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Depression in Later Life?

Understanding Depression

There is no specific stage of life when depression is most likely to occur. Although it is sometimes assumed that life after retirement is a golden time with little reason for people to feel depressed, the biological and emotional changes that may accompany the normal aging process may contribute to a depression in later life. The small but cumulative losses of physical stamina, work status, financial stability, and health may contribute to the onset of depression and present a significant challenge to older persons. Most adults accept these losses and learn to live with them. However, when a person is overwhelmed with loss and is unable to cope, depression may become a severe problem.

Undetected Depression in Older Adults

The wide range of estimates available on the incidence of depression among mid-life and older adults attests to the difficulty of diagnosing the illness in the older population. Many family physicians may be unfamiliar with the symptoms of depression in later life, or may not diagnose the illness because its symptoms can be masked by other physical problems. Family or friends often mistake depressive symptoms as the everyday problems of the older adult, or misconstrue the signs as the onset of senility. In addition, many older people rarely admit to having feelings of depression and may attribute their symptoms to physical ailments.

Some of the recognizable symptoms of depression are:

• change in eating, sleeping and sexual habits;
• inability to concentrate or difficulty in making decisions;
• withdrawal from social contact;
• preoccupation with "aches and pains";
• persistent sadness or hopelessness, frequent crying for no apparent reason
• general irritability;
• thoughts of death or suicide, or suicide attempts; and
• decreased energy or fatigue.

Although episodes of depression may occur for the first time in later life, depressive illness in older adults often is a continuation of earlier struggles with the illness. But depression in later life may be more complex. It involves the biology of aging, life’s ups and downs, a person’s medical history and treatments, and the ability to anticipate and plan for change.

Suicide—The Risk of Unrecognized Depression

It isn’t typical to be depressed in late life. Depression is a serious illness that needs to be identified and treated. Unrecognized depression is untreated depression. Without proper treatment, depression can continue for months or even years, and escalate into suicidal feelings and gestures.

Depression may be the cause of up to two-thirds of suicides in older adults. Older Americans are considered the group most at risk for suicide. Caucasian men, particularly those over the age of 65, have the highest rate of suicide in the country, three to four times greater than the general population.

Feelings of worthlessness, helplessness and hopelessness are major factors contributing to depression and suicide among older adults. Warning signs helpful for detecting suicidal behaviors include such verbal clues as, "I want to end it all," or "My family is better off without me," or such behavioral signs as neglecting self-care, suddenly putting personal affairs in order, giving away special possessions, or sudden interest or disinterest in religion. Do not ignore the threats of suicide.

 What Can Be Done about Depression

1. Recognize the Symptoms
Older people tend to deny feeling depressed and are uncomfortable with the word "depression". Many were raised in an era when people did not talk about their feelings, and individuals with emotional problems were perceived as having a character flaw but "toughed it out." Nonetheless, family members, friends, caregivers and professionals who serve older adults should be alert to the changes in a person’s appearance and behavior, rather than only relying on what he or she says.

2. Consider Intervention
Perhaps the most important thing family and friends can do is encourage the depressed person to get appropriate treatment. When symptoms linger beyond several weeks, an observant and caring friend or relative should help the depressed person get professional assistance. Since depression generally destroys self-confidence and esteem, those around a depressed person should provide support, love and encouragement.

3. Rule Out and/or Treat Physical Causes
Physicians, patients and their families need to recognize that the symptoms of depression may appear as a result or sign of a medical problem. Depression may be caused by a medication, hormonal imbalance, nutritional deficiency, major illness, or any combination of these. For example, an older person may experience a "sense o~ dread" as an early symptom of heart disease. These same complaints can be true for some canters and gastrointestinal, pulmonary, cardiovascular and other medical problems. A good medical evaluation will rule out or identify physical causes of depression.

4. Treat the Depression
Depression is one of the most easily treatable medical problems. The earlier the depressed person receives help, the sooner the symptoms can be alleviated and recovery can begin. Friends and family should take an active role in seeking professional assistance for an older depressed adult.

Some of the treatment options commonly used to treat depression are:

• Medications
  Medications can make the difference between a person’s ability to function or not. Medicine can alleviate depression by correcting a chemical imbalance in the brain. The medications most frequently used for treating depressive disorders are antidepressants, minor and major tranquilizers and lithium. All medications should be used with caution because they produce side effects. Many older adults metabolize and excrete drugs more slowly than younger people, so they may require a lower dose of medication. Older persons respond more slowly to an antidepressant drug —maximum effect is usually not achieved before two to six weeks.

• Psychotherapy
  Psychotherapy, a form of counseling, is usually used to treat mild to moderate depression, but also may relieve severe depression. Therapy helps patients to understand the anxieties, conflicts and pain involved with depression, and to develop coping skills to manage their stressful situations. The three major therapies used to treat depressive disorders are: cognitive, to help people change negative thinking; behavioral, to emphasize the importance of daily experiences and behavior; and interpersonal, to focus on relationship problems and role conflicts that may contribute to depression. For older adult patients with moderate to severe depression, a combination of psychotherapy and medication is commonly used.

• Environmental Changes
  Support from family, friends and caregivers is critical and helps prevent the depressed person from giving up or withdrawing further. A supportive environment is one in which others know when and how much to help without contributing to a person’s sense of helplessness. Practical measures, such as providing transportation to a clinic, assistance with medical bills, and changing the environment of a depressed person can help eliminate the feeling of isolation and expedite the recovery process.

5. Reduce the Likelihood of Depression

Older persons can reduce the likelihood of a depressive illness by taking the following measures:

• have regular physical examinations to rule out other medical conditions or disorders which may cause depressive symptoms;
• develop a regular, physician-approved exercise regimen;
• follow a good nutrition program;
• adopt a positive attitude and healthy lifestyle; and
• build an adequate social support network of family, friends and social service professionals.

  Where to Get Help

If you suspect you or someone you care about may be experiencing depression, talk to your physician and a mental health professional. The following mental health services are resources usually found in local communities:

• community mental health center;
• private mental health professionals, psychologists, psychiatrists, social workers, counselors;
• local and state hospital geriatric programs;
• clergy trained in counseling; and
• area agencies on aging.

Remember, there is help for depression. It’s never too late to heal.

Resources:

For a free set of brochures on mental health, send a request on a postcard to AARP Fulfillment (EE0088), 601 E Street NW, Washington, DC 20049. Allow 6-8 weeks for delivery.

To order brochures about the symptoms and treatments of depression, call the National Institute of Mental Health, Depression Awareness, Recognition, and Treatment Program at 1-800-421-4211.

For a free information booklet on depression, call the National Mental Health Association at 1-800-243-2525.

For information on depression in late life, call the National Alliance for the Mentally Ill at 1-800-950-NAMI

For a free copy of Depression Is a Theatable H/ness. A Patient’s Guide, call 1-800-358-9295 or write AHCPR Publications Clearinghouse, P0 Box 8547, Silver Spring, MD 20907

For information on support resources, contact: American Self-Help Clearinghouse, St. Clares-Riverside Medical Center, 25 Pocono Road, Denville, NJ 07834 or call (201) 625-7101.

 © 1993, American Association of Retired Persons