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Depression In Old Age – Causes, Diagnosis and Treatment

A drawn-out feeling of intense and deep despair and hopelessness. Depression is also called depressive disorder or major depressive disorder. Individuals older than age 75 appear to be at greater risk for depression than those who are younger; nevertheless, an adult of any age may have problems with depression. According to the American Psychiatric Association, about 20-25 percent of individuals with serious disorders additionally have problems with depression, including patients with DIABETES, HEART ATTACKS, STROKES, and CANCER.

Doctors and therapists have to differentiate depression from temporary states like BEREAVEMENT that happen when an elderly man loses a loved one to death. Depression must also be differentiated from the ordinary ups and downs of dispositions that everyone has.

For a diagnosis of depression, the blue mode must have survived at least two weeks and it must additionally come with three or more of these signals: a weight change (up or down) of at least 5 percent within a month; a sleep disorder (not sleeping or sleeping always); low energy; poor focus; feelings of worthlessness and recurrent thoughts of suicide or death. The elderly man who’s depressed may also have problems with delusions (false beliefs) and hallucinations (seeing things which are not there and hearing things which aren’t said). A loss of interest in once-pleasurable activities might also be an important sign of depression.

In its most extreme state, depression can lead someone to chew over or even to perform a strategy for SUICIDE: old guys in particular have a high suicide rate. Depression may additionally result in ALCOHOLISM or SUBSTANCE MISUSE. (It is, in addition, accurate that alcoholism or substance misuse can result in a depression.)

It may look “natural” to some doctors and others when old folks appear depressed. They may suppose that declining health, loss of loved ones, and deficiency of exciting actions would “depress anyone.” Nevertheless, depression isn’t a standard state for elderly individuals, and it should be treated. Depression can impair the individual’s health status as well as influences others around the blue man. .

About 2-4 percent of individuals older than age 65 who live in the community encounter depression, and this percentage increases to as high as 20 percent or more for those who are hospitalized, that have been recently hospitalized, or who live in nursing homes.

A Challenging Diagnosis

It can be hard for physicians to diagnose depression in elderly people for several reasons. First, many elderly individuals are less likely than younger folks to talk with a physician about their feelings of depression and misery. They may worry the physician will believe that they’re “insane.” Instead, they may “somaticize,” or concentrate on their obscure body aches and pains that don’t seem to be serious medical issues to the physician.

Another reason why Diagnosis may be challenging is that depressive symptoms may resemble symptoms of other disorders, like THYROID DISORDER or vitamin deficiencies. For instance, the man who has an underactive thyroid gland (hypothyroidism) may be lethargic, have trouble concentrating, and show little emotion. In this instance the patient needs thyroid hormone, not an antidepressant. Specific drugs may also make patients lethargic or sluggish.

In addition , there are many other disorders with symptoms that can mimic depression, for example PARKINSON‘S DISEASE, HUNTINGTON’S DISEASE, Stroke, CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD), multiple sclerosis, Cushing’s disease, and Addison’s disease. Virtually any important medical procedure can either have depression as a part or can mimic some of the indications of depression.

Even some infectious diseases can bring symptoms that resemble those of depression, for example hepatitis and the human immunodeficiency virus (HIV). It’s extremely important for physicians to perform an entire workup of patients to first rule out other diseases and illnesses.

Potential Causes of Depression

Some elderly people have suffered from depression for years; others may experience depression late in life. Some issues that could activate a depression in elderly individuals are:

. Serious long-term health problems or a brand new health problem, like a fall or heart attack

  • Biochemical changes
  • Hormonal imbalances (hypothyroidism, hypoglycemia)
  • Loss of a loved one
  • Enforced life changes, such as having to move to a brand new residence or to a nursing home
  • Relationship tensions with MATURE KIDS or others

Long-Term or New Health Problems

Many elderly individuals have long-term medical issues, and this also raises the chance that they’ll also experience depression. Occasionally, it’s hard for the doctor to sort out which symptoms are representative of depression and which link to other medical issues.

New health problems may also activate a depression, like FALLS that cause injuries or a recent heart attack.

Biochemical and Brain Changes

As people age, their biochemistry additionally changes and occasionally goes “out of equilibrium.” Some specialists consider a heightened amount of cortisol is present in some elderly people, hastening the risk of depression in addition to that of anxiety. There might also be imbalances of neurotransmitters, including serotonin and dopamine. Many drugs can have an interaction with brain substances and can create symptoms of depression.

Additionally, there are brain changes that can lead to depression. Based on the American Psychiatric Association in the 2000 version of the Diagnostic and Statistical Manual of Mental Disorders, DSM IV TR, “Among people that have depression in later life, there’s evidence of subcortical white matter hyperintensities connected with CEREBROVASCULAR DISORDER. These ‘vascular’ melancholy are correlated with greater neuropsychological damages and poorer reactions to conventional treatments.”

