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Depression: A Serious but Treatable Illness


Everyone gets the blues now and then. It's part of life. But when there is little joy or pleasure after visiting with friends or after seeing a good movie, there may be a more serious-problem. A depressed mood that stays around for a while, without let-up, can change the way a person thinks or feels. Doctors call this "clinical depression."

Being "down in the dumps" over a period of time like this is not a normal part of growing old, but it is a common problem. An older person who feels this way needs medical help. For most people, depression can be treated successfully. "Talk" therapies, drugs, or other methods of treatment can ease the pain of depression. There is no reason to suffer.

There are many reasons why depression in older people is often missed or untreated. As a person ages, the signs of the disease are much more likely to be dismissed as crankiness or moods of "old age." Depression can also be tricky to recognize. Confusion or attention problems caused by depression can sometimes mimic the symptoms of Alzheimer's disease or other disorders of the brain. Mood changes and common symptoms of depression are sometimes the result of side effects of drugs commonly taken by older patients for high blood pressure and heart disease. Depression in late life also frequently occurs with other chronic diseases, making diagnosis difficult and treatment challenging. Depression in older people may not be easy to diagnose, but it should not be ignored because it typically responds to appropriate treatment.

What To Look For

How do you know when help is needed? After all, older people experience more events and problems that might cause anyone to become "depressed" - deaths of loved ones and friends, being unsure of what to do in retirement, or coping with chronic illness. Usually, though, after a normal period of time grieving or feeling troubled, people resume their daily lives. When a person is clinically depressed, his or her ability to function both mentally and physically is affected, and the trouble may last for weeks, months, or even years.

Here is a list of the most common signs of depression. If several of these symptoms last for more than 2 weeks, see a doctor.

  • An "empty" feeling, ongoing sadness and anxiety.
  • Tiredness, lack of energy.
  • Loss of interest or pleasure in ordinary activities, including sex.
  • Sleep problems, including very early morning waking.
  • Problems with eating and weight (gain or loss).
  • A lot of crying.
  • Aches and pains that just won't go away.
  • Difficulty concentrating, remembering, or making decisions.
  • Feelings that the future looks grim; feeling guilty, helpless, or worthless.
  • Irritability.
  • Thoughts of death or suicide; a suicide attempt.

Families, friends, and health professionals should look carefully for signs of depression in older people.. Symptoms vary widely among people and, sometimes, depression can hide behind a smiling face. For depressed people who live alone, for instance, feelings of despair or loneliness can change briefly when someone stops by to say hello or during a visit to the doctor. The person may get such a boost from the contact with another individual that, for the moment, the depressive symptoms subside.

Don't ignore the warning signs. At its worst, serious depression can lead to suicide. Statistics show that the rate of completed suicides, about 25 percent of those attempted, is higher for older people than that of the general population. Listen carefully when an older friend or relative complains about being depressed or of people not caring. The person may be telling you that he or she needs help.

What Causes Depression?

There is no single cause of depression. For some people, just one event can bring on the illness. Others seem to become depressed for no clear reason. One way that scientists classify depression is to divide it into two forms: primary and secondary. Primary depression occurs in people who have generally been well but who may show symptoms of depression in response to events beyond their control. A death in the family or sudden illness, for example, might bring on depressed feelings. Also, differences in brain chemistry that affect mood can be a cause of primary depression.

Secondary depression is linked to drugs or certain illnesses. Some medications used to treat arthritis, heart problems, high blood pressure, and cancer can produce depression. The effects of these drugs may not always be clear right away. Scientists also think some illnesses themselves can bring about depression. These include Parkinson's disease, stroke, and hormonal disorders.

Genetics, too, can play a role. Studies show that some forms of depression run in families. Children of depressed parents may be at a higher risk of getting the disease themselves.

Treating Depression

Depression is the most treatable of all mental illnesses. About 60 to 80 percent of depressed people can be treated successfully outside a hospital with psychotherapy alone or with special drugs. Medical research has made great progress in recognizing the problem of depression among older people and devising treatments. In fact, this has led to the development of a new medical specialty, geriatric psychiatry, with doctors trained in the diagnosis and relief of depression in late life.

Depending on the case, various kinds of therapies seem to work. Treatments such as psychotherapy and support groups help people deal with major changes in life, such as retirement, moving, or health problems that require new coping skills and social support. Several short-term (12-20 weeks) "talk" therapies have proven useful. One method helps patients recognize and change negative thinking patterns that have led to the depression. Another approach focuses on improving a patient's relationships with people as a way to reduce depression and feelings of despair. A doctor might also suggest that an older patient use community-based programs such as senior centers, volunteer services, or nutrition programs.

Antidepressant drugs can also help. These medications can improve mood, sleep, appetite, and concentration. There are several types of these drugs available, with doctors favoring medications that may have fewer side effects harmful to older people. Drug therapies often take at least 6 to 19 weeks before there are real signs of progress and may need to be continued for 6 months or longer after symptoms disappear.

Despite their benefits, antidepressant drugs need to be used with great care. Many older people take a number of drugs for other problems. A doctor must know about all prescribed and over-the-counter medications being taken and should be aware of all physical problems. This can help avoid unwanted side effects. Also, remember to take the medication in the proper dose and on the right schedule; if not, the drugs may not work.

