Treatment of Depression in Older People

While living a long and happy life is a common goal, aging is unfortunately closely associated with decline in overall health. Not only are physical capabilities reduced, but also cognitive and memory abilities change and it may take longer to recall and process information. However, if the blanket assumption is that these symptoms are all the result of physical aging, one might overlook miss signs of depression.  

According to a variety of health statistics, approximately 10-15 percent of senior citizens experience some form of depression. Yet only two percent are diagnosed with major depression.

Older adults are particularly at risk of Depression due to:

• Declining physical health

• Being less active

• Loss of purpose

• Bereavement

• Isolation

Elderly individuals are often more likely to experience the physical and cognitive symptoms of depression. Physical ailments can amplify these physical depression symptoms. Depression is diagnosed enough of the symptoms of depression listed below occur for over two weeks.  

• Feelings of sadness and even despair

• Loss of interest or pleasure

• Aches and pains with no known medical cause

• Difficulty sleeping or difficulty waking

• Excessive fatigue and reluctance to get out of bed

• Lack of motivation for activities

• Reduced interest in activities they once enjoyed

• Social withdrawal or isolation

• Feelings of worthlessness (feeling like a burden)

• Slowed speech or movement

• Increased thoughts of death or suicidal ideation

• Slowed thinking and memory problems

• Neglecting basic care (personal hygiene, housekeeping)

• Loss of appetite or forgetting to eat

• Difficulty concentrating

• Increased worry

Left untreated, depression can lead to worsening mental and physical health problems and decline in cognitive function. The challenge becomes magnified in elderly individuals because dementia and depression can manifest with similar symptoms.

RECOGNIZING DEPRESSION IN OLDER ADULTS

While some elderly individuals develop the "classic" symptoms such as persistent sadness and despair, others may be dealing with symptoms commonly associated with medical problems. For example elderly adults may experience heart palpitations, fatigue, tremors, body aches, nausea  dizziness, shortness of breath, fainting, or facial flushing. Cognitive issues such as poor concentration or memory, along with mood disturbances such as anxiety and irritability are also common.

In order to address depression in older indivdiuals, clinicians must consider the impact of physical health problems on mental health. On occasion, treating an underlying medical problem can alleviate depression.  Many older individuals will require a combination of psychotherapy, antidepressant medications, and close medical follow up to address their overall health.  Depression can mimic early dementia, but distinguishing between the two can be challenging.

TREATMENT

Psychotherapy can help an elderly individual to re-engage in activities, increase social interaction, and incorporate health habits that support positive mood. Psychotherapy techniques may include a practical approach to improve your mood, thinking patterns, behaviors, relationships, and overall functioning.

Psychotherapy can also be helpful in uncovering the root emotional causes of the depression. There are a range of psychotherapies that can be helpful including cognitive behavioral therapy, supportive psychotherapy, psychodynamic psychotherapy, and spiritual counseling. Support groups may be helpful to foster connection with others over shared experiences. Psychotherapy is helpful and effective, but tends to be underutilized by the elderly population.

When social support and talk therapy are not effective, other treatment options include medications and in some situations electroconvulsive therapy (ECT).

Antidepressants. SSRIs and SNRIs are helpful in the treatment of depression. Medications may increase risk for bone loss and increase risk for fractures,thus close monitoring and medical follow up are neeed. Medications may also be less effective in older individuals and often multiple trials of medications may be needed. Antidepressants may also have interactions with medications used for medical reasons so keeping track of medication interactions is important.  Starting with lower doses and gradually increasing dose with close monitoring can reduce the risk for adverse side effects.

ECT also known as shock therapy has been shown to be effective for severe depressive symptoms in the elderly when other depression treatments are not effective. Side effects however may include memory loss.

TAKE ACTION

The combination of depression and the physical manifestations of aging can make diagnosis and treatment of depression challenging. However, depression in the elderly is treatable and treatment can slow down aging and protect physical and cognitive function.

If you are an older individual experiencing depression, it's important to seek help. If you are the loved one of an elderly person, whom you are worried about, it is wise to speak up and connect them to help. Look for a compassionate psychotherapist or psychiatrist, who has experience working with elderly individuals and can offer appropriate treatment.