Elderly depression occurs in an estimated 6 million Americans over the age of 65 and unfortunately many go untreated with only about 10% receiving treatment for their depression symptoms. Older patients who suffer from depression tend to face a number of challenges that may prevent them from getting the proper help. Whether it is having their symptoms of depression mistaken and confused with physical ailments, their own efforts to hide their feelings due to shame, or the general attitude by some that depression is a just natural byproduct of being old, elderly patients often do not get the care they deserve to treat their mental illness. It is important to recognize the symptoms elderly patients often show, the risk factors for older people to become clinically depressed and the treatment options available to effectively combat depression in the elderly.
Symptoms of depression in elderly patients tend to present themselves in a different fashion. Older patients are more inclined to try and hide their feelings (sadness, hopelessness, helplessness, guilt etc.) out of a feeling of shame. The elderly instead usually complain of the physical symptoms that are associated with depression. This makes it more difficult to diagnose an elderly patient for depression because often they may be suffering from some other form of physical ailment or sickness. It would be quite easy for a caregiver to confuse the symptoms of depression for side effects of a physical condition. Even if there isn’t a physical condition present, some might view an increase in physical complaints as a by-product of getting old.
While older patients may experience any of the usual signs of depression, some of the more common symptoms seen in older patients include:
- Increased number of physical complaints of aches and pains
- Overly demanding or irritated
- Insomnia or sleeping very little
- Loss of memory
- Inability to think clearly or inability to concentrate
- Weight loss
- Sometimes in a confused state
As you can see, some of these symptoms may be simple to overlook as being something other than depression in an older person. Mistaken symptoms are a main reason why the elderly often do not receive treatment for their depression.
While there is no single definitive cause for depression there are certain risk factors that may contribute to a person developing the illness. From genetics and biological reasons to life and environmental events, those who may be susceptible to depression should be extra vigilant. Some of the risk factors for elderly individuals may include:
- Being a female
- Being alone (widowed, divorced or single)
- Little to no family or friend support system
- Stressful life events such as deaths in the family, being forced to move after a long time in one place or economic hardships for example.
Women are twice as likely to suffer from depression than men in general. Some think that hormonal changes in older women make them more susceptible to developing depression. Losing a long time spouse or even a child is a significant risk factor as well. Having less involvement of family and friends to act as a support system is also a factor. As people get older they more likely they are to feel more alone especially if death of close loved ones is involved. This has a major impact on someone’s vulnerability to suffer from depression.
There are also some physical conditions that elder patients may suffer from that can be potential risk factors for an onset of depression. Diabetes, heart conditions, cancer, bypass surgery, stroke, macular degeneration and heart attack are a few of the conditions that may lead to depression. Conditions that limit mobility such as a broken hip or hip replacement in addition to anything that produces severe and chronic pain are risk factors as well.
- Additional risk factors for older patients may include:
- A family history of depression
- A personal history of depression (have had bouts of clinical depression earlier in life)
- Previous suicide attempts
- A fear of dying or death
- Taking medications where depression may be a side effect
- Drug or alcohol abuse
- Other illnesses or disorders
Elderly Depression Treatment
Before being diagnosed with depression, an elderly patient should first have a complete medical history and physical examination done to rule out the possibility of a medical condition as the cause of their depressive state. After a proper diagnosis, a treatment plan can begin. Along with anti-depressants the patient may receive psychotherapy treatment as well as ECT (electro-convulsive therapy) or any combination of the three.
Most of the popular depression medications tend to be equally effective in treating depression in older patients. Some of these may include Zoloft, Paxil, Wellbutrin and Prozac. Anti-depressants tend to take longer to work however in older patients. Since the older population is more prone to be on some other type of medications it is important for the treating physician to be made aware of all drugs currently being prescribed to the patient for any other health conditions to prevent any dangerous drug interactions and potential side effects. It is important to take depression medications as prescribed and forgetful patients may need some or be extra prudent to stay on schedule for the medications to be effective.
Psychotherapy (talk therapy) can provide important support in conjunction with a drug treatment plan, but it can also have tremendous value for patients who do not wish to take medication or cannot take anti-depressants due to side effects or harmful drug interactions with their other medications. For those without any sort of family support system, or those that live alone, just having someone to talk to can have substantial health benefits while at the same type working through their troubles.
Electroconvulsive therapy (shock treatment) can also be beneficial for certain older patients where traditional depression medications or other treatments either don’t work or cannot be administered due to drug interactions or other health concerns.
Elderly depression can be effectively treated with an estimated 80% success rate using any combination of the above options. Older patients tend to take a little longer to see their symptoms decrease than those of a younger age and similarly the amount of time recommended for treatment is longer.
An elderly patient suffering their very first depressive episode should expect to continue receiving treatment for 6 months to a year after their symptoms have subsided. For those who have had two or three depressive episodes in their life it is recommended to continue treatment for up to two years. And for elderly patients who have multiple (more than three) major depressive episodes, treatment after getting better may be a life long recommendation.Relieving depression is the first part, staying depression free is just as important and is why maintenance is encouraged.
Depression in the elderly population is considered a national health problem by the National Institute of Mental health and some of the statistics are sobering. With only an estimated 10% of older individuals who suffer from depression getting treatment it is important that proper awareness take hold. Suicide is always a risk for anyone suffering from major depression. White males ages 80 to 84 have twice as high of a suicide rate than the general population. It may be hard to diagnose for a number of reasons, but elderly depression can be effectively treated if everyone knows what to look out for.