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If You're Over 65 And Feeling Depressed... You should know DEPRESSION IS NOT A NORMAL PART OF AGINGGrowing old certainly involves a variety of life stressors that can lead to depression. Some people have trouble making the transition from full time productive careers to retirement. Others have been forced to retire because of chronic health problems or disability. For some, mounting medical bills threaten their future financial stability. The loss of a loved one, or serious illness in a lifelong friend, or in your spouse, can add tremendous caretaking responsibilities, and also creates much sadness. Lack of mobility, either due to physical illness, or loss of driving privileges, can result in social isolation and loneliness. All these factors can lead to depression. However, despite these problems, most older people are satisfied with their lives. Depression is not normal, at any age. This page provides information about depression and older adults, and contains links to other pages with more general information about depression, treatment of depression, and descriptions and treatment of other psychological problems. The following topics are covered on this page:
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What is depression?Most people think of depression only as sadness and a low mood, but clinical depression is far more than the ordinary "down" moods everyone experiences now and then. Sadness will pass after a visit with a friend or a good movie. Depression is also more than feeling sad or "down." Depression affects our thinking, our emotions, our behavior and our physical health. You might feel down, or empty. Some people have difficulty remembering, or can't make decisions like they once did. Many leisure activities just don't interest you any more. You have aches and pains that keep coming back, and your physician can't explain it. Depression, with many of these symptoms, that goes on and on and on for weeks and months is called clinical depression. Depression is also more than the feeling of grief you experience after losing someone you love. Following such a loss, for many people, a depressed mood is a normal reaction to grief. Some people find it helpful to join a mutual support group, such as a widowed-persons group, to talk with others experiencing similar feelings. But, if the grief does not go away within a few months, it may be depression. When a depressed mood continues for some time, either following a loss or trauma, or for no apparent reason, you may be suffering from clinical depression--psychological problem that can be treated effectively with counseling or psychotherapy. Remember, clinical depression is a whole body disorder. It affects the way you think and the way you feel, both physically and emotionally. It isn't "normal" to feel depressed all the time when you get older. In fact, most older people feel satisfied with their lives. Nonetheless, among people 65 and over, as many as 3 out of 100 experience clinical depression. This is a serious problem, and can even lead to suicide. But there is good news. Nearly 80 percent of the people with clinical depression can be treated successfully with psychotherapy. Sometimes a combination of psychotherapy and medication works better, especially if you have very disturbed sleep, or can't get yourself out of bed to do anything. Even the most serious depressions usually respond rapidly to the right treatment. But first, depression has to be recognized. Topic List - Top of Page Other Psychology Topic Links
Types of Clinical DepressionThe two more serious types of clinical depression are major depression and bipolar disorder. Some people have dysthymia, which is less intense than major depression, but has persisted for a long time, at least two years. The most common form of depression is reactive depression, which is diagnosed as an Adjustment disorder with depressed mood. This refers to the mild or moderate depression that occurs after a significant loss, or in response to serious life adjustment problems. Major Depression: Major depression makes it almost impossible to carry on usual activities, sleep, eat, or enjoy life. Pleasure seems a thing of the past. This type of depression can occur once in a lifetime or, it can recur several times. People with a major depression need psychological counseling, and may also need medication to regain control of their lives. Bipolar Disorder (Manic-depressive Illness): Another type of depression, bipolar disorder--or manic-depressive illness--leads to severe mood swings, from extreme "lows" to excessive "highs." These states of extreme elation and unbounded energy are called mania. This disorder usually starts when people are in their early twenties, but the milder forms may not be properly diagnosed until a person is in their forties or fifties. It is unusual for this type of depression to start for the first time in later life, but if you think your symptoms indicate a possible problem, you should seek help immediately Also, if you have been diagnosed with bipolar depression earlier in your life, it may recur again later in life. This problem requires treatment, whatever the person's age. Topic List - Top of Page Other Psychology Topic Links
Depression Symptom ChecklistCheck any symptoms experienced for more than 2 weeks. If you check four or more of the symptoms for depression or mania, a physical and psychological evaluation is recommended. Remember, your physician can evaluate you physically, to determine that the symptoms are not being caused by some other medical problem, but you should also talk to a psychologist, as counseling is also indicated. Even though medication may make you feel better, it is not a cure for depression, it only masks the symptoms. Symptoms of Depression:
If you have recently experienced a loss, these feelings may be part of a normal grief reaction. But, if the feelings persist beyond three months, with no lifting mood, you probably need psychological treatment. Symptoms of ManiaThese symptoms may range from moderate to severe. When mania is moderate, only people close to the affected person may be able to spot the symptoms.
