Depression is an illness that affects many older people. It generally affects their physical as well as their mental well-being. Fortunately, it is a highly treatable illness. Complete, or at least partial improvement, can be obtained in eighty to ninety percent of cases.
Depression can occur "out of the blue," for no obvious reason, or it can occur as a response to adverse life circumstances, such as the loss of a spouse, the loss of a job, the loss of good health, or the loss of any other significant thing or relationship. Regrettably, the nature of depression is such that affected persons, as a result of being depressed, are actually unlikely to realize that they are depressed, and even more unlikely to seek help for themselves. This is related directly to the nature of the symptoms of depression which we will discuss momentarily. The implication of this fact, however, is that healthy relatives and friends of older people should be on the lookout for signs of depression among their older relatives and friends, so they can assist them to obtain treatment.
The Tell Tale Signs of Depression
Not every depressed person experiences all of the signs of depression. But the presence of a whole cluster of these signs should arouse concern, and should lead to having the person evaluated by a physician or mental health professional. The most common signs of depression are:
- a sad, discouraged, mood
- blue, or empty
- persistent pessimism about the present, the future, and the past
- loss of interest in work, hobbies, social life, and sex
- difficulty in making decisions
- lack of energy, and feeling slowed down
- thoughts of suicide
- restlessness, irritability
- loss of appetite and loss of weight
- disturbed sleep, especially early morning awakening
- depressive, gloomy, or desolate dreams
Treatment of Depression
There are three main forms of treatment for depression: (1) counseling and/or psychotherapy; (2) antidepressant medications; and (3) electroconvulsive therapy or ECT.
Psychotherapy can be used when the individual who is depressed is still able to interact with a counselor or therapist, and when a specific loss can be identified about which the depressed person can talk with a therapist.
Antidepressant medication can be used when the depression comes on "out of the blue," or when the individual can no longer respond to verbal support, explanations, or other psychological interactions.
ECT is used only rarely, in the most severe cases, when the patient does not respond to these other forms of therapy, or when medications cannot be used due to specific medical reasons.
A variety of mental health professionals, including physicians, psychologists, or social workers, can provide counseling or psychotherapy. Antidepressant medication can only be prescribed by a physician, who may be a psychiatrist, a family doctor or internist. ECT can generally only be administered in a psychiatric hospital setting.
Response to therapy may take several weeks. Antidepressant medications may have side effects. These can include drowsiness, constipation, blurred vision, dry mouth, and even dizziness. When such side effects occur, they must be reported promptly to the doctor who will determine with the patient whether to continue the medication, reduce the dosage, switch to another medication or stop medication altogether.
As the depressed person begins to feel better, he or she should not stop treatment on their own but do so only on the advice of their doctor. Recent research has shown that people with recurrent depressions should stay on a maintenance dose of antidepressants. Above all, resuming an active life after depression is important in preventing the recurrence of "the mean blues."