by Abdul Nadeem, M.D.
As we age, we become more likely to experience depression. This condition is often unrecognized and undiagnosed among older people, although about 15 percent of those over 65 are afflicted. The incidence is even higher in several subpopulations. Among nursing home residents, the incidence may reach 51 percent while the rate among patients in outpatient clinics may go up to 32 percent.
The major reason for the under-diagnosis of depression in older adults is that they often do not complain of feeling depressed and their symptoms are not typical of depression. These symptoms may be misinterpreted to be the result of aging or general medical illnesses. Seniors complain mostly of fatigue, insomnia, physical symptoms and memory difficulties and in fact depression is often associated with general medical illnesses, especially neurological diseases. We see depressive symptoms of varying intensity in up to 50 percent of patients with dementia and Parkinson's disease.
Risk Factors: A number of stressors make older people vulnerable to depression. These include the death of a spouse and other loved ones, loss of mobility, physical illnesses, relocation to a nursing home or assisted living facility, financial problems, retirement and medications with depressant effects.
Importance of Recognition: It is very important to recognize depression in older people because this group has the highest suicide rate of all adults. Up to 20 of 100,000 elderly persons commit suicide every year—twice as many as the general population—with the highest rate among older white males at 43 suicides per 100,000 persons.
Major depression causes a long-term loss of productivity similar to that caused by a major heart attack. In addition, depression significantly delays recovery from medical illnesses. It should never be considered a fleeting condition. Depressive symptoms are chronic in up to 40 percent of seniors. We should not expect them to “just get over it.”
Treatment: It is a myth that depression in old age cannot be treated adequately, or that treatment carries great risks. The elderly respond to treatment as well as others. In experienced hands, current treatment—psychotherapy and medications—are very effective and virtually free of side effects.
A qualified therapist can help patients choose among the many forms of therapy, which include individual, group and family therapy. Individual therapy provides support, advice and help in changing negative beliefs that lead to depression. Group therapy provides the opportunity to learn from peers and presents the opportunity to build a support network. Family therapy helps to resolve family conflicts.
The serotonin and norephinephrine systems of the brain have been implicated in the development of depression and anxiety disorders. Newer medications such as the SSRls (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors) are effective because they improve the functioning of these systems.
Summary: We should recognize the possibility of depression in ourselves as we age, and should also pay special attention to our older loved ones who may be suffering from this condition. With the availability of excellent treatment methods, there is no reason for depression to go untreated—and a great deal of risk if it is ignored.
One of nine psychiatrists on staff at Manatee Glens, Dr. Abdul Nadeem received his basic medical education at the Sindh Medical College at the University of Karachi, Pakistan, then performed his residency in general psychiatry at New York Hospital/Cornell Medical Center. Under a subsequent two-year fellowship, he worked in geriatric psychiatry at Brown University in Rhode Island.