Everyone experiences the occasional blues or lethargy. But if feelings of sadness or tiredness occur more often than not, do not ignore them. It is important to pay attention to how long these emotional waves last, as they may signal something more alarming – depression.
Depression is not an easy topic to discuss. It is a real condition, and it can be treated. In older adults, depression can be even more tricky to understand.
We are here to help you recognize depression as an older adult and determine what treatments are most effective. Depression is not a normal process of aging. It is a misconception that depression inevitably occurs in older adults and is untreatable. Rather than ignoring the signs, let’s learn how you can treat depression.
Depression in older adults takes on various forms that differ from what’s observed in younger adults. Younger people tend to have more stereotypical signs of depression. Most older adults may not recognize that they are experiencing depression because of the popular belief that a person must only feel ‘down’ or sad in order to be depressed. Because of this stereotype, older adults dismiss important signs that actually point towards depression.
Being able to tease out whether you may be experiencing signs of depression requires close attention to changes in your daily life. Have there been changes in your routine? What physical changes have you noticed? Have you noticed yourself having new, unexplainable health complaints?
Believe it or not, a depressed mood is often not the main complaint among older adults experiencing depression. Signs of depression vary for each person. Knowing the common issues reported by older adults experiencing depression can help put things into perspective:
Some experts disagree as to whether mild depression should be categorized as clinical depression in older adults. Despite these disagreements among clinicians and scholars, your personal concern for depression is most important.
Mild forms of depression are referred to as minor depression, depressive episodes, or depressive symptoms. Clinical depression, or Major depressive disorder (MDD), is a formal diagnosis that is made from a healthcare professional based on specific criteria. Whether mild or severe, both require attention and should be addressed.
How do you know when it’s depression or just feeling a bit ‘down’? Symptoms and duration are the two giveaways. Admittedly, these may sound scary or even tough to hear. Consider these the ‘nuts and bolts’ to determine if depression is formally roaming around.
See below for the signs and symptoms:
If you experience at least two persistent signs/symptoms during the same two-week period, mild depression may be present. If you experience five or more of the signs/symptoms during the same two-week period with either (1) depressed mood or (2) loss of interest or pleasure, MDD may be present.
Now that we understand the ‘nuts and bolts’ of depression, the truth is that the criteria listed above largely pertain to younger adults. Most scientists, researchers, and doctors don’t have a clear picture of depression in older adults.
Depression in older adults is often overlooked and not given the attention it deserves. This is largely due to the fact that depression gets quite muddy in older adults.
Depression among older adults can be tied to the ‘chicken or the egg’ dilemma. Were you depressed before the several life changes during the aging process or did the several life changes lead to your depression?
As you get older, medical difficulties and emergencies will emerge. You may have new and complicated medication routines that annoy you enough to cause a headache in and of itself. Accepting that you won’t be able to beat your kids at a sport may just be around the corner. The loss of close friends and family will become more common.
These are difficult questions to answer. There are no definitive answers, so researchers tend to look at the patterns in older adults who are suspected of being depressed. To better understand, let’s look at how to recognize depression among older adults:
Medical illness, anxiety, and disability coexist in older adults. Detecting depression thus becomes complicated. A positive force when dealing with depression is the involvement of family and friends.
A research study found that when family is involved, older adults follow the rules of treatment better, which ultimately leads to reduced depression. Friends and family are excellent resources for pointing out things about yourself that you may not recognize as signs of depression. You may initially meet them with resistance, but keep your door open when you’re ready for them to be involved in your care.
For more resources about family education and depression in older adults, visit familyaware.org.
When healthcare professionals suspect depression, they often give questionnaires to help understand your condition. They sometimes give questionnaires during visits even if they do not suspect depression. Consider it as a ‘better safe than sorry’ approach to ensure that they do not miss an opportunity to treat or address undiagnosed depression.
In these questionnaires, you self-rate your responses to the questions that either ask for the presence or frequency of potential depressive signs and symptoms. The score will ultimately tell you whether you are high or low risk. The questionnaires are also used to track the progress of your depression if receiving active treatment.
As an example, Patient Health Questionnaire (PHQ-9) asks:
Your responses for each question include:
2. If you checked off any problem in this questionnaire so far, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?
Your responses for this question include:
Questionnaires become even more important because depression is underreported and stigmatized in older adults. A research study found that older adults underreport depressive symptoms due to memory problems.
Family members or caregivers often become the main source for identifying depression in forgetful older adults. Secondly, depression is underreported because it has a tedious rule-out process. Healthcare professionals need to rule other potential causes that mimic depression in older adults such as:
Older adults are more accepting of physical illness than a mental illness. The saying, “if you can’t see it, it’s not there,” holds no merit when it comes to depression in older adults.
Why is it so important to shift the attitudes and beliefs about depression in older adults? Research has shown that depressed people are three times more likely to not follow medical treatment recommendations compared to non-depressed people.
Not following medical treatment leads to a vicious circle of poor health, increased time in the hospital, and higher chances of depression. Stigma needs to be thrown out the door. Depression in older adults cannot be ignored.
Treating depression is not easy and it doesn’t happen as often as it should, but it is possible. Most older adults do not receive treatment at all, receive lower-than-recommended doses of medications, or are treated for only brief periods. Two main treatments for depression in older adults involve pharmacological and non-pharmacological treatment.
Antidepressants are the most popular medication for treating depression. Older adults have coexisting medical illnesses in addition to their depression that require their own medications. Combining multiple medications to treat medical conditions can cause further health problems.
What are some of the complications with anti-depressants?
How effective are antidepressants? A study of antidepressants was shown to reduce a relapse or recurrence of depression up to 28 percent. Different types of antidepressants exist. The most often prescribed and considered the most effective are ‘selective serotonin reuptake inhibitors’ (SSRIs).
Discuss antidepressants with your primary care physician before you make any sudden changes to your medication routine. All medications you are currently taking need to be thoroughly reviewed by your physician. If not reviewed thoroughly, antidepressants can actually create new depression or worsen depressive symptoms.
‘Psychotherapy’ is a fancy way of saying you are treating a mental illness without the use of medication. Psychotherapy has proven to have similar effectiveness to antidepressants. For older adults with mild forms of depression, psychotherapy is recommended as the first form of treatment.
Why consider psychotherapy over antidepressants? Mentioned earlier, antidepressants come with a long list of potential risks. Psychotherapy, on the other hand, allows you to develop life-long skills to manage your depression.
This is particularly beneficial when it comes to depression relapses. You can use the learned techniques from psychotherapy rather than need a new prescription that will require another visit to your primary physician’s office.
CBT’s goal is designed to give you the skills to change your irrational emotional responses by changing the way you think and behave. Several different skills can be learned under CBT:
PST provides you with the ability to learn how to improve your coping skills with minor and major stressors in life. Four key strategies are included in PST:
RLR takes many forms, but the main goal is to decrease depression, increase life satisfaction, and improve taking care of oneself. Skills are developed to better deal with moments of crises, loss of loved ones, or life changes. Things to expect in RLR:
CBT is the most studied and popular form of psychotherapy of the three.
Another form of treatment that is often overlooked is exercise. For instance, a group exercise class is beneficial for improving depression in older adults by increasing social interactions, forming new relationships, and becoming part of a community. You may want to consider yoga, tai chi, and mindfulness meditation specifically for improving depression.
A combination of antidepressants, psychotherapy, and exercise can provide the greatest benefit for depression. Now that you have the tools, start the conversation. Don’t ignore depression nor let it dominate your life. By changing your perspective and using your newly acquired knowledge, you can beat depression.