometimes, a sense of guilt can also reach delusional proportions (such as feeling that you are to blame for world poverty).
Significant Weight Loss or Gain
An example of "significant" weight loss or gain could be gaining or losing over 5% of your body weight in a month, when not dieting or trying to gain weight. Weight gain or loss is usually the result of changes in appetite.
Psychomotor Agitation or Retardation
Psychomotor agitation may appear as pacing, having trouble sitting still, hand wringing, or pulling at skin. Examples of psychomotor retardation can include either long pauses before answering questions and/or slowed thinking, speaking, and moving.
Diagnosis of depression is largely based on self-reporting. A senior or caretaker will have to take initiative to present the possibility of a problem to a physician or medical professional. Only then will the medical professional be able to assess the senior's situation.
A physician may ask the senior general questions about mood or habits or give the senior a list to fill out/check off symptoms. Physicians may also interview relatives or caretakers that are close to the senior. Physicians use medical history information and physical examinations to determine the possible extent of depression. Other illnesses and conditions are known to cause depression, such as substance abuse disorders, concurrent medication, and other general medical disorders. Physicians should seek to identify and diagnose these conditions before making a final diagnosis of depression.
Treatments for elderly persons suffering from depression are similar to treatments for other populations, with a few exceptions.
Medications are often prescribed and closely monitored, since side effects may be more severe among older people. Because many elderly people are being treated for other health problems, it is important to let their doctors know what other medications they are taking to avoid harmful drug interactions.
If medications are ineffective, a psychiatrist may prescribe Electroconvulsive Therapy (ECT), a treatment for severe mental illness in which a brief application of electric stimulus is used to produce a generalized seizure. Although rarely prescribed, this is a treatment which works well for many elderly people with depression.
Psychotherapy is a way to treat depression in the elderly. Talking about problems in individual or group therapy may help reduce depression and anxiety and lift spirits. Or, just talking with family members or friends may help a person feel much better. In fact, a strong support system is an important aspect of good health. A senior with depression may benefit greatly from involvement in a social group with others his/her own age. Senior centers and other community or church organizations are a good place for elderly people to socialize and to make friends.
A hospital stay offers support in a safe environment for the small percentage of people with severe symptoms of clinical depression. It is especially helpful for those who:
have lost the ability to function in their daily lives.
have lost hope and have persistent thoughts of harming themselves or suicide.
are severely suffering from their symptoms.
Other treatments include:
Talking to an expert (therapist) or group of other seniors who feel like you do
Talking to your family and friends about how you feel (being able to count on family and friends is important)
Getting together with other seniors for fun and to visit, for example, at senior and community centers and church functions.