Depression in Older Adults: Meeting the Challenge
Getting treatment for major depression is essential at any age, but it may be especially important for older individuals. Depressed older adults experience faster brain aging and cognitive decline and face a significantly greater risk of developing dementia than adults of a similar age who do not have depression, research suggests.
A review of 23 studies involving 50,000 older adults who were followed for a median of five years found that participants with major depression were two times more likely to develop vascular dementia (characterized by strokes or other factors that diminish blood flow to the brain) and 65 percent more likely to develop Alzheimer’s disease (AD) than participants who were not depressed. The research, which was published May 1, 2013 in the British Journal of Psychiatry, suggests that getting prompt and aggressive treatment for depression and taking steps to prevent a recurrence of mood problems might be one way to lower the incidence of dementia among older people.
“It is estimated that five percent of community-dwelling older people and 20 to 25 percent of older nursing home patients experience major depression, and another 15 percent may be coping with mild depression,” says Feyza Marouf, MD, a geriatric psychiatrist at MGH. “For these older individuals, depression raises serious issues, because the mood disorder is more likely to involve a complex interrelationship between medical and neurological comorbidities than in younger individuals. For example, problems affecting blood vessels and circulation that affect a significant proportion of older people contribute to both depression and vascular dementia.”
WHAT YOU CAN DO
If you or a loved one are experiencing depression that has lasted two weeks or longer, consider contacting one of the following for a referral to a mental health professional:
- Your doctor or insurance provider
- A local university’s psychiatry or psychology department
- A local hospital or clinic
- Ask trusted friends and relatives for recommendations.
Depression differs
Some symptoms of depression—such as decreased energy, changes in appetite and sleep patterns, feelings of hopelessness or sadness, restlessness, irritability, difficulty concentrating, and problems with drug or alcohol abuse—are common to all people with the mood disorder. But older adults may be more likely than younger adults to exhibit symptoms such as apathy, social withdrawal, demanding behavior, or evidence of deterioration in self-care, relationships, and overall health status. They may complain of memory problems or appear confused, or even exhibit symptoms of psychosis. Depressed older people are also more likely than younger adults to entertain suicidal thoughts, the data suggest.
“Older individuals are also less likely to seek help for mood problems, and when they do see their doctor, they are more likely to complain of vague physical aches and pains than talk about their feelings,” Dr. Marouf adds. “Depression in older adults is often missed be-cause it is thought to be a normal aspect of growing old, or is attributed to the consequences of a physical disorder or medication,”
Health problems, many of which are more common in older age, are often associated with depression, and depression, in turn, can make health problems worse. Older people, may develop symptoms of depression linked to the use of certain medications, inflammatory processes associated with medical conditions, cardiac surgery, and diseases such as Parkinson’s disease and stroke. Finally, stressful life experiences, such as bereavement, isolation, pain, and loss of independence, are more common among older adults, Dr. Marouf points out: “These can trigger depression in vulnerable individuals.”
Treating the older patient
The first step in evaluating depressed older people is usually a review of their medications and a thorough physical examination to eliminate other possible causes of the mood symptoms. Depression is ad-dressed with antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs), talk therapy, or a combination of the two. In cases involving treatment-resistant depression—often a complication in older adults—electro-convulsive therapy may offer relief.
“Because older individuals tend to be more sensitive to drug effects, we often proceed more cautiously with antidepressant medications,” says Dr. Marouf. “As many as 15 percent of older patients develop problems with antidepressants that result in confusion or delirium, and some may have heart disease or other conditions that must be taken into account.
“We also make an effort to use a team approach with older patients, reaching out to other medical professionals who are involved with their care, and to their families.
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