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