Depression in the Elderly
It’s real and it’s dangerous. It is also treatable.
Maureen Duffy’s memories of her grandmother are cloudy. Not because of time, but by a condition that cast a shadow over the woman Duffy had visited as a child.
“She was blue. Even as a child I could see it. She was very negative and just could never really find any joy in life…not even from her children or grandchildren,” Duffy recalls. “A physician diagnosed her with depression, but she was only given tranquilizers. She was not a happy person. By the time she went to a nursing home, no one wanted to visit her. It hurt my heart.”
Duffy’s story is not uncommon. According to the National Institutes of Health, of the 35 million Americans age 65 and over, about 2 million suffer from full-blown (major depressive disorder) depression and another 5 million suffer from less severe forms. In 2004, adults 65 and older accounted for 16 percent of suicides in the United States; non-Hispanic white men 85 and older have the highest suicide rate in the country.
“It is very much a serious condition that can be life-threatening. There are several risk factors that can make you more susceptible to it,” says Jair Soares, MD, chairman of the Department of Psychiatry and Behavioral Sciences at The University of Texas Medical School, part of The University of Texas Health Science Center at Houston (UTHealth) and co-director of the UT Center of Excellence on Mood Disorders. “Today, imaging also shows us that changes in the brain as we age can make a person predisposed for a type of depression called vascular depression.”
Anatomy of depression in the elderly
Vascular depression occurs when blood vessels leading to the brain become clogged, even to the point of stroke. The reduced blood flow impacts the cerebral nerve pathways that are involved in mood.
Risk factors for vascular depression include diabetes, high blood pressure, high cholesterol and high lipid levels. “It is just one of many physical and life changes that can increase an elderly person’s risk of depression,” Soares says.
Other risk factors include
- bereavement—mourning the loss of a spouse, family member or close friend or multiple losses of contemporaries
- loneliness and isolation that may be caused by living alone
- less social interaction or becoming a caregiver
- fear of death and anxiety about aging
- job loss including retirement
- financial distress
- loss of purpose after retirement or reduced mobility
- a family history of depression
- necessary medications for other chronic conditions that can trigger depression
- Major illnesses including stroke and heart attack that can lead to depression. In fact, Soares says, 50 percent of stroke patients will develop depression
The encouraging news is that all forms of depression are highly treatable using medication and psychotherapy, Soares reassures.
“Depression in the elderly has to be treated very carefully. The depressed elderly need to be closely monitored for side effects and compliance with medication,” says Vineeth John, MD, associate professor of psychiatry also at UTHealth Medical School. “As we age, our bodies do not metabolize medications the same way they did when we were younger. A treatment plan must be highly individualized and approached with the utmost care.”
John is a geriatric psychiatrist, the specialized field of psychiatry that addresses the needs of elderly patients. “The need for mental health intervention in the elderly will be great as a high number of the US population enters their senior years,” explains John, who practices at UTHealth’s Behavioral and Biomedical Sciences outpatient clinic and at the UT Physicians Bellaire clinic.
“Depression that isn’t treated in the elderly could lead to worsening health complications including dementia,” John says. “Family members, friends and neighbors should be watchful of any symptoms of depression in their older loved ones. It is important to ask them questions if you suspect depression.”
- Are you basically satisfied with your life?
- Have you dropped many of your activities and interests?
- Do you feel like your life is empty?
- Do you often get bored?
- Do you feel happy most of the time?
John says to pay close attention to the answers provided. If you suspect aging members of your life might be depressed, speak with them or encourage them to make an appointment with their family physician. “An elderly person may not even realize he or she is depressed,” John says. “By intervening early, you can actually save someone’s life. Untreated depression is the leading cause for suicide. The suicide rate for the elderly is very high.”
Warning signs of depression include irritability, difficulty sleeping or sleeping too much, change in weight, lack of interest in personal care, frequent crying, memory problems, expressions of hopelessness, helplessness or loss of happiness.
Duffy says her experience with her grandmother helped her recognize the warning signs in her mother-in-law. Despite her best efforts, however, she wasn’t able to persuade her mother-in-law to get help. “My advice is to just keep pushing and asking questions. I kept at it,” Duffy remembers. “I even spoke to her physician about her symptoms, but she didn’t want to seek help. She was in denial. She could have enjoyed life so much more had she gotten the help she needed. Instead, she spent many of her days locked in her bedroom. She eventually died alone in her room.”
The strongest possible prevention for depression is to live a healthy lifestyle, experts say.
“Take care of yourself. Eat well, exercise and if you have an illness be proactive,” Soares says. “We still don’t have a full understanding of depression. We aren’t there yet, but we hope to be soon.”