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Depression in the Elderly

Clinical depression in the elderly is common. That doesn't mean, though, it's normal. Late-life depression affects about 6 million Americans age 65 and older. But only !" recei#e treatment for depression. The li$ely reason is that the elderly often display symptoms of depression differently. %epression in the elderly is also fre&uently confused 'ith the effects of multiple illnesses and the medicines used to treat them.

How does depression in the elderly differ from depression in younger adults?
%epression in later life fre&uently coe(ists 'ith other medical illnesses and disabilities. )n addition, ad#ancing age is often accompanied by loss of social support systems due to the death of a spouse or siblings, retirement, or relocation of residence. Because of changes in an elderly person's circumstances and the fact that elderly people are e(pected to slo' do'n, doctors and family may miss the signs of depression. As a result, effecti#e treatment gets delayed. *any seniors find themsel#es trying to cope 'ith symptoms that could ha#e been easily treated. %epression tends to last longer in elderly adults. )t doubles their ris$ of cardiac diseases and increases their ris$ of death from illness. At the same time, depression reduces an elderly person's ability to rehabilitate. +tudies of nursing home patients 'ith physical illnesses ha#e sho'n that the presence of depression substantially increases the li$elihood of death from those illnesses. %epression also has been associated 'ith increased ris$ of death follo'ing a heart attac$. ,or that reason, ma$ing sure that an elderly person you are concerned about is e#aluated and treated is important, e#en if the depression is mild. %epression in the elderly, especially elderly 'hite men, is more li$ely to lead to suicide. The suicide rate in people ages -! to -. is more than t'ice that of the general population. The /ational )nstitute of *ental 0ealth considers depression in people age 65 and older to be a ma1or public health problem.

How is insomnia related to depression in the elderly?

)nsomnia is usually a symptom of depression. /e' studies re#eal that insomnia is also a ris$ factor for depression onset and recurrence -particularly in the elderly. To treat insomnia, e(perts recommend the ne'er 2hypnotic2 drugs that are safe and effecti#e in elderly people. )f there's no impro#ement in the sleep

disorder and3or depression, a psychiatrist or psychopharmacologist may prescribe medications and3or psychotherapy.

What are risk factors for depression in the elderly?

,actors that increase the ris$ of depression in the elderly include4

Being female Being single, unmarried, di#orced, or 'ido'ed Lac$ of a supporti#e social net'or$ +tressful life e#ents

5hysical conditions li$e stro$e, hypertension, atrial fibrillation, diabetes, cancer, dementia, and chronic pain further increase the ris$. Additionally, the follo'ing ris$ factors for depression are often seen in the elderly4

Certain medicines or combination of medicines %amage to body image 6from amputation, cancer surgery, or heart attac$7 ,amily history of ma1or depressi#e disorder ,ear of death Li#ing alone, social isolation 8ther illnesses 5ast suicide attempt6s7 5resence of chronic or se#ere pain 5re#ious history of depression 9ecent berea#ement +ubstance abuse

Brain scans of people 'ho de#elop their first depression in old age often re#eal spots in the brain that may not be recei#ing ade&uate blood flo'. Chemical changes in these cells may enhance the li$elihood of depression separate from any life stress.

What types of treatment are available for depression in the elderly?

There are se#eral treatment options a#ailable for depression. They include medicine, psychotherapy or counseling, or electrocon#ulsi#e therapy. )n more difficult to treat cases, a combination of these may be appropriate.

How do antidepressants relieve depression in the elderly?

*ost of the a#ailable antidepressants are belie#ed to be e&ually effecti#e in elderly adults. But the ris$ of side effects or potential reactions 'ith other medicines must be carefully considered. ,or e(ample, certain older antidepressants -- such as amitriptyline and imipramine -- can be sedating or cause a sudden drop in blood pressure 'hen a person stands up. That can lead to falls and fractures. Antidepressants may ta$e longer to start 'or$ing in older people than they do in younger people. +ince elderly people are more sensiti#e to medicines, doctors may prescribe lo'er doses at first. )n general, the length of treatment for depression in the elderly is longer than it is in younger patients.

Can psychotherapy help relieve depression in the elderly?

*ost depressed people find that support from family and friends, in#ol#ement in self-help and support groups, and psychotherapy are helpful. 5sychotherapy is especially beneficial for those 'ho prefer not to ta$e medicine. )t also is helpful for people 'ho cannot ta$e drugs because of side effects, interactions 'ith other medicines, or other medical illnesses. 5sychotherapy in older adults can address a broad range of functional and social conse&uences of depression. *any doctors recommend the use of psychotherapy in combination 'ith antidepressant medicines.

Who may benefit from electroconvulsive therapy (ECT ?

:CT can play an important role in the treatment of depression in older adults. ;hen older patients are unable to ta$e traditional antidepressant medicines because of side effects or interactions 'ith other medications, :CT is an effecti#e alternati#e.

What other problems affect treatment of depression in the elderly?

The stigma attached to mental illness and psychiatric treatment is e#en more po'erful among the elderly than among younger people. That $ind of

thin$ing is also often shared by members of the patient's family, friends, and neighbors. This stigma can $eep elderly patients from ac$no'ledging they are depressed, e#en to themsel#es. %epression may be e(pressed through physical complaints rather than traditional symptoms. That delays appropriate treatment. )n addition, depressed older people may not report their depression because they belie#e there is no hope for help. :lderly people may also be un'illing to ta$e their medicines because of side effects or cost. )n addition, ha#ing certain other illnesses at the same time as depression can interfere 'ith the effecti#eness of antidepressant medicines. Alcoholism and abuse of other substances may interfere 'ith effecti#e treatment. And unhappy life e#ents -- including the death of family or friends, po#erty, and isolation -- may also affect the person's moti#ation to continue 'ith treatment.