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Depression in older people may be easily missed but if treated on time can be fully controlled to enable a happy life.

1 in 5 affected by this quiet menace, Depression

Depression affects 1 in 5 older adults in the community and 2 in 5 in care homes. Feeling sad is not uncommon but older adult have more reasons to feel low for example, physical health issues (disabilities or long-term illnesses), loss (death of partner or friends), loss of role (retirement, voluntary redundancy) or less disposable income. Majority are able to cope with lifetime adversaries but a proportion of older adults may go on to develop clinical depression. An important fact to reassure you is that help is at hand.

Unfortunately, older adult may fail to recognize the symptoms of depression, or may not  take the steps to get the help they need.  Assuming that you have good reason to be down or it is part of aging,  being isolated or failing to recognize that physical complaints may be signs of depression and reluctance to talk about feelings are some reasons for this.

Although some symptoms of depression in older adults are similar to a younger person, many are dissimilar and complex. Symptom profile may be laden with anxiety, health related symptoms and present with somatic preoccupation (appetite, sleep-wake cycle) and lack of sexual desire. In severe cases intention to self-harm is usually profound.

 

Medical conditions that can cause depression in older adults.

It’s important to be aware that medical problems can cause depression in older adults (e.g. Parkinson’s disease, stroke, heart disease etc.) either directly or as a psychological reaction to the illness. Any chronic medical condition, particularly if it is painful, disabling, or life-threatening, can lead to depression or make depression symptoms worse.

 

Depression due to medication

Symptoms of depression can also occur as a side effect of many commonly prescribed drugs, particularly if taking multiple medications. While the mood-related side effects of prescription medication can affect anyone, older adults are more sensitive because, as with age body is less efficient at metabolizing and processing drug e.g. Beta-blockers, Calcium-channel blockers, Steroids (e.g. cortisone and prednisone)

 

Depression Vs Dementia

Loss of mental sharpness could be a sign of either depression or dementia, both of which are common in older adults. Depression and dementia share many similar symptoms, including memory problems, sluggish speech and movements, and low motivation, so it can be difficult to tell the two apart. Whether cognitive decline is caused by dementia or depression, it’s important to see a doctor right away. If it is depression, memory, concentration, and energy will bounce back with treatment.

 

Grief Vs Depression

Experiences with loss with age are not uncommon. Grief is an emotional reaction to loss and in older adults the various losses are; independence, mobility, health, retirement, or death of spouse/partner or friend. Distinguishing between grief and clinical depression isn’t always easy, since they share many symptoms. However, there are ways to tell the difference. Older people are able to grief normally and come out of it within approximately six months’ time. Unfortunately for some grief may become complicated; too intense, too delayed, getting stuck or have depression on top of grief. In these times older adult may need to get some help.

 

TREATMENTS FOR DEPRESSION

Seeing a specialist

GPs treat majority of the people with depression, however due to complexities in the nature of the illness and prescribing issues he or she may ask a specialist for expert opinion or advice about the best treatment for the older adult.

Talking therapies

There are various therapies available to suit the need and degree of depression of the older person. At the outset GP may consider talking therapies at primary level e.g IAPT, iTalk or counselling. Other therapies that are accessed via specialists are psychotherapy and Cognitive Behavioural therapy.

Antidepressant medications

GP may consider starting on an antidepressant before considering referral to a specialist. There are several types of antidepressants available and at least 50-60% people find them beneficial. When considering antidepressant prescribing or continuation, a specialist also have to consider the number of episodes of depression, the intensity of present and the past episodes.

Herbal antidepressants

St John’s Wort is a common herbal remedy that can be sought from a chemist without a prescription. It has fewer side-effects than prescribed antidepressants, but is not effective in more severe depression. It can be harmful if taken with some other medications. It is worth discussing with your GP.

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy (ECT for short) has role in treatment of depression when it is severe, laden with psychotic symptoms (delusions or hallucinations), if the person’s life is at risk or when other treatments have failed. This is prescribed by specialists and treatment is offered in specialist centers.

Transcranial Magnetic Stimulation (TMS)

This new treatment has been used successfully in cases where medication has not helped or it can not be tolerated by patient due to side effects. It works by stimulating the brain cells, encourages better blood flow in areas of the brain and even new brain cell formation. Unlike ECT it is painless and has few side effects. On the down side it has to be administered daily, 5 days a week for at least 4 weeks to prove effective.

Hospital admission and treatment

A small number of older adult with depression may need hospital admission due severity of the illness or seriousness of the risks they pose to themselves (e.g. not eating or drinking, or trying to kill themselves), with the view to provide safe environment, consistency of supervision and optimization of medication

Self help

If you are feeling low, talk to somebody and seek help at the earliest. Remember depression is an illness not a sign of weakness.
Being physically active, pursuing hobbies and staying connected with family and friends help mood.
Eat and drink well although these may appear as a chore when depressed. Do not drink alcohol as it can exacerbate depression and may react with antidepressants or other medications.
Lack of sleep makes depression worse. Aim for somewhere between at least 7 hours of sleep each night. You can help yourself get better quality sleep by avoiding alcohol and caffeine, keeping a regular sleep-wake schedule, and making sure your bedroom is dark, quiet, and cool.

You could help your friend or loved one

A relative or a friend may be the first person to notice signs of depression, a change in the behavior and attitudes (withdrawing from activities, being negative towards life or self). A depressed person may just want somebody to talk to, somebody to offer hope or empathize with their feelings. Lend a listening ear. Encourage them to seek professional help, tell them that depression is quite common, it can be treated and that they will get better.