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Mental Health

12/12/2014 4:58:42 PM

Many elderly adults face significant life changes and stressors that put them at risk for depression. Those at the highest risk include older adults with a personal or family history of depression, failing health, substance abuse problems, or inadequate social support.

Warning Signs of Depression

Sudden changes in mood and interest can signal more than just old age. The National Institute of Mental Health (NIMH) reports that elderly depression is not only widespread but is a serious public health concern. Recent research suggests that as many as 15% of elders - that's 6.5 million Americans - suffer from depression, and still more, 25%, report that they suffer from persistent feelings of sadness. The United States has seen a significant increase in the elderly suicide rate in the past 10 years, and many health experts blame untreated depression. Though adults over the age of 65 make up only 13% of the nation's population, they account for 20% of all suicide deaths, according to the National Institutes of Health.

Geriatric psychiatrists and knowledgeable physicians who care for the elderly ask the following questions to screen for elderly depression:

  1. Have you been sad or depressed, or had feelings of helplessness, most of the time over the last two weeks?
  2. Have you lost interest in almost everything in the last two weeks?

While it's natural to experience some grief in the face of major life changes, clinical depression doesn't go away by itself, lasts for several months, and needs to be treated by a professional. According to NAMI, unresolved depression can affect the immune system, which makes the depressed person more susceptible to other illnesses.

If you suspect that your parent or loved one is suffering from depression, pay attention to these health indicators:

  1. Irritability. While your loved one used to be a content and happy person, are they now cranky and easily irritated by small things? Sudden mood changes can suggest depression.

  2. Loss of self-regard. One of the most obvious signs of depression in elders is seen when they show a lack of pride in their personal appearance. Perhaps your mother has stopped wearing makeup, or your father has stopped bathing. Loss of pride in personal appearance can signal a problem.

  3. Social withdrawal. Did you have lunch with your dad every Wednesday, but now he's making excuses about why he can't join you? Depressed elders, note experts, tend to take on the "hermit mentality," shutting out others-even loved ones-and avoiding social situations.

  4. Increased pain. One of the greatest myths about depression is that it's only in the mind. In fact, depression amplifies physical pain.

  5. Recent Major Medical Issues. Has your loved one suffered a stroke or had a major surgery recently? Elders recovering from major illness or surgery are much more likely to develop a depressive episode, and some go on to have a depression disorder.

  6. Recent Loss. Has your loved one lost a spouse, child, or relative to death recently? Depression in bereavement is common and elderly persons have a much higher risk of plummeting into depression after the loss of a loved one than a younger person.

  7. Move. Has your loved one recent moved from their family home? Adjusting to a new place, with new people can be very overwhelming.

  8. Loss of Independence. As people age and start having more difficulties getting around or caring for oneself, their self esteem and self worth can be greatly impacted.

  9. Overuse of alcohol or medications. Self-medication with alcohol or medications, such as sleep aids, can sometimes mask symptoms and can make depression worse.

Many health practitioners who care for the elderly are unprepared and unable to detect signs of depressed individuals. To make matters worse, seniors themselves often ignore - even hide - their debilitating mental conditions. While many elderly individuals may downplay their depression, the illness can have frightening consequences if not addressed.

In older adult populations, it's common for depressed individuals to stop taking critical medications such as insulin treatment or prescriptions for serious heart conditions. Research shows that elderly depression can double the risk of cardiac disease and increase the risk of developing other serious health conditions. In studies where nursing home patients with physical illnesses were examined, the advent of depression significantly increased the chance of death from those illnesses. In addition, non-depressed elders are more likely to recover from a heart attack, while depressed seniors have a greater chance of dying after a cardiac incident.

Getting Help

While 50% of depressed elders will eventually recover on their own without any intervention, half will not-an important reason to make sure your loved lone gets help. Studies show that elders who have a support network are more likely to pull through a depressive episode than those who are isolated.

But there are tactful ways of approaching such a sensitive topic, especially when an adult child approaches the matter with compassion and sensitivity. Try saying things like: "You don't have to feel this way, let's get you some help"; or "I want to understand your condition better. Let's talk to the doctor. I'll go with you."

While families can be enormously helpful to their depressed loved one, occasionally the opposite is true. And that's where a mental health practitioner comes in. When selecting a psychotherapist, look for someone who specializes in geriatrics (care for the elderly). 

Call your health care provider if you feel persistently sad, worthless, or hopeless, or if you cry often. Also call if you are having trouble coping with stresses in your life and want to be referred for talk therapy.

Go to the nearest emergency room or call your local emergency number (such as 911) if you are thinking about suicide (taking your own life).

If you are caring for an aging family member and think they may have depression, contact their health care provider.

Senior Reach. If you need help and live in Boulder, Broomfield, Jefferson, Clear Creek and Gilpin counties, Senior Reach is a great resource. Call 1-866-217-5808 or go to  Click on these links to see testimonials on how depression treatment has made a difference in people's lives.

Senior Reach Can Help
Senior Reach Helped My Change My Life

Treatment Options

When it comes to elderly depression, each patient is different and requires a customized treatment approach to his or her unique needs and circumstances. Often the treatment plan will combine the following different approaches:

Medication. Most studies show that only half of people treated with medicine get better. Still, many respond well to medication. Whatever the medication, each dose has to be properly administered to produce the desired effect. And when the depression seems to be "cured"? Research published in a recent issue of The New England Journal of Medicine reports that elderly patients who remained on antidepressant drugs after recovering from depression are significantly less likely to relapse or have further depressive episodes than those who were taken off their medication entirely. As with most treatment methods, if you add psychotherapy, you get the best results. Most people get medication only, but the best treatment is combined with psychotherapy.

Psychotherapy and Social Support Intervention. While it does take time - 10 to 12 sessions to get the person to the point where they've recovered from their depression, followed by one session a month to sustain progress - results can be dramatic and productive.

Exercise. According to researchers at Duke University Medical Center in Durham, North Carolina, exercising just three times per week can relieve and even cure the symptoms of elderly depression. In fact, according to the study, activities such as walking, light aerobics, or swimming may have greater depression-fighting properties than the leading anti-depressant medications.

Electroconvulsive Therapy. For severe cases of depression that do not respond to medication or where the depression is accompanied by schizophrenia or psychosis, there is the option of electroconvulsive therapy (ECT), which uses electrical shocks to produce monitored seizures that release certain chemicals, or neurotransmitters, in the brain-a process that can provide dramatic short-term improvement for depression. While ECT today is generally considered by psychiatrists to be a very safe and effective procedure when performed under current guidelines, controversy still surrounds it. An unfortunate history of indiscriminate and sometimes abusive usage has resulted in extremely negative depictions of it in popular culture. Some psychiatrists believe ECT should be used only as a last resort, and some strongly oppose it.

Additional information

So what's the bottom line about elderly depression? Don't let it go untreated. If you suspect your loved one is suffering from minor or major depressive symptoms, encourage them to seek help.

Staying Sharp: Current Advances in Brain Research and Depression

A Place for Mom: Elderly Depression and Care for the Elderly

Access Mental Health Treatment through the Colorado Public Mental Health System, find services that are near you.