Tuesday, January 31, 2006

Depression in the Elderly

If you’re a young or middle-aged adult, you know how crippling depression an be. But for the elderly, it can be severe and more often fatal. 20 percent of America’s elderly deal with depression and other related illnesses, but only a fraction are getting the treatment they need. Unfortunately some of these deaths do occur through suicide. But many can become so debilitated by depression that they are not able to manage. Such things as hypertension or diabetes or the just might not be eating right. Doctors believe part of the problem is that it’s not treated either because patients don’t go see their doctor or the physician isn’t looking for depression or its symptoms.
Another problem facing doctors is that certain aspects of depression do become more distinctive with age. The elderly tend to have different symptoms than younger ones. A lot of people experience depression without sadness. Instead, they a complain that their food doesn’t taste good, or they’re not sleeping, or having trouble remembering things and making decisions. Because some are likely to deny he/she is depressed, memory and cognitive problems may make the person seem as if he/she has dementia. Risk factors for depression, such as psychological stress and family history, are not so important when it comes to older people who are experiencing their first episode of depression. Also caregivers and family members may thin it’s normal for older people to feel that way at that age and tend to miss the signs of depression.
Sadly, according to the National Institute of Mental Health, people age 65 and older accounted for 18 percent of all suicides in 2000. Of nearly 35 million Americans over 65, it’s estimated that 2 million have a depressive illness and 5 million may have depressive symptoms.
Now two groups of anti-depressant medications are more commonly used on the elderly; they include SSRI’S (selective serotonin reuptake inhibitor) such as Prozac and Paxil, and newer non-SSRI’s such as Wellbutrin and Effexor. When applying these medications, it is often done with a lower dosage and increases are done more slowly with the elderly. This is because treatment can be complicated by the fact that older people tend to have more chronic medical conditions requiring more medications. Then you run the risk of sensitivity to side effects and drug interaction.
Another option to think about is psychotherapy. Usually the depressed elderly are isolated. It’s important to get them out of the house and involved in something important. Also critical is their diet and exercise. A study published last December in the Journal of the American Medical Assoc. discovered that telephone support helped people take their medications as prescribed. After doing this for a year, 45 percent of those involved reported a reduction in depression symptoms of 50 percent or more, compared to 19 percent who weren’t in the follow-up program. Finally, it’s important to remember that depression treatment should always continue. It is highly recurrent in older people and recurrences happen sooner. So it is very important to not only get them well, but to keep them well.

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