What is clinical depression?

Clinical depression is a biologically-based brain disorder that affects one's thoughts, feelings, behavior, and physical health. It is an "affective disorder," which means that changes in mood occur in the depressed person. Clinical depression does not discriminate -- it can develop in anyone at any age. Depression is a serious medical illness that affects more than 11.6 million Americans, including older persons, in any given year. Of these people, less than one third actually seek treatment for their illness.

Why does depression in the older population go untreated?

As the population grows older, untreated depression among senior citizens is becoming a more widespread problem. The depressed older person often mistakes his or her feelings of symptoms for dementia or the normal aging process. Many older people and their families don't recognize the symptoms of depression, aren't aware that it is a medical illness, and don't know how it is treated. Also, many older people think that depression is a character flaw and are worried about being stigmatized, so they blame themselves for their illness and are too ashamed to get help. Others worry that treatment would be too costly. It should be noted, too, that depression is also a side effect of some medications commonly prescribed to older persons, such as medications to treat hypertension.

What are the symptoms of depression in older people?

Symptoms in older persons may differ somewhat from symptoms in other populations. Depression in older people is often characterized by memory problems, confusion, social withdrawal, loss of appetite, inability to sleep, irritability, and, in some cases, delusions and hallucinations. Older depressed individuals often have severe feelings of sadness, but these feelings are not acknowledged or openly shown. Thinking that depression is an inevitable sign of aging, many older individuals ignore or deny their symptoms. The commonly believed myth that depression comes naturally with old age is not true. Clinical depression is an illness that needs medical attention just like any other illness.

How can clinical depression be distinguished from normal sadness and grief?

It's natural to feel grief in the face of major life changes like those so many older people experience, such as leaving a home of many years or losing a loved one. Sadness and grief are perfectly normal temporary reactions to the inevitable losses and hardships of life. Unlike normal sadness, however, clinical depression doesn't go away by itself. It needs to be treated professionally. Any unresolved depression can affect the immune system, which makes the depressed individual more susceptible to other illnesses. This complication is often found in older individuals.

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What causes depression in older people?

Although there is no single, definitive answer to the question of cause, many factors -- psychological, biological, environmental and genetic -- likely contribute to the development of depression. Scientists think that some people inherit a biological make-up that makes them more prone to depression. Certain brain chemicals called neurotransmitters -- like norepinephrine, serotonin, and dopamine -- are probably involved in major depression.

While some people become depressed for no easily identified reason, depression tends to run in families, and the vulnerability is often passed from parents to children. When such a genetic vulnerability exists, other factors like prolonged stress, loss, or a major life change can trigger the depression. For older people, the loss of a spouse or a friend, retirement, moving out of the family home, or some other stressful event may bring about the onset of a depressive episode.

Who among the older population are at the highest risk for depression?

Older women are at the greatest risk because women in general are twice as likely as men to become seriously depressed. Biological factors, like hormonal changes, may make women more vulnerable. The stresses of maintaining relationships or caring for an ill loved one and children also fall more heavily on women, which could contribute to higher rates of depression. Unmarried and widowed individuals as well as those who lack a supportive social network also have elevated rates of depression.

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Can depression in older persons be treated?

Fortunately, the prognosis is good. Once diagnosed, 80 percent of clinically depressed individuals, including older persons, can be effectively treated by medication, psychotherapy, electroconvulsive therapy (ECT) or any combination of the three.

Four groups of antidepressant medications have been used to effectively treat depressive illness:

• Tricyclics
• Monoamine oxidase inhibitors (MAOIs)
• Selective serotonin reuptake inhibitors (SSRI's)
• Norepinephrine and serotonin reuptake inhibitors (NSRIs)

Medication compliance is especially important, but can be a problem among older patients. It has been estimated that 70 percent of these patients fail to take 25 to 50 percent of their medication. For this reason, ECT has had an important role in the treatment of depression in older adults. Patients over 61 years old make up the largest group of individuals receiving ECT. Unfortunately, ECT is generally underused, unavailable, or burdened with myth and misinformation about its safety and efficacy.

Psychosocial treatment can also play an essential role in the care of older persons who have significant life crises, lack social support, or lack coping skills to deal with their life situations. Because large numbers of older persons live alone, have inadequate support systems, or do not have contact with a primary care physician, special efforts are needed to locate and identify these people to provide them with needed care. There are services available to help older individuals, but the problem of clinical depression must be detected before treatment can begin.

Resources

Updated: 5/6/1999

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