Treatment Options Effective For Depression In The ElderlyA Support System Can Help< August 27, 2003 >While depression and related illnesses affect 20 percent of America's elderly, only a fraction are getting the treatment they need. "[Elderly] people can be so debilitated by depression that they are not managing their hypertension or diabetes, or they are not eating right," says Dr. Barry Lebowitz, director of treatment research at the National Institute of Mental Health (NIMH), of the National Institutes of Health (NIH). Dr. Vincent Marchello, medical director of the Metropolitan Jewish Geriatric Center in New York City, says, "Depression is very treatable in elderly patients. Part of the problem is that it's not treated for a variety of reasons. "Patients don't go see their physician in the first place, or the physician is not looking for depression," he says. Depression is not a normal part of aging. But certain aspects of depression do become more distinctive with age. For one thing, the elderly may have different symptoms than younger patients. "Older people will basically agree that they're experiencing every symptom of depression except depression," Dr. Lebowitz says. Depression's "Other" SymptomsExperts often refer to this as "depression without sadness." A person may complain that food does not taste good, sleep is disturbed, and remembering things and making decisions are difficult. Memory and other cognitive problems may combine to make the person seem to have dementia, says Dr. Howard Berkowitz, director of the consultation and emergency psychiatry service at Maimonides Medical Center in New York City. "The person may also look apathetic rather than overtly depressed and is likely to deny he or she is depressed," he says. Risk factors are also often different for older people. "Psychological stress and family history are not so important when it comes to older people experiencing a first episode of depression," Dr. Lebowitz says. Some experts even hypothesize that there is such a thing as "vascular depression," brought on by cerebrovascular disease. Also, people who are not elderly - including caregivers and family members - tend to miss signs of depression in older individuals, thinking it is normal to feel that way at that age. Of the nearly 35 million Americans 65 and older, an estimated 2 million have a depressive illness, and another 5 million may have depressive symptoms, federal health officials estimate. Elderly Have Options for HelpTwo newer groups of anti-depressant medications are more commonly used among the elderly: SSRIs (selective serotonin reuptake inhibitors) such as Prozac®, Zoloft®, and Paxil®; and the even-newer non-SSRIs such as Wellbutrin® and Effexor®. The medications tend to be applied a little differently, however. "With age, one tends to lower the dosage and give increases more slowly," Dr. Berkowitz says. Treatment of depression in the elderly can be complicated by the fact that they tend to have more chronic medical conditions that require more medication. "You have to be more sensitive to side effects and also drug interactions," says Dr. Marchello. Psychotherapy is another option. Social support can play a big part in a person's recovery. "Usually the depressed patient is an isolated patient," Dr. Marchello says. "Getting patients out of the house, getting them more involved is so important." Diet and exercise are also critical. Studies have shown that support systems seem to help seniors comply with their medication regimens. One study published last year in the Journal of the American Medical Association found that an organized program of telephone support helped people take their drugs as prescribed. After a year, 45 percent of the people involved in the support program reported a reduction in depression symptoms of 50 percent or more, compared to only 19 percent of those who were not in the follow-up program. Another major issue in depression is continuity of treatment. "It's not enough to get people well. You've got to work to keep people well," Dr. Lebowitz says. "This [depression] is highly recurrent in older people and recurrences happen sooner. The issue is very, very much keeping people well, not just getting them well." A person suffering a first episode of depression in late life needs to keep taking medications for a year or two years after they seem well. In some cases, Dr. Lebowitz says, "we're talking about continuing treatment for the rest of their lives." Always consult your physician for more information. |
For more information on health and wellness, please visit health information modules on this Web site. What Is Major Depression?Major depression, also known as clinical depression or unipolar depression, is classified as a type of affective disorder or mood disorder that goes beyond the day's ordinary ups and downs. The following are the most common symptoms of major depression. However, each individual may experience symptoms differently. Symptoms may include:
According to the National Institute of Mental Health (NIMH), many factors can contribute to depression in the elderly: Other Illnesses Medications Genetics and Family History Personality Life Events Always consult your physician for more information. Online Resources(Our Organization is not responsible for the content of Internet sites.) American Psychological Association Centers for Disease Control and Prevention (CDC) National Institute of Mental Health (NIMH) National Institute on Aging (NIA) |
