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by Joseph J. Gallo MD, MPH
and Ira Katz MD, PhD
"Do not ignore warning signs of depression.
Treatment can be more successful if family members participate
in care."
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Q. Is feeling
depressed a normal part of growing older?
A. It
is easy to think that feelings of depression in an older person
are due to physical illness or life events, such as loss of
loved ones. But "being down in the dumps" with little
joy or pleasure from life is not normal. Older persons without
depression are able to bounce back from adversity and maintain
a zest for living; however, when people remain depressed for
more than a week or two, the reason may be a treatable illness.
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Q. What are common
signs of depression?
A. Because
an older person suffering from depressive illness may deny feeling
sad or depressed, friends and family should watch for the following
symptoms of depressive disorder:
- loss of interest in self-care and/or following
medical advice
- little interest in social activities
- feeling "empty" inside
- trouble sleeping and/or anxiety
- trouble concentrating or remembering things
- unexplained aches and pains
- change in appetite and weight
- feeling hopeless about the future
- feelings of helplessness
- easily irritated and/or listless
- feeling that one is a burden
Q. What causes depression?
A. There is
no single cause of depression. Depression may be related to changes
in brain chemistry that affect mood; however, mood changes and
signs of depression can be the result of medications that an older
person is taking, or can be the direct result of physical illnesses.
Q. What are the risk
factors for suicide in older persons?
A. Thoughts
of death are not abnormal for older people. However, people who
feel hopeless, helpless, or that life is a burden, are at increased
risk for suicide. Persons who have recently experienced a loss
or bereavement, a new physical illness, who are living alone or
are socially isolated, or who drink alcohol, may be at increased
risk. Giving away possessions, or making casual comments about
not being around, may indicate a need for further assessment.
Q. What should the
doctor do if depression is a concern?
A. In order
to identify potential correctable causes, the doctor should take
a history and perform a physical examination looking for medical
conditions that might result in depression. Also, it is important
that all medications taken by a patient, including over-the-counter
medicines or herbal remedies, be brought to the exam for the doctor
to review. In some cases, the doctor may want to refer persons
to a mental health specialist.
Q. What if the patient
resists seeing a mental health specialist?
A. Older persons
should be made aware that most consultations require no more than
one or two visits and that effective treatment is available, without
hospitalization, for most patients in the community. Older persons
may feel more comfortable going to a specialist if they are assured
they will receive follow-up care with their own doctor. For some
persons, it is best to introduce the idea of a referral over time,
rather than forcing the issue.
Q. What treatment options
are available for depression?
A. The good
news about depression is that treatment works! Counseling and
medications are the primary methods of treatment. Counseling is
used to counter negative thinking, solve problems, and deal with
interpersonal conflicts. Medications for depression help most
people who take adequate doses over a long period of time–generally,
it takes several weeks for treatment to become effective.
Q. What should I know
about antidepressant medications?
A. Medications
take at least two to four weeks to become effective. Although
side effects vary depending on the particular antidepressant prescribed,
those that do occur generally resolve with continued treatment.
These medicines should be taken even if one is feeling better,
usually for several months. Today's medications are not addicting.
Some older medicines used to treat anxiety do have the potential
for abuse and addiction, but are no longer routinely prescribed
to treat depression.
Q. What about St. John's
Wort and other herbal remedies?
A. There is
some evidence that St. John's Wort may be useful for mild cases
of depression; however, it is important to be evaluated by a health
professional to be sure there are no medical reasons for depression
and that the depression is not more severe than it appears.
Q. What can family
members do if they suspect an older relative is depressed?
A. Do not
ignore warning signs of depression. Listen carefully if an older
person complains about feeling depressed or says people don't
care. Treatment can be more successful if family members participate
in care. Because caring for a depressed older person can be stressful,
caregivers should pay careful attention to the need for taking
a break from care giving tasks.
Q. What resources are
available for help or more information?
A. Written
material available in most bookstores:
- Bloomfield HH, McWilliams P. How to Heal
Depression. Los Angeles, Prelude Press, 1994.
- Mathiasen P, Levert S. Late Life Depression.
New York: Dell Publishing, 1997.
Other sources of information can be found on the world wide web
or telephone:
- National Institute of Mental Health, www.nimh.nih.gov,
800-421-4211
- National Institute on Aging, "Age Pages"
under "Health Information," look for Depression: A
Serious but Treatable Illness, www.nih.gov/nia,
800-222-2225
- National Depressive and Manic Depressive
Association, www.ndmda.org,
800-826-3632
- National Mental Health Association, www.nmha.org,
800-969-NMHA or TTY 800-433-5959
- National Alliance for the Mentally Ill,
www.nami.org,
800-950-NAMI (6264)
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