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When doctors talk about depression, they aren’t talking about occasional feelings of sadness or “the blues” that all of us experience at one time or another. They are referring to a group of symptoms that persist consistently for two weeks or more. These can include: insomnia, loss off appetite, fatigue, inability to concentrate, loss of interest in one’s usual activities, feelings of hopelessness and even suicidal thoughts.
Doctors used to believe that those 65+ were most likely to experience depression. Not any longer. Recent studies have shown that the post World War II generation, the baby boomers, are at greatest risk for this mood disorder. Dr. Gerald Klerman, professor of Psychiatry at Cornell University Medical Collage in New York, believes the reason for this phenomenon has a lot to do with the time in which baby boomers grew up: a time of record economic expansion, which created expectations of wealth and success. The enormous size of this generation led, however, to unprecedented competition for schools and jobs, leaving some with unfulfilled dreams. Depression in some boomers may also be the result of growing up in the turbulent 50’s and 60’s, when two unsettling elements were present: divorce and drugs.
That’s not to say that depression is uncommon among older adults. Nursing homes report that 20% of their residents are depressed. As you age, your chance of having one or more chronic illnesses greatly increases. Chronic illnesses are depressing, and the ensuing depression often makes the malady worse. In fact, depression is one of the most potentially dangerous complications of chronic illness, particularly in people who have had recent heart attacks (45%), hospitalized cancer patients (42%), people with Parkinson’s disease (40%) and diabetes (33%).
Other stresses that can trigger depression in older adults usually involve personal losses, the death of loved ones and friends.
Unfortunately, depression in the 65+ population can often go undiagnosed and untreated. While younger people tend to have the classic symptoms of depression -- persistent sadness and sleep and appetite disturbances -- older people often develop physical symptoms that may mask the disorder. What they often complain to a doctor about are aches and pains, intestinal complaints, and breathing problems. When asked by a doctor if they feel depressed, seniors often deny feeling sad, anxious or unhappy.
Many doctors are not trained to spot depression in older patients. Then there is the time pressure of today’s hurried HMO patient exam. Doctors simply don’t have the time to explore a patient’s emotions, let alone review all the medications their patients are taking. This can be a tragic oversight as many medications that seniors take can cause reactions that mimic the symptoms of depression. The fact that depression often causes mental cloudiness and confusion also makes it harder to spot in the 65+ population. After all, everyone loses some mental sharpness during the course of normal aging.
Tragically, not treating senior depression can lead to suicide. Senator Harry Reid of Nevada stated on the floor of the Senate that every 83 minutes, a senior citizen takes his or her own life. Older Americans have a 50% percent higher suicide rate than the rest of the population. Older white males who lost their wives in the last six months are most at risk. The rate for successful suicide attempts is also much higher among seniors -- one in four versus one in 200 for adolescents.
Sometimes myths get in the way of preventing a potential suicide.
Some of them are:
• If someone is determined to kill themselves, no one can stop
them.
• Those who commit suicide do not seek help before their attempt.
• Those who kill themselves must be crazy.
• Asking someone about suicide can lead to suicide.
• Those who talk about suicide rarely actually do it.
Although suicide may follow a loss or trauma, it is most often a byproduct of depression. That’s why it is so important that depression be diagnosed. Not only is this mental health problem treatable, but a number of drug and non-drug therapies are proving to be very effective. Among the non-drug therapies that the National Institute of Mental Health has endorsed are talk therapy, support groups, and cognitive therapy. Exercise has also been shown to be very effective. It normalizes the chemical imbalances in the brain that have been linked to depression.
Doctors typically prescribe antidepressants to older patients who are
depressed. In just 12 weeks, this class of
drugs -- along with talk therapy -- has been shown to alleviate symptoms
in 85% of the patients taking them.
However, many depressed seniors who would like treatment are not getting it. The barriers include both the high costs of psychotherapy as well as the expense of the newer anti-depressant drugs, which can easily run $60 to $100 a month. And that’s on top of the other medications many older Americans have to take.
How does one start to combat depression in seniors? A good place to begin is with the education of primary-care physicians. They are the professionals older Americans go to for their health needs. Mental health professionals also should be placed in nursing homes and other senior settings.
Many of today’s active seniors want to be in charge of how they feel.
Hopefully, they will be more likely to confront depression head on, if
and when it strikes. They will be proactive and seek out appropriate treatment.
Depression
is not a necessary part of aging.
Further resources:
Encyclopedia of Health and Aging by Evelyne Michaels
No Time to Say Goodbye: Surviving the Suicide of A Loved One, by Carla Fine
“Depression: a Treatable Disease,” by the National Academy on An Aging
Society
www.agingsociety.org
202-408-3375
A policy institute of The Gerontological Society of America with a mission to promote innovative and responsible thinking on issues arising from the aging of our society.
The Merck Manual of Geriatrics online www.MerckGeriManual.com
Use the search for the keyword “depression.”
www.suicidology.org
The American Association of Suicidology
Dedicated to the understanding and prevention of suicide.