Some Drugs

Some medications may cause a depressive state or may make someone look depressed. Drugs in these categories can cause depressive symptoms:

  • Antihypertensive drugs (Reserpine, Inderal [propranolol], clonidine)
  • Cardiovascular medicines (digitalis, diuretics)
  • Sedatives (barbiturates, benzodiazepines)
  • Steroids (corticosteroids, estrogens)


It’s clear for individuals whose loved ones have perished to feel deep dismay, and such conduct doesn’t always mean a man needs to be treated for depression (unless they show suicidal signals). But if the high degree of sadness goes beyond two months and shows no signs of abatement, this could signal a depression which should be treated.

Applied Life Changes A depression may be activated by a necessity to move to a brand new area, move in with an adult child, or move to a nursing home. Changes can be very hard for elderly individuals.

Relationship Tensions with Others Elderly individuals who are dependent on mature kids may discover that it’s difficult to reach a fresh relationship and to accept that they’re no longer “in charge” as they were previously. Having mature kids who control many of the routine life activities (managing the post, assessing

Report, transport, and so forth) may also be a stress and can result in a depression.

A Treatable Illness

Depression is highly treatable oftentimes, according to shrinks. Elderly patients often respond well to drugs for depression in addition to psychotherapy and support groups.

Drugs for Elderly Individuals There are several main categories of drugs used to treat depression in elderly individuals. Nevertheless, it’s vital that you bear in mind that elderly individuals may metabolize drugs at an alternate speed and also that they’re more likely to be taking other medicines that could socialize with the antidepressant and cause additional difficulties.

Some medicines can affect the liver and other organs, and because of this, any drug should be selected with additional warning. Additionally, patients should make absolutely sure that their doctor has knowledge of every one of their drugs, including NUTRITIONAL SUPPLEMENTS, and nutrients before beginning any new medicines.

Tricyclic antidepressants like Elavil (amitriptyline) may be prescribed to help the person around-come the sleeplessness which will accompany depression. Drugs in this category may be sedating and nearly always creates a really dry mouth. Some specialists consider Elavil an improper drugs for elderly individuals. Elavil can cause urinary retention in men. It may also cause dizziness and confusion and at higher doses may impact the heart’s rhythm.

Another type of antidepressant drugs is the serotonin selective reuptake inhibitors (SSRIs), which can be tremendously successful in treating depression. This category contains drugs like Prozac (fluoxetine) and Zoloft (sertraline).

Some physicians treat patients with depression with monoamine oxidase inhibitor (MAO) drugs; yet, these medicines are generally not prescribed for elderly individuals because they need an extremely strict dietary regimen that’s hard for most folks to follow.

One crucial issue in treating depression (as well as a difficulty with treating many other sicknesses) is that many elderly individuals don’t take their medication. Charles F. Reynolds III, M.D., wrote in his post on aged patients with depression for Psychiatric Quarterly in 1997, “The most significant barrier to adequate treatment of late-life depression is patient compliance. As many as 70% of aged patients require just 50-75% of their prescribed dose.”

Depression Can Change Physical Health

The existence of depression can worsen a patient’s state by delaying healing from an injury or an illness. In a study of 542 depressed and no depressed elderly patients who’d been hospitalized, reported in a 1999 issue of the American Journal of Geriatric Psychiatry, the researchers found that depressed patients saw their physicians more often after the hospitalization (although not for depression) and were more likely to want re-hospitalization. The patients who were diagnosed with depression frequently didn’t get mental health services.

The writers said, “The low utilization of mental health services by blue elderly patients in this study was especially upsetting. The 160 blue patients averaged less than one mental health visit tor every 3 months of tallow-up, even though most patients experienced constant depression during the first 6 months after dismissal. . . . This degree of psychiatric services is consistent with the general low rate of Diagnosis and treatment of depression in elderly medical patients.”

Who Treats Depression

Psychiatrists are medical doctors who treat emotional disorders including depression. Although any doctor may treat depression, shrinks are usually the most knowledgeable about psychiatric drugs and treatments. Furthermore, due to their knowledge of the brain, neurologists are also proficient at diagnosing and treating depression. Psychologists aren’t medical doctors and cannot prescribe medication, but they’re able to provide help with enhancing coping skills and with other restorative alternatives. They’re an excellent resource for drug treatment alternatives for depression.

Needless to say, it is extremely significant for the treating doctor to organize any prescribed medicine with the individual’s primary care physician and to ensure that any difficulty with drug interactions are prevented or minimized.

Depression and Anxiety May Go Together

Shrinks report that many elderly individuals that have depression also show symptoms of clinical anxiety, including obsessive worrying and fear of leaving the house. Anxiety is, in addition, a treatable illness.

Health Professionals Are Influenced By A Relative’s Depression

The depression of the elderly person additionally influences others. The depression of a relative who’s age 80 and older can also raise the stress of FAMILY HEALTH PROFESSIONALS who are female, based on a study reported in a 2001 issue of the Journal of Gerontology. (Male health professionals weren’t analyzed but presumably also experience stress.) Relieving the depression of the senior would theoretically work to enhance the stress of the health professional.

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