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Depression In The Elderly

Definition

Depression is a medical condition that leads to intense feelings of sadness or despair. These feelings do not go away by themselves. They are not necessarily related to a particular life event.

What is going on in the body?

Depression is a disorder of the brain. Researchers believe that chemicals called neurotransmitters are involved in depression. Nerve impulses cause the release of neurotransmitters from one nerve cell, or neuron, to the next. This release allows cells to communicate with one another. Too little or too much of these important neurotransmitters may be released and cause or contribute to depression.
Some of the neurotransmitters believed to be linked to depression are serotonin, norepinephrine, and dopamine. The elderly face many situations that can contribute to depression. Important social support systems are sometimes lost. This may be due to the death of a spouse or close friend, retirement, or moving to a new home. The elderly are often also dealing with chronic illnesses. The illnesses can limit the person's activity, which also leads to depression.

Risks

What are the causes and risks of the condition?

There are many theories about what causes depression. Depression may be caused by any of these things:
  • chronic illnesses, especially cancer, heart disease, stroke, or arthritis
  • various medications or medication interactions
  • changes in brain chemicals
  • heredity
  • hormonal changes
  • lack of sunlight
  • major stresses
  • negative thinking patterns
Risk factors for depression in adults include:
  • alcohol abuse
  • drug abuse and addiction
  • personal history of a suicide attempt
  • personal or family history of depression
  • job strain
  • retirement
  • financial concerns
  • stress
Older individuals may face additional risk factors because of the aging process. These factors include:
  • age-related hearing, vision, or other sensory loss
  • concern about living arrangements
  • death of a spouse or other loved one

In the U.S., depression affects 3% to 5% of people over age 65. When the person has a medical illness, such as coronary artery disease, the rate increases to 40%.

Prevention

What can be done to prevent the condition?

Depression may not be preventable. However, these steps may be helpful in preventing it:
  • avoiding alcohol and illegal drugs
  • avoiding cigarette smoking
  • getting prompt treatment for other psychiatric disorders
  • seeking effective treatment for chronic diseases
  • talking with a counselor after experiencing a major trauma
Depression can lead to suicide. The lifetime risk of suicide for a person with depression is about 15 percent. It is important to recognize and treat the condition early. Individuals should be encouraged to seek help from a physician, licensed counselor or psychologist if they are concerned about depression. Conversations with clergy members, trusted friends, and family members are important and very helpful, but do not substitute for the clinical care needed to treat depression.

Diagnosed

How is the condition diagnosed?

Screening tests for depression include:
  • the Beck Depression Inventory (BDI) 19
  • the Center for Epidemiologic Studies Depression (CES-D) Scale
  • the Zung Depression Questionnaire
  • the Hamilton Depression Scale
A person who screens positively on one of these tests should have a comprehensive evaluation for depression. The evaluation may include a medical history, physical examination, and laboratory tests.
Depression is underdiagnosed in the elderly. The signs of depression may not be as clear as they are in a younger person. Elderly people may tell their healthcare provider about aches and pains or other mood states such as agitation.
Symptoms may be confused with other ailments, such as Alzheimer's disease. Seniors may not be aware that they are depressed. Some may believe that they are too old to benefit from help, or may think that seeking help is a sign of weakness.

Long Term Effects

What are the long-term effects of the condition?

With good treatment, many people recover from depression. Some people experience it only once in their lives. Others have periodic bouts of depression.
If depression is not effectively treated, a person can experience serious difficulties in every area of life. Depression often hurts relationships. It also impairs work and volunteer participation. In some cases, it leads to suicide.
People with depression are at higher risk for many chronic diseases and conditions, including:
  • coronary artery disease
  • heart attack
  • personality disorders
  • stroke
Seniors who are depressed are more likely to report poor health status and low quality of life. They are also more likely to die from health problems, such as heart attack.

Other Risks

What are the risks to others?

Depression is not contagious.

Treatments

What are the treatments for the condition?

The two most common ways of treating depression are with antidepressant medicines and psychotherapy. Often a combination is used. Occasionally, a person must be hospitalized for intense treatment or for his or her own safety.
Antidepressant medicines are effective in:
  • increasing the person's ability to function in daily life
  • lowering the risk of suicide
  • making the person feel better
The following types of medicines are used to treat depression:
  • selective serotonin reuptake inhibitors (SSRIs), including paroxetine HCl (i.e., Paxil, Pexeva) and fluoxetine HCl (i.e., Prozac, Serafem)
  • monoamine oxidase inhibitors (MAOIs), such as phenelzine sulfate (i.e., Nardil) and tranylcypromine sulfate (i.e., Parnate)
  • other antidepressants, such as nefazodone (i.e., Serzone) and venlafaxine (i.e., Effexor)
  • tetracyclic antidepressants, such as maprotiline HCl and mirtazapine (i.e., Remeron)
  • tricyclic antidepressants (TCAs), including nortriptyline HCl (i.e., Aventyl, Pamelor) and desipramine HCl (i.e., Norpramin). Some experts recommend that another TCA, amitriptyline not be used in the elderly
Psychotherapy can help people:
  • cope better with having depression
  • feel less alone
  • improve relations with family, friends, and coworkers
  • learn about depression and how it affects them
  • learn to recognize and avoid situations that can bring on a depressive episode
  • learn to view the world and others more positively and more realistically
  • positively address problems that they may be facing
  • stop episodes of depression early by recognizing warning signs and symptoms

Side Effects

What are the side effects of the treatments?

Antidepressants may cause mild and usually temporary side effects in some people. The most common side effects are:
  • dry mouth
  • agitation
  • insomnia
  • constipation
  • dizziness
  • drowsiness
  • nausea

After Treatment

What happens after treatment for the condition?

An individual can help prevent relapses by living a healthy lifestyle. Some important parts of the healthy lifestyle include:
  • avoiding alcohol, illegal drugs, and smoking
  • doing regular exercise
  • eating a balanced diet, following the food guide pyramid
  • finding a support system for dealing with depression
  • finding ways to manage stress
  • getting enough rest

Monitor

How is the condition monitored?

Once a person has an episode of depression, he or she is at higher risk for further episodes. Any new or worsening symptoms should be reported to the healthcare provider. The provider may recommend regular visits to monitor symptoms. The provider may also order blood tests to monitor the levels of medicines.

Sources

Professional Guide to Diseases, Sixth Edition. Springhouse: Springhouse Corporation, 1998. Conn's Current Therapy. Philadelphia: W.B. Saunders Company, 1999

"Unmasking Depression in the Elderly", [hyperLink url="http://www.dana.org/dana/daybook/dbk_0299.html" linkTitle="www.dana.org/dana/daybook/dbk_0299.html"]www.dana.org/dana/daybook/dbk_0299.html[/hyperLink]

"Depression in the Elderly", [hyperLink url="http://www.depression.com/health_library/special_groups/special_02_elderly.html" linkTitle="www.depression.com/health_library/special_groups/special_02_elderly.html"]www.depression.com/health_library/special_groups/special_02_elderly.html[/hyperLink]

"Diagnosis and Treatment of Depression in Late Life", [hyperLink url="http://www.text.nlm.nih.gov/nih/cdc/www/86txt.html" linkTitle="www.text.nlm.nih.gov/nih/cdc/www/86txt.html"]www.text.nlm.nih.gov/nih/cdc/www/86txt.html[/hyperLink]

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