Benj Vardigan
CONSUMER HEALTH INTERACTIVE

Note: This article has been localised for an Irish audience.

Depression is the most common psychiatric problem among older people, but it's not a natural or inescapable part of ageing. "Grumpy old men" and "crotchety old ladies" don't necessarily come by their temperaments simply because of their age; they may be clinically depressed. And that may be misinterpreted by others -- as well as by the depressed older people themselves. It's not that friends, family, and even doctors don't notice that the person feels blue, but that they don't consider the symptoms part of a bona fide, treatable illness. Doctors often confuse clinical depression with the symptoms of other acute and chronic illnesses, such as Parkinson's disease. And older people themselves may decide that the way they feel is par for the course as they grow older.

In older as in younger people, depression is by no means a benign disease -- it can lead to faster physical and mental decline in older people and even to death at an earlier age. An older person who's been depressed for at least six years is twice as likely to develop cancer, according to a 1998 US study, and depressed people over 70 years are more likely to develop other diseases after two years. Other studies have found that isolation can be a result of depression, as well as one of its causes, as despondent older people cut themselves off from friends and family.

It's important to acknowledge that many older people have good reasons to feel sad. It is understandable for someone with cancer to be despondent over the illness, just as it's normal for someone to be devastated by chronic pain, the loss of a spouse, or the inability to do scores of things that used to be second nature. Doctors and family members need to keep a watchful eye for the difference between clinical depression and grief over painful losses.

Major depression is a despair and hopelessness so profound that the person may lose interest in life. He may be unable to get out of bed or eat for days at a time. Nothing seems pleasurable anymore. Mild depression, or dysthymia, involves a chronically dampened mood, poor self-esteem, and low-level symptoms of major depression. Some depressive symptoms can be traced to specific problems, as in the case of people who suffer from seasonal affective disorder (SAD) or "winter blues" -- thought to be a reaction to lack of sunlight. But very often, major depression has no precipitating event. Doctors generally consider a person clinically depressed when he has suffered at least two weeks of despair and several weeks of the symptoms commonly associated with depression, which include hopelessness, apathy, and a loss of interest in most activities.

•Feelings of overwhelming sadness and frequent crying.

•Hopelessness and pessimism.

•Changes in eating habits with weight loss or weight gain.

•Changes in sleeping habits, such as insomnia, waking in the small hours of the morning, or sleeping all the time.

•Indifference toward activities a person used to enjoy.

•Sluggishness, fatigue, and a feeling of profound emptiness and flatness.

•Trouble concentrating or thinking clearly.

•Morbid or suicidal thoughts.

•Medications. Some common prescription drugs may cause symptoms of depression. These include blood-pressure medicines such as Catapres and Aldomet (these are seldom used nowadays);

Propranolol for heart problems; drugs used to treat Parkinson's disease, such as L-dopa and bromocriptine; some arthritis medicines; and steroids, such as cortisone and prednisolone.

•Illnesses. Any person with a chronic illness is susceptible. Those who've suffered heart attacks or strokes or have diabetes or cancer are more likely to be depressed, as are sufferers from Parkinson's disease or hormonal disorders. Seniors whose illnesses have left them unable to perform basic daily activities such as using the telephone or getting dressed are particularly at risk. In addition, depression often accompanies other psychiatric disorders, particularly anxiety.

•Substance abuse disorders. Problems with alcohol and prescription drugs often result in despair for seniors.

•Genetics. Having relatives who suffered from depression increases your chance of developing depressive symptoms at some point in your life.

•Life events. People often go through an overwhelming amount of loss late in life, be it death of a spouse, of siblings, or of other loved ones. In addition, disabilities or illnesses often leave older people housebound most of the time. All of these factors -- combined with the very nature of growing older -- can amount to a lonely and isolated life, the perfect breeding ground for depression.

The two are often confused. Because depression can cause concentration problems and trouble thinking clearly, it's often mistaken for Alzheimer's. Certainly, older people suffering from Alzheimer's and dementia are more likely to become depressed. But many times, the symptoms of depression are assumed to be part of Alzheimer's disease when in fact they are independent and treatable.

A controversial school of thought -- supported by a 1999 Swedish study -- contends that symptoms of depression such as low energy and concentration problems may often actually be early signs of Alzheimer's disease. Instead of becoming depressed because of failing memories and disorientation associated with Alzheimer's, the study suggests the depression symptoms come first. However, it's still not known whether depression is an early symptom of Alzheimer's.

Helping someone who's depressed can be tough, given that your loved one will likely withdraw from family and friends and resist assistance. But the best idea is to lend an understanding ear and tactfully -- without standing in judgement -- encourage her to consult a doctor or another healthcare professional. GPs can refer her to a geriatrician, who specialises in elder care. In extreme cases -- if the person seems in danger of taking her own life -- urge her to call a suicide prevention hotline, such as the Samaritans, or call one yourself. AWARE is a patient support group for those suffering from depression also provides excellent advice.

One of the worst things you can do is try to talk someone out of a depression either by being overly cheerful or insisting the person "just get over it." Depression is a disease. It's biological, and it's not relieved by an act of will.

Many older patients suffering from depression do not receive psychotherapy. But when treated, older patients respond well.

Older people with mild depression respond well to a class of drugs called selective serotonin re-uptake inhibitors (SSRIs). Among antidepressants, SSRIs -- which include Fluoxetine -- cause fewer side effects and interact less with other medications, because they pinpoint only one area in the brain.

But these drugs also present complications for older people. A 1998 study found that elderly patients taking SSRIs had 80 percent more falls than patients not on antidepressants, and since older people are often taking an array of prescription drugs, there is always an increased risk of dangerous interactions.

Non-pharmacological approaches, such as psychotherapy, have been suggested by some studies. Therapies that foster social activity for older people seem to be particularly effective. Some experts believe that the elderly would benefit from a society-wide re-evaluation of attitudes toward ageing. As adults, we do pretty well at understanding teenagers, for example, because we were once young ourselves -- but we don't have the same empathy for older people if we haven't yet reached that age.

Volunteer programmes are a great way for older adults to get involved in the community again. Getting a pet or taking up gardening are also potential lifestyle changes that can act as solutions to depression. At a time when a lot of things and people are disappearing from a person's life, it's sometimes necessary to add new things.

Exercise is also a good non-chemical way to beat depression. A 1999 study in the US found that among 156 men and women with major depression disorder, antidepressants were more effective early on, but that after 16 weeks, aerobic exercise proved to be equally effective in reducing depressive symptoms. (For good exercise routines for older people, see "Seniors and Exercise." )

Aware: 72 Lr Leeson Street. Dublin 2 01 6617208; email: aware@webireland.ie

The Samaritans. Branches nation-wide. Dublin: 018727700; Cork: 021 271323; Ennis: 065 6829777; Galway: 091 561222; Limerick: 061 412111; Sligo: 071 42011; Tralee: 066 7122566; Waterford: 051 872114.

This article has been revised by Vhihealthe for its audience and may contain, among other things, information or medical practices that are unique to Ireland. Neither Consumer Health Interactive nor the original author make any warranty as to the accuracy of the article as revised, and assume no responsibility for modified content.

First published November 27, 2001
Copyright © 2000 Consumer Health Interactive

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