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Depression Shares Symptoms with Other Medical ConditionsSome symptoms of depression also occur in medical conditions. For example, weight loss, sleep disturbance, and low energy also occur in diabetes and heart disease. Apathy, poor concentration, and memory loss are also found in Parkinson's and Alzheimer's diseases. Achilles or fatigue may be present in many other conditions. In addition, fatigue, high or low mood, sedation, and difficulty with memory or concentration can be depressive symptoms but can also occur as side effects of medication. The current medications taken by an individual should also be evaluated in determining the diagnosis. To determine the proper diagnosis, your physician must conduct a thorough physical evaluation, to rule out a serious medical condition or medication problem. But, many physicians only focus on possible physical illness, and may not consider that depressed older people are more likely to complain of physical problems, rather than expressing sad, anxious, or hopeless feelings as possible depression. You should consider consulting a psychologist, as well as your physician, if you experience many symptoms of depression. Topic List - Top of Page Other Psychology Topic Links
Depression and Medical IllnessesDepression often co-occurs with medical, psychiatric, and substance abuse disorders, though it is frequently unrecognized and untreated. This can lead to unnecessary suffering since depression is usually treatable, even when it co-occurs with other disorders. As a matter of fact, psychological treatment is often indicated when an individual experiences depression because of a chronic illness, chronic pain, or increasing disability. Not only is it important to treat the psychological components of these medical problems separately, but research shows that psychological treatment frequently improves the treatment success rate for a variety of medical conditions. Medical IllnessesDepression occurs at higher than average rates in heart attack and cancer patients, persons with diabetes, and post-stroke patients. Untreated depression can interfere with the patient's ability to follow the necessary treatment regimen or to participate in a rehabilitation program. It may also increase impairment from the medical disorder and impede its improvement. For example, cancer patients who receive psychotherapy, in addition to their traditional medical treatment, have shown improvement in their medical condition that may be attributed to reduced depression, an improved attitude or outlook on life, and increased motivation to survive and recover. Research is continuing in this area. Other Psychological ProblemsDepression also occurs more frequently in persons with other psychological disorders, especially anxiety disorders. In such cases, detection of depression can result in more effective treatment and a better outcome for the person. A psychologist can design a treatment program that will address multiple psychological problems, such as anxiety and depression. It makes no sense to treat one problem, and allow others to continue without treatment. Substance Abuse DisordersSubstance abuse disorders (including alcohol and prescription drugs) frequently coexist with depression. Substance use must be discontinued in order to clarify the diagnosis and maximize the effectiveness of psychological treatment. Sometimes, people begin to abuse alcohol or drugs to self-treat their depression. In such cases, both problems must be addressed. Individuals or family members with concerns about the co-occurrence of depression and other medical illnesses or other psychological problems should discuss these issues with their physician, and should consult with a psychologist for a complete psychological evaluation. Topic List - Top of Page Other Psychology Topic Links
Causes of DepressionMany factors can contribute to depression. Some people become depressed for a combination of reasons. For others, a single factor appears to trigger depression. Some people seem to become depressed for no apparent reason. Regardless of the cause, depression should be diagnosed and treated by a licensed psychologist. Some of the contributing factors that are particularly important among older people are:Personality FactorsCertain personality traits seem to be more common in people who become depressed. For example, people with low self-esteem, greater pessimism, or greater dependency needs, seem to be more vulnerable to depression. Certainly, because of the role of cognitive evaluations and pessimism in depression, some personality traits are likely to be more closely related to the development of depression. However, these factors can be treated by a psychologist. Life EventsThe death of a loved one, divorce, moving to a new place, money problems, or any sort of loss have all been linked to depression. People without relatives or friends to help may have even more difficulty coping with their losses. Significant life stress is a factor in depression, regardless of the age of the person. However, certain stressors are more common in older people, such as chronic medical problems, financial distress, loss of close friends and family, and loneliness. Sadness and grief are normal responses to loss and other life stressors, but if these symptoms linger or are severe, psychological help should be sought. Just because stress is common does not mean we should ignore its effects. Psychologists can help you to develop better life coping skills, and can help you learn how to accept the inevitable losses we all encounter in our lives. When trying to deal with life events beyond our control, the supportive aspects of psychotherapy are