Identify and Treat Patients’ Depression

As I sit across from my patients, hearing about their loss and loneliness, witnessing their pain, limited mobility, and dependency, it’s easy to understand why many people believe depression is a natural part of the aging process. It is not. Depression is a medical illness that if left untreated, leaves older adults at increased risk for serious negative health impacts or death.

It is not fully understood why the elderly are more susceptible to late-life depression. The aging process leads to hormonal changes that can affect sleep and body rhythms, which may play a role. In addition, the presence of other illnesses, especially thyroid disease, dementia, chronic pain states, or having multiple chronic illnesses can contribute to depression. Finally, the increased presence of major life stressors such as the loss of a spouse, close friends/family, and functional and sensory abilities, is believed to contribute as well. No matter the cause, elders who develop depression are at increased risk for further health complications.

In a recent study published in the Journal of the American Geriatric Society, researchers followed 7,000 older adults in France for 10 years. Periodic assessments of symptoms of depression were identified and episodes of heart disease and stroke were recorded. The higher the level of study participants’ depressive symptoms, the more likely patients were to have an episode of heart disease or stroke.1

In some cases, other medical illnesses or medications can cause symptoms of depression including weight loss or a change in appetite, slowing down, apathy, loss of energy or fatigue, insomnia or hypersomnia, and difficulty concentrating. Older adults are more likely to experience weight loss, cognitive impairment, and psychosis (ie, thoughts disconnected from reality) but less likely to report feelings of guilt and worthlessness. Educating your patients about these symptoms and encouraging them to discuss them with you will go a long way toward breaking down barriers to obtaining help.

It may also be valuable for you to update your patients about treatment options for depression. Some may not realize depression can be treated. In the past, pharmacologic treatment for depression was limited or, frankly, even scary. Early versions of antidepressants had serious side effects that limited their use in older adults. Modern antidepressants, however, most commonly the class of drug called selective serotonin reuptake inhibitors, are excellent agents for older adults. For some patients an important part of the treatment of depression is “talk therapy” or psychotherapy either in groups, with the family/couple, or individually, depending on circumstances. Following a regular routine of physical exercise has also shown benefit to depressed patients. Often a combination of therapies is best.

Depression is a serious illness. Encourage your patients and/or their caregivers to alert you if they or a loved one has symptoms of depression. Be sure they know that it’s not acceptable to write it off as “just getting old.” Aging does not cause depression. Depression has the potential to become life threatening. Among the sad statistics about the challenges of aging is the fact that elderly men have the highest suicide rates in the United States. This is all the more distressing because depression is a treatable illness. For more information and patient education materials visit www.cdc.gov/aging/mentalhealth/depression.htm.

— Rosemary Laird, MD, MHSA, AGSF, is a geriatrician, executive medical director of senior services for Florida Hospital at Winter Park, and past president of the Florida Geriatrics Society. She is a coauthor of Take Your Oxygen First: Protecting Your Health and Happiness While Caring for a Loved One With Memory Loss.

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