Depression: A Serious but Treatable Illness.

National Institute on Aging

Introduction

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 after 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, drags, 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 deaths 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 ordinary 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 that 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 drags or certain illnesses. Some medications used to treat arthritis, heart problems, high blood pressure, or cancer can produce 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. Drags may need to be used for 6 months or more after symptoms disappear.

Antidepressant drags should be used with great care. This can help avoid unwanted side effects. Older people often take many drags, 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 drag treatments can't be tolerated or there is an unacceptable delay in when drags 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 fife, 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 important 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 drag 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 drag-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 to 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 you get 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.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 (N) 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

Published in 1998