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Depression Weighs Heaviest on the Elderly By
Amanda Gardner, HealthDay, Yahoonews August
24, 2003 As
crippling as depression can be for young and middle-age adults, it's truly
severe in the elderly, and more often fatal. And
while depression and related illnesses afflict 20 percent of America's
elderly, only a fraction are getting the treatment they need. "Depression
kills not just through suicide," says Barry Lebowitz, director of
treatment research at the National Institute of Mental Health.
"[Elderly] people can be so debilitated by depression that they are
not managing their hypertension or diabetes or they are not eating right.
People die from the sort of excess disability that is created by
depression in the context of other diseases." Adds
Dr. Vincent Marchello, medical director of the Metropolitan Jewish
Geriatric Center in New York City: "Depression is very treatable in
elderly patients. Part of the problem is that it's not treated for a
variety of reasons. Patients don't go see their physician in the first
place, or the physician is not looking for depression." Contrary
to conventional wisdom, depression is not a normal part of aging. But
certain aspects of depression do become more distinctive with age. For
one thing, the elderly may have different symptoms than younger patients. "Older
people will basically agree that they're experiencing every symptom of
depression except depression," Lebowitz says. Experts
often refer to this as "depression without sadness." A person
may complain that his food doesn't taste good, that he's not sleeping and
that he is having trouble remembering things and making decisions. Memory
and other cognitive problems may combine to make the person seem to have
dementia, says Dr. Howard Berkowitz, director of the consultation and
emergency psychiatry service at Maimonides Medical Center in New York
City. "The person may also look apathetic rather than overtly
depressed and is likely to deny he or she is depressed," he says. Risk
factors are also often different for older people. "Psychological
stress and family history are not so important when it comes to older
people experiencing a first episode of depression," Lebowitz says.
Some experts even hypothesize that there's such a thing as "vascular
depression," brought on by cerebrovascular disease. Also,
people who aren't elderly -- including caregivers and family members --
tend to miss signs of depression in older individuals, thinking it's
normal to feel that way at that age. Tragically,
the depressed elderly are more likely to take their own lives. Comprising
just 13 percent of the U.S. population, people age 65 and older accounted
for 18 percent of all suicides in 2000, according to the National
Institute of Mental Health. Of
the nearly 35 million Americans 65 and older, an estimated 2 million have
a depressive illness, and another 5 million may have depressive symptoms,
federal health officials estimate. Thanks
to recent drug developments, however, there are more and safer treatment
options for seniors. Two newer groups of anti-depressant medications are
more commonly used among the elderly: SSRIs (selective serotonin reuptake
inhibitors) such as Prozac, Zoloft and Paxil; and the even-newer non-SSRIs
such as Wellbutrin and Effexor. The
medications tend to be applied a little differently, however. "With
age, one tends to lower the dosage and give increases more slowly,"
Berkowitz says. Treatment
of depression in the elderly can be complicated by the fact that they tend
to have more chronic medical conditions that require more medication. "You
have to be more sensitive to side effects and also drug
interactions," says Marchello. Psychotherapy
is another option. Social
support can play a big part in a person's recovery. "Usually the
depressed patient is an isolated patient," Marchello says.
"Getting patients out of the house, getting them more involved is so
important." Diet and exercise are also critical. Studies
have shown that support systems seem to help seniors comply with their
medication regimens. One study published last December in the Journal
of the American Medical Association (newsfound that an organized
program of telephone support helped people take their drugs as prescribed.
After a year, 45 percent of the people involved in the support program
reported a reduction in depression symptoms of 50 percent or more,
compared to only 19 percent of those who weren't in the follow-up program.
Another
major issue in depression is continuity of treatment. "It's
not enough to get people well. You've got to work to keep people
well," Lebowitz says. "This [depression] is highly recurrent in
older people and recurrences happen sooner. The issue is very, very much
keeping people well, not just getting them well." A
person suffering a first episode of depression in late life needs to keep
taking medications for a year or two years after they seem well. In some cases, Lebowitz says, "we're talking about continuing treatment for the rest of their lives."
Copyright
© 2002 Global Action on Aging
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