Depression in the Elderly

By Kathryn Berlá, Ed.D.

Dear B.E.,

Depression in older people frequently coexists with other disabilities or medical problems. In addition, the elderly are often faced with significant changes in life circumstances, such as loss of a spouse or siblings, retirement, or changes of residence. Not only are these issues disruptive, but they also represent a loss of key sources of social support. Your father very well could be depressed. If so, it warrants attention form his physician and his family. Here's why:

Although the majority of elderly people do not become depressed, it is extremely common among older individuals with one or more physical problems. Sometimes, the symptoms displayed by older people are not the usual signs of depression. Symptoms that are typical of depression — significant changes in weight or appetite, lethargy or fidgety behavior, and insomnia or excessive sleep — are often mistakenly attributed to normal signs of aging. Other times, the symptoms are attributed to side effects from a medical problem or medication.

The greatest risk presented by depression is suicide. The highest risk factor for suicide is simply being an elderly white male. People over the age of 65 are five times more likely to commit suicide than people under the age of 65. They alone account for 19 percent of all suicides in the population. With adequate intervention, seventy percent of depressed elderly people will improve. Depressed senior citizens are also more likely to die from other illnesses than those who are not depressed. That is, someone with a physical illness who is also depressed is less likely to survive the physical ailment. Sometimes depression can be a reaction to an illness or medical problems, but if it remains untreated, it may hinder the patient's recovery from the physical problem.

Factors that increase the risk of depression in the elderly include: being female, being widowed or unmarried, stressful life events, and a lack of a supportive social network. Having physical conditions such as cancer, stroke or dementia increases the risk further. Depression can also affect the immune system, rendering someone more susceptible to other illnesses or infections.

The following risk factors are often found in the elderly:

• • Certain medications
• Other illnesses
• Living alone or other social isolation
• Recent bereavement
• Presence of chronic or severe pain
• Damage to body image (from surgery or heart attack)
• Fear of death
• Previous history of depression
• Family history of major depressive disorder
• Past suicide attempt
• Substance abuse

The best treatment outcomes are usually achieved by a combination of approaches, such as by pairing medication with psychotherapy. Antidepressants take longer to work in older people than they do in younger people. The elderly are usually more sensitive to medications because of internal changes that occur with aging. For this reason, physicians usually start elderly patients on lower initial doses. The basic principle of treatment is to start on a low dose and increase slowly. With close supervision, the elderly often can tolerate a full therapeutic dose of antidepressants. Another difference in this population is in how drugs are absorbed and cleared from the body. A drug that is completely cleared from the body of a thirty-year-old in twenty-four hours may still be present in the bloodstream of a seventy-year-old several days after it was taken. Older people frequently have fewer intestinal cells to absorb drugs, and decreased blood flow through the intestines, liver and kidneys. All of these factors interfere with the body's ability to break down and excrete drug molecules.

Most depressed people find that support from family and friends, as well as involvement in self-help or psychotherapy is very helpful. Psychotherapy is especially beneficial to patients who choose not to take medications or for those who cannot tolerate the drugs due to side effects, other illnesses or interactions with other medications. The use of psychotherapy in older adults is especially beneficial because of the broad range of social and functional consequences in this age group. As stated before, the best treatment outcomes are seen with a combination of medication and psychotherapy; therefore, this is usually the recommendation of most treating physicians.

If you have a question that you would like for our psychologist to answer, please write to: Family Matters Column , KHF, P.O. Box 436387 , Louisville , KY 40253-6387 . You can e-mail questions to: bdaykhf@kentuckianahealthfitness.com or fax to: 502-245-4098. Due to the volume of submissions, inquiries may not receive direct responses.

Kathryn Berlá, Ed.D. Is a licensed psychologist in private practice in Louisville . She may be reached at 502-412-2226.