"Shock" therapy, or electroconvulsive (ECT) therapy, can also help. While its long-term benefits need more study, ECT can work well as a short-term treatment. New techniques assure that ECT is safe and effective when properly used, not like the scary movie version of years ago.

Prevention

In some cases, major depressive illness can be avoided. This is especially true when depression is linked to life events, such as widowhood and retirement, that occur more often with age. For instance, fostering and maintaining relationships with people over the years can help lessen the effects of losing a spouse. Developing interests or hobbies, staying involved in activities that keep the mind and body active, and keeping in touch with family and friends are all ways to keep major depression at bay.

Overall, physical fitness and a balanced diet are important ways to help avoid illnesses that can bring on disability and depression. Also, following the doctor's prescription on the proper use of medicines will reduce the risk of depression as a drug side effect.

Getting Help

The first step to getting help is to overcome negative attitudes that stand in the way. The subject of mental illness still makes many, especially older people, uncomfortable. Some feel that getting help is a sign of weakness. Many older people, their relatives, or friends mistakenly believe that a depressed person can quickly "snap out of it" or that some people are too old to be helped.

Once the decision is made to get medical advice, start with the family doctor. The doctor, whether in private practice, a clinic, or a health maintenance organization, should decide if there are medical or drug-related reasons for the symptoms of depression. After a complete exam, the physician may refer the older patient to a mental health specialist for further study and possible treatment. Be aware that a few doctors may share some of the negative attitudes about aging and depression and may not be interested in the complaints. Insist that your concerns be taken seriously or find a doctor who is willing to help.

If a depressed older person refuses to go along with evaluation and treatment, relatives or friends can be reassuring. Explain how treatment will reduce symptoms and make the person feel better. In some cases, when an older person can't or won't go to the doctor's office, the doctor or mental health specialist can call and arrange a visit to the patient's home. The telephone is not a substitute for the personal contact needed for a complete medical checkup, but it can break the ice.

Don't avoid seeking help because you are afraid of how much treatment might cost. Often, the problem can be solved with weeks - not months or years - of therapy or medications. Also, community mental health centers offer treatment based on a patient's ability to pay.

For More Information

Many groups offer more information on depression and older people. The following list can help get you started:

The National Institute of Mental Health's (NIMH) special DEPRESSION Awareness, Recognition, and Treatment Program offers several publications, including "If You're Over 65 and Feeling Depressed: Treatment Brings New Hope." Contact the Information Resources and Inquiries Branch, NIMH, Room 7C-02, MSC 8030, Bethesda, MD 20892-8030; 800-421-4211. Visit the website at http://www.nimh.nih.gov.

The National Depressive and Manic Depressive Association (National DMDA) has over 200 chapters in the United States and Canada offering support to people with depression and their families. They sponsor education and research programs and distribute brochures, videotapes, and audio programs. Write to the National DMDA, 730 N. Franklin Street, Suite 501, Chicago, IL 60610-3526; call 800-826-3632. Visit their website at http://www.ndmda.org.

The National Alliance for the Mentally Ill (NAMI) has a Medical Information Series that provides patients and families with information on several mental illnesses and their treatments, including the publication "Understanding Major Depression: What You Need To Know About This Medical Illness." NAMI state affiliates provide emotional support and can help find local services. Write or call NAMI at 200 North Glebe Road, Suite 1015, Arlington, VA 22203-3754; 800-950-NAMI (6264). The website is http://www.nami.org.

The National Mental Health Association (NMHA) publishes information on a variety of mental health issues and has special information on depression and its treatment. NMHA also provides referrals and support. Write or call the NMHA Information Center, 1021 Prince Street, Alexandria, VA 22314-2971; 800-969-6642. Visit the website at http://www.nmha.org.

The American Association for Geriatric Psychiatry (AAGP) is a national professional organization of specialists in geriatric psychiatry. It provides teaching materials and brochures about selected mental health disorders, including depression. Write to Publications, AAGP, 7910 Woodmont Avenue, Suite 1350, Bethesda, MD 20814-3004. Visit the website at http://www.aagpgpa.org.

The American Psychological Association (APA), the professional and scientific organization for the practice of psychology, has several brochures and fact sheets for consumers and health professionals, including a pamphlet "What You Should Know About Women and Depression." Write or call APA Public Affairs, 750 First Street, NE, Washington, DC 20002-4242; 800-374-3120. The website is http://www.apa.org.

The National Institute on Aging (NIA) distributes Age Pages and other materials on a wide range of topics related to health and aging. For a list of free publications, write to the NIA Information Center, P.O. Box 8057, Gaithersburg, MD 20898-8057; or call 800-222-2225, or 800-222-4225 (TTY). Visit the website at http://www.nih.gov/nia.

The Alzheimer's Disease Education and Referral (ADEAR) Center is a clearinghouse supported by the NIA with information on Alzheimer's disease and related disorders. For information about depression for Alzheimer's patients and caregivers, contact the ADEAR Center at P.O. Box 8250, Silver Spring, MD 20907-8250; 800-438-4380. Visit the ADEAR Center's website at http://www.alzheimers.org.

National Institute on Aging
U. S. Department of Health and Human Services
Public Health Service
National Institutes of Health
1996