Needham Acts - Elders: Depression in Older Adults

Depression in Older Adults

Depression Is Not A Normal Part of Aging
(adapted from Debra Moore, PhD, www.the-bright-side.org)
Depression is not a normal part of aging. It's not just "a case of the blues," and it's not something you can "just pull yourself out of." It's not "all in your head."

Sure, we all go through difficult times. The senior population, like all age groups, has its own challenges. Retirement, children moving away, loss of spouse or friends, and changing medical concerns can all cause temporary sadness or conflict. But these feelings diminish as we meet these challenges.

Depression is more serious. Sadness, hopelessness, or irritability persist and worsen. Thinking slows down, concentration suffers, and decisions become more difficult to make. Hobbies and friends which once brought pleasure are now unappealing or even irritating. Appetite and weight may change. Sleep is often disturbed and fatigue may become a constant companion. Thoughts of death may begin coming to mind, and a desire to "just fall asleep and not wake up" may even occur.

People who are depressed are often afraid to tell others how they are feeling. They may think they are a failure for "not snapping out of it." When depression occurs, our thinking changes and we become full of self-doubt and self-blame.

What causes depression? We know depression is associated with an imbalance of certain chemicals, called neurotransmitters, in the brain. Research has shown that people who have a family history of depression are at increased risk of becoming depressed. Life events may serve as triggers. These might include death of a loved one, a serious illness or chronic condition, or the loss of a job or a marriage. Sometimes, though, there is no apparent cause for depression.
Sometimes, it just happens.

Treatment can be both medical and psychological. A number of very effective medications can help restore sleep, appetite, and energy. At least some counseling is usually necessary to sustain recovery. This helps the depressed person to identify and correct the distortions in their thinking, and to refocus their energy on productive, satisfying goals. Support groups, often free or low cost, are also very helpful.
Most people with depression will respond well to treatment. The help and support necessary to begin enjoying your life again are available. It's never too late to feel good again.

Signs and Symptoms of Depression in the Elderly

“My father doesn’t seem depressed; he’s just cranky and irritable. He is mad all the time.”

“After I retired, I started drinking a lot.”

“I don’t want to be a burden. My family would be better off if I died.”
Recognizing depression starts with knowing the signs and symptoms.

Fatigue
Abandoning or losing interest in hobbies or other pleasurable pastimes
Social withdrawal and isolation (reluctance to be with friends, engage in activities, or leave home)
Weight loss; loss of appetite
Sleep disturbances (difficulty falling asleep or staying asleep, oversleeping, or daytime sleepiness)
Loss of self-worth (worries about being a burden, feelings of worthlessness, self-loathing)
Increased use of alcohol or other drugs
Fixation on death; suicidal thoughts or attempts

Depression without Sadness (www.helpguide.org/mental/depression)
Older adults don't always fit the typical picture of depression. Many depressed seniors don’t claim to feel sad at all. They may complain, instead, of low motivation, a lack of energy, or physical problems. In fact, physical complaints, such as arthritis pain or headaches that have gotten worse, are often the predominant symptom of depression in the elderly.

Older adults with depression are also more likely to show symptoms of anxiety or irritability. They may constantly wring their hands, pace around the room, or fret obsessively about money, their health, or the state of the world.

Additional signs of depression in older adults can include the following:

Unexplained or aggravated aches and pains
Lack of interest in personal care
Irritability
Excessive worry
Loss of feeling of pleasure

Help for Depression
“I just could not get the nerve to ask my doctor about my low mood. At a visit for my high blood pressure, my doctor asked me how I was sleeping and I finally mentioned that I don’t sleep because I worry. She asked if I felt depressed and I finally told her. I wish I had said it so much earlier. She did not seem surprised at all and was very helpful. She even said it was common. I would give other people that advice. Don’t wait as long as I did.” - Kay

“I finally realized I was depressed when I didn’t even want to play cards. I had been playing with a group of men for years and always enjoyed it. When I stopped going to my weekly game, my daughter called my doctor and said she thought I was depressed. I was embarrassed that she did that - treating me like a kid, but I guess she was right. I take a medicine now that does help. I think I was just too stubborn to admit I had a problem.” - Al

“Once my elderly neighbor stopped driving, she seemed to become depressed. She stopped doing her shopping and errands. She doesn’t seem to enjoy the children in the neighborhood like she did. I mentioned this to her son when he visited her. He said he had no idea, but would talk to his mother. I hope she gets help; we miss the old Mrs. Anderson.” - Kim

You don’t need to suffer with depression alone. Speak to someone you can trust such as a family member, friend, health care provider, social worker, or clergy member. Depression can be treated in the elderly and it is just as effective as it is in younger people. It is very important that you see your health care provider. Many medical conditions and medicines can affect mood or compound depression. Doctors and nurse practitioners commonly treat patients including elder patients with depression. You will not say anything that will surprise your health care provider. He or she wants to help you, but you need to express your concern. Sometimes, office visits are quick and time is taken up with other health issues. Understandably, it is difficult to say what is worrying you. The following are some examples of ways you can begin the conversation with your doctor about depression.

“I wonder if any of my medications could be affecting my mood”

“I don’t feel as energetic and happy as I used to”

“I can’t seem to get over this sadness that I have felt ever since…….”

Depression can be treated with therapy or medication or both. Talk to your health care provider about what might be helpful for you.

Self-help for Mild Depression (adapted from www.helpguide.org/mental/depression_elderly)

If you are depressed, you may not want to do anything or see anybody, but isolation and inactivity only make depression worse. The more active you are—physically, mentally, and socially—the better you’ll feel.

Some ways to combat and prevent depression include the following:

Getting out in to the world – Try not to stay cooped up at home all day. Go to the park, take a trip to the hairdresser, or have lunch with a friend.
Connecting to others – Limit the time you’re alone. If you can’t get out to socialize, invite loved ones to visit you, or keep in touch over the phone or email.
Participating in activities you enjoy - Pursue whatever hobbies or pastimes bring or used to bring you joy.
Volunteering your time – Helping others is one of the best ways to feel better about yourself and regain perspective.
Taking care of a pet – Get a pet to keep you company.
Learning a new skill – Pick something that you’ve always wanted to learn, or that sparks your imagination and creativity.
Enjoying jokes and stories – Laughter provides a mood boost, so swap humorous stories and jokes with your loved ones, watch a comedy, or read a funny book.
Maintaining a healthy diet – Avoid eating too much sugar and junk food. Choose healthy foods that provide nourishment and energy, and take a daily multivitamin.
Exercising - Even if you’re ill, frail, or disabled, there are many safe exercises you can do to build your strength and boost your mood—even from a chair or wheelchair.

Please, if you are feeling depressed, reach out and tell someone. Depression is very common in the elderly as well as in the general population. Depression, just like physical illness, can be treated.