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Depression is not a normal part of aging; but, unfortunately,
it is very common in the elderly. Late-life depression affects about 6 million
Americans age 65 and older, but only 10 percent receive treatment. This is likely
because the symptoms of depression in the elderly are often confused with the
effects of multiple illnesses and the medicines used to threat them.
How does depression in the elderly differ from depression
in younger people?
Depression in later life frequently coexists with other medical illnesses
and disabilities. In addition, advancing age is often accompanied by loss of key
social support systems due to the death of a spouse or siblings, retirement,
and/or relocation of residence. Because of their change in circumstances and the
fact that they're expected to slow down, doctors and family may miss the
diagnosis of depression in elderly people, delaying effective treatment. As a
result, many seniors find themselves having to cope with symptoms that could
otherwise be easily treated.
Depression tends to last longer in elderly adults. It also
doubles their risk of developing cardiac disease, reduces their ability to
rehabilitate, and increases their risk of death
from illness. Studies of nursing
home patients with physical illnesses have confirmed that the presence of depression
substantially increased the likelihood of death from those illnesses. Depression
also has been associated with increased risk of death following a heart attack.
In addition, depression in the elderly is more likely to lead to suicide.
Elderly white men are at greatest risk, with suicide rates in people ages 80 to
84 being 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.
For these reasons, make sure that an elderly person you are
concerned about is evaluated and treated, even if the depression is mild.
What are the risk factors for depression in the elderly?
Factors that increase the risk of depression in the elderly include: Being
female, unmarried (especially if widowed), stressful life events, and lack of a
supportive social network. Having physical conditions like stroke, hypertension,
atrial fibrillation, diabetes, cancer, and dementia further increases that risk. While depression may be an effect of
certain health problems, it can also increase a person's risk of developing
other illnesses -- primarily those affecting the immune system, like infections.
Risk factors for depression that are often seen in
the elderly include:
- Use of certain medicines or combination of medicines
- Presence of other illnesses
- Living alone, social isolation
- Recent bereavement
- Presence of chronic or severe pain
- Damage to body image (from amputation, cancer surgery,
or heart attack)
- Fear of death
- Previous history of depression
- Family history of major depressive disorder
- Past suicide attempt(s)
- Substance abuse
Persons who develop their first depression in old age are very
likely to have very small "hyperlucencies" on head imagery that
indicate tiny spots in the brain may not be receiving an adequate blood supply. Consequent
chemical changes in these cells enhance the likelihood of depression, apart from
any life stress.
What types of treatment are available for older individuals
with depression?
There are several treatment options available for depression
including medicine, psychotherapy (counseling), electroconvulsive therapy, or a
combination in more difficult to treat cases.
- Antidepressant medicines
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 traditional antidepressants -- such as amitriptyline and imipramine --
can be sedating and cause a sudden drop in blood pressure when a person stands
up, which 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 then it is in younger
patients.
- Psychotherapy
Most depressed people find that support from family and
friends, involvement in self-help and support groups, and psychotherapy are very
helpful.
Psychotherapy is especially beneficial for those patients who
prefer not to take medicine, as well as for those not suitable for treatment
with drugs because of side effects, interactions with other medicines, or other
medical illnesses. On the other hand, many doctors
also recommend the use of psychotherapy in combination with antidepressant medicines.
- Electroconvulsive therapy (ECT)
ECT plays an important role in the treatment of depression in
older adults. Because many older patients are unable to take traditional
antidepressant medicines due to side effects or interactions with other
medications they may be taking, ECT is an extremely effective alternative.
What other problems affect treatment of depression in the
elderly?
The stigma attached to mental illness and psychiatric
treatment is even more powerful among the elderly and is often shared by members
of the patient's family, friends, and neighbors. This stigma can keep elderly
patients from seeking treatment. In addition, depressed older people may not
report their depression because they believe there is no hope for help.
Elderly people may also not be willing to take their medicines
because of side effects or cost. In addition, having certain other illnesses at
the same time as depression can interfere with the effectiveness of
antidepressant medicines.
Alcoholism and abuse of other substances may interfere with
effective treatment, and unhappy life events -- including the death of family or
friends, poverty, and isolation -- may also affect the patient's motivation to
continue with treatment.
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