very helpful. MedicationsSome medicines cause depressive symptoms as side effects. Certain drugs used to treat high blood pressure and arthritis fall in this category. In addition, different drugs can interact in unforeseen ways when taken together. It is important that each doctor know all the different types and dosages of medicine being taken and discuss them with the patient. This is another reason why older people should consider psychotherapy first in treating depression. If you are taking medication for a medical condition, you always run the risk of a medication interaction with antidepressant medications, unless closely supervised and monitored. If your depression can be treated without medication, it is healthier, and presents less risk for additional problems. Genetics and Family HistoryDepression runs in families. Children of depressed parents have a statistically higher risk of being depressed themselves. Because of these statistics, researchers believe that some people may have a biological make-up that makes them vulnerable to depression. However, to date, these possible biological causes have not been identified. Topic List - Top of Page Other Psychology Topic Links
Treatment for Depression One of the biggest obstacles to getting help for clinical depression can be a person's attitude. Many people think that depression will go away by itself, or that they're too old to get help, or that getting help is a sign of weakness or moral failing. Such views are simply wrong. Depression is a treatable psychological problem. Even the most seriously depressed person can be treated successfully, often in a matter of weeks, and return to a happier and more fulfilling life. Such outcomes are a common story, even when people feel hopeless and helpless. Types of treatment for depressionThe most commonly used treatments for depression are psychotherapy and antidepressant medication, or a combination of the two. Which of these is the right treatment for an individual depends on the nature and severity of the depression and, to some extent, on individual preference. In mild or moderate depression, psychotherapy is most likely the most appropriate treatment. But, in severe or incapacitating depression, medication is generally recommended, in addition to psychotherapy. In combined treatment, medication can relieve physical symptoms quickly, while psychotherapy allows you to learn more effective ways of handling your problems. Topic List - Top of Page Other Psychology Topic Links
PsychotherapyPsychotherapy is used to treat depression in several ways. First, supportive counseling can help to ease the pain of depression, and can address the hopelessness of depression. Second, cognitive therapy works to change the pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that create the depression and sustain it. Cognitive therapy can help the depressed person recognize which life problems are critical, and which are minor. It also helps them to learn how to accept the life problems that cannot be changed. Third, problem solving therapy is usually needed to change the areas of the person's life that are creating significant stress, and contributing to the depression. Behavioral therapy can help you to develop better coping skills. Interpersonal therapy can assist in resolving relationship conflicts. Research has shown that psychotherapy is particularly helpful for treating depression. Topic List - Top of Page Other Psychology Topic Links
MedicationExcept in the more severe depressions, and bipolar depression, medication is usually an option, rather than a necessity. Antidepressant medication does not cure depression, it only helps you to feel better by controlling certain symptoms. If you are depressed because of life problems, such as the loss of a loved one, financial problems, or serious medical problems in yourself or a family member, taking a pill will not make those problems go away. The medications used to treat depression include tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), serotonin reuptake inhibitors (SRIs), and bupropion. Each acts on different chemical pathways of the human brain related to moods. Antidepressant medications are not habit-forming. To be effective, medications must be taken for about 4-6 months (in a first episode), carefully following the doctor's instructions. Medications must be monitored to ensure the most effective dosage and to minimize side effects. Your prescribing doctor will provide information about possible side-effects and/or dietary restrictions. Always remember that all prescription drugs have potential side effects. In addition, any other medically prescribed medications you are using should be reviewed by your physician, because some can interact negatively with antidepressant medication.
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Where to Get HelpTrained professionals in numerous settings diagnose and treat clinical depression: Family physicians, clinics, and health maintenance organizations can provide medical treatment for depression, but should also make a referral to a psychologist Psychologists are trained to provide treatment for depression and other psychological problems. Like physicians, they have a doctoral degree, only it is in psychology, rather than medicine. Psychologists will often work with your family physician, if medication is needed. Community mental health centers provide treatment based on the patient's ability to pay. They usually have a variety of mental health specialists in a CMHC, although most psychotherapy services will be provided by non-psychologists, with less training. Topic List - Top of Page Other Psychology Topic Links |
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