About depression in the elderly
What is depression in the elderly?
Clinical depression in the elderly is common. Although, that doesn't mean it's normal. Late-life depression affects about 6 million Americans age 65 and older. But only 10% receive treatment for depression. The likely reason is that the elderly often display symptoms of depression differently. Depression in the elderly is also frequently confused with the effects of multiple illnesses and the medicines used to treat them.
How does depression in the elderly differ from depression in younger adults?
Depression impacts older people differently than younger people. In the elderly, depression often occurs with other medical illnesses and disabilities and lasts longer.
Depression in the elderly often increases their risk of cardiac diseases. Depression doubles an elderly person's risk of cardiac diseases and increases their risk of death from illness. At the same time, depression reduces an elderly person's ability to rehabilitate. Studies of nursing home patients with physical illnesses have shown that the presence of depression substantially increases the likelihood of death from those illnesses. Depression also has been associated with increased risk of death following a heart attack. For that reason, making sure that an elderly person you are concerned about is evaluated and treated is important, even if the depression is mild.
Depression also increases the risk of suicide, especially elderly white men. The suicide rate in people ages 80 to 84 is more than twice that of the general population. The National Institute of Mental Health considers depression in people age 65 and older to be a major public health problem.
In addition, advancing age is often accompanied by loss of social support systems due to the death of a spouse or siblings, retirement, or relocation of residence. Because of changes in an elderly person's circumstances and the fact that elderly people are expected to slow down, doctors and family may miss the signs of depression. As a result, effective treatment often gets delayed, forcing many elderly people unnecessarily struggle with depression.
How is insomnia related to depression in the elderly?
Insomnia is usually a symptom of depression. New studies reveal that insomnia is also a risk factor for depression onset and recurrence -- particularly in the elderly.
To treat insomnia, experts recommend the newer "hypnotic" drugs that are safe and effective in elderly people. If there's no improvement in the sleep disorder and/or depression, a psychiatrist or psychopharmacologist may prescribe medications and/or psychotherapy.
What are the symptoms for depression in the elderly?
Symptoms of depression are the same in any age group. They can include:
- feelings of worthlessness
- crying spells
- lack of concentration
- sleep problems
- changes in appetite
- thoughts of suicide
- physical aches and pains
Depression is often the cause of physical pain in older adults that is not explained by other medical conditions.
What are the causes for depression in the elderly?
There is no single cause of depression in any age group. Some research indicates that there could be a genetic link to the disease. However, biological, social, and psychological factors all play a role in depression in older adults.
Research suggests that the following may contribute to depression:
- low levels of key neurotransmitter chemicals in the brain (such as serotonin and norepinephrine)
- a family history of depression
- traumatic life events, such as abuse or the death of a loved one
Complications associated with aging may contribute to depression in older adults. These problems can include:
- limited mobility
- facing mortality
- transitioning from work to retirement
- financial hardships
- prolonged substance abuse
- deaths of friends and loved ones
- widowhood or divorce
- chronic medical conditions
What are the treatments for depression in the elderly?
Just as depression has no single cause, no one treatment works for everyone. Finding the right depression treatment often takes time. Typical treatment involves a combination of therapy, medication, and lifestyle changes.
Medications used to treat depression include:
- selective serotonin reuptake inhibitors (SSRIs)
- selective serotonin-norepinephrine reuptake inhibitors (SNRIs)
- tricyclic antidepressants
- monoamine oxidase inhibitors (MAOIs)
Lifestyle changes used to treat depression include:
- increasing physical activity
- finding a new hobby or interest
- having regular visits with family and friends
- getting enough sleep daily
- eating a well-balanced diet
Numerous therapies can also help an elderly person with depression. Art therapy is a process in which you express your feelings creatively. In psychotherapy, you speak in a private setting with a trained therapist.
Living with geriatric depression
Geriatric depression can worsen the problems associated with aging. It isn’t always easy to diagnose, but proper treatment can greatly increase your quality of life.
If you’re concerned that someone you know may be depressed, know that family and loved ones can have a profound effect on an older adult’s care. Encourage treatment and offer support to help your loved one live a full, happy life.
What are the risk factors for depression in the elderly?
Factors that increase the risk of depression in the elderly include:
- Being female
- Being single, unmarried, divorced, or widowed
- Lack of a supportive social network
- Stressful life events
Physical conditions like stroke, hypertension, atrial fibrillation, diabetes, cancer, dementia, and chronic pain further increase the risk of depression. Additionally, the following risk factors for depression are often seen in the elderly:
- Certain medicines or combination of medicines
- Damage to body image (from amputation, cancer surgery, or heart attack)
- Family history of major depressive disorder
- Fear of death
- Living alone, social isolation
- Other illnesses
- Past suicide attempt(s)
- Presence of chronic or severe pain
- Previous history of depression
- Recent loss of a loved one
- Substance abuse
Brain scans of people who develop their first depression in old age often reveal spots in the brain that may not be receiving adequate blood flow. Chemical changes in these cells may enhance the likelihood of depression separate from any life stress.
Is there a cure/medications for depression in the elderly?
There are several treatment options available for depression. They include medicine, psychotherapy or counseling, or electroconvulsive therapy. Sometimes, a combination of these treatments may be used.
How do antidepressants relieve depression in the elderly?
Most of the available antidepressants are believed to be equally effective in elderly adults. But the risk of side effects or potential reactions with other medicines must be carefully considered. For example, certain older antidepressants such as amitriptyline and imipramine can be sedating or cause a sudden drop in blood pressure when a person stands up. That can lead to falls and fractures.
Antidepressants may take longer to start working in older people than they do in younger people. Since elderly people are more sensitive to medicines, doctors may prescribe lower doses at first. In general, the length of treatment for depression in the elderly is longer than it is in younger patients.
Can psychotherapy help relieve depression in the elderly?
Most depressed people find that support from family and friends, involvement in self-help and support groups, and psychotherapy are helpful. Psychotherapy is especially beneficial for those who prefer not to take medicine and who have mild to moderate symptoms. It also is helpful for people who cannot take drugs because of side effects, interactions with other medicines, or other medical illnesses.
Psychotherapy in older adults can address a broad range of functional and social consequences of depression. Many doctors recommend the use of psychotherapy in combination with antidepressant medicines.