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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 seeing a good movie, there
may be a more serious problem. Being depressed for a while, without letup,
can change the way a person thinks or feels. Doctors call this "clinical
depression."
Being "down in the
dumps" over a period of time is not a normal part of growing old. But
it is a common problem, and medical help may be needed. 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 depression are much more likely to be dismissed as
crankiness or grumpiness. Depression can also be tricky to recognize.
Confusion or attention problems caused by depression can sometimes look
like Alzheimer's disease or other brain disorders. Mood changes and signs
of depression can be caused by medicines older people may take for high
blood pressure or heart disease. Depression can happen at the same time
as other chronic diseases. It can be hard for a doctor to diagnose depression,
but the good news is that people who are depressed can get better with
the right treatment.
What To Look
For
How do you know when help is needed? After all, older people may have
to face the kinds of problems that could cause anyone to feel "depressed."
Many older people have to deal with the death of loved ones or friends.
Some may have a tough time getting used to retirement. Others are trying
to deal with chronic illness. But, after a period of grieving or feeling
troubled, most older people do get back to their daily lives. A person
who is clinically depressed continues to have trouble coping both mentally
and physically and may not feel better for weeks, months, or even years.
Here is a list of the most common signs of depression. If these 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 everyday 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.
- A hard time focusing,
remembering, or making decisions.
- Feeling that the
future looks grim; feeling guilty, helpless, or worthless.
- Being irritable.
- Thoughts of death
or suicide; a suicide attempt.
Families, friends,
and health workers should watch for clues of depression in older people.
Sometimes depression can hide behind a smiling face. A depressed person
who lives alone may briefly feel better when someone stops by to say hello
or during a visit to the doctor. The symptoms may seem to go away. But,
when someone is very depressed, the signs come right back.
Don't ignore the
warning signs. Serious depression can lead to suicide. Listen carefully
if someone complains about being depressed or says people don't care.
That person may be telling you he or she needs help.
What Causes Depression?
There is no one cause of depression. For some people, one event can bring
on the illness. Depression often strikes people who felt fine but who
are struggling with a death in the family or a sudden illness. Sometimes
differences in brain chemistry can affect mood and cause depression. Sometimes
people become depressed for no clear reason.
Depression is sometimes
linked to prescription drugs or certain illnesses. Some medications used
to treat arthritis, heart problems, high blood pressure, or cancer can
cause depression as a side effect. These side effects may not happen right
away. Scientists also think some illnesses can cause depression. These
include Parkinson's disease, stroke, and hormonal disorders.
Genetics, too, can
play a role. Studies show that depression may run in families. Children
of depressed parents may be at a higher risk.
Treating Depression
Depression can be treated successfully. Depending on the case, different
therapies seem to work. For instance, support groups help some people
deal with major life changes that require new coping skills or social
support. A doctor might suggest that an older person use a local senior
center, volunteer service, or nutrition program. Several kinds of "talk"
therapies are useful as well.
One method helps
people change negative thinking patterns that might have led to depression.
Another way works to improve a person's relationships with others in an
effort to lessen feelings of despair.
Antidepressant drugs
can also help. These medications can improve mood, sleep, appetite, and
concentration. There are several types of antidepressants available. Some
drugs can take 6 to 12 weeks before there are real signs of progress.
Drugs may need to be used for 6 months or more after symptoms disappear.
Antidepressant drugs
should be used with great care. This can help avoid unwanted side effects.
Older people often take many drugs, and a doctor must know about all prescribed
and over-the-counter medications being taken. The doctor should also be
aware of any other physical problems. It is important to take antidepressant
drugs in the proper dose and on the right schedule.
Electroconvulsive
therapy (ECT) can also help. It is most often recommended when drug treatments
can't be tolerated or there is an unacceptable delay in when drugs would
become effective. ECT, which works quickly in most people, is given as
a series of treatments over a few weeks. Like other antidepressant therapies,
followup treatment with medication or occasional ECT is often needed to
help prevent a return of depression.
Prevention
What can be done to lower the risk of depression? How can people cope?
There are a few practical steps you can take. One way to prepare for major
changes in life, such as retirement or the death of family or friends,
is to keep and maintain friendships over the years. Friends can help ease
the loneliness of losing a spouse. You can also develop interests or hobbies,
keep the mind and body active, and stay in touch with family to help limit
the effects of depression.
Being physically
fit and eating a balanced diet are ways to help avoid illnesses that can
bring on disability or depression. Follow the doctor's directions on using
medicines to lower the risk of depression as a drug side effect.
Getting Help
The first step to getting help is to accept that help is needed. The subject
of mental illness still makes some people uncomfortable. Some feel that
getting help is a sign of weakness. Many older people, their relatives,
or friends may believe, mistakenly, 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
should check to see if there are medical or drug-related reasons for the
depression. After a complete exam, the doctor may suggest talking to a
mental health specialist. The special nature of depression in older people
has led to a new medical specialty--geriatric psychiatry.
Be aware that some
family doctors may not understand about aging and depression. They may
not be interested in these complaints. Or, they may not know what to do.
If your doctor is unable or unwilling to take seriously your concerns
about depression, you may want to consult another health care provider
who can help.
If a depressed older
person won't go to a doctor for treatment, relatives or friends can help.
They can explain how treatment may help 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 start by making a phone call.
The telephone can't take the place of the personal contact needed for
a complete medical checkup, but it can break the ice. Sometimes a home
visit can be set up.
Don't avoid getting
help because you are afraid of how much treatment might cost. Short-term
psychotherapy, with or without medication, will work in many cases. It
is often covered by insurance. Also, community mental health centers offer
treatment based on a person'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.
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