In later life

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Depression in Later Life

RECOGNITION AND TREATMENT

PNW 347

Revised July 2004 A Pacific Northwest Extension Publication Oregon State University ? Washington State University ? University of Idaho

Archival Copy. For current information, see the OSU Extension Catalog:

Contents

What is depression? _______________________________________________ 2

How depression differs from grief Types of depressive illness

Myths and facts about depression and suicide ________________________ 4

What triggers depression? _________________________________________ 7

Recognizing the signs of depression _________________________________ 9

Age-related changes Denial Atypical signs Physical illness

Treatments for depression ________________________________________ 12

Medication therapy Psychotherapy Electroconvulsive therapy Alternative treatments

Helping the depressed person _____________________________________ 18

Encourage treatment Get expert help Seek help for yourself Listen and validate feelings Build a supportive environment Structure activity Give the person control Learn about medications Be alert to signs of suicide

Handling special problems ________________________________________ 24

When the person denies being depressed Helping from a distance Identifying and responding to a suicidal person

Summary________________________________________________________ 29

For further information ___________________________________________ 29

Authors

Vicki L. Schmall, Extension gerontology specialist emeritus; and Sally Bowman, Extension family development specialist; Oregon State University.

Acknowledgments Photos by Rod Schmall, West Linn, OR.

The authors are grateful to Clifford Singer, M.D., clinical director of geriatric psychiatry, Oregon Health and Science University, Portland, OR, for his valuable assistance in preparing this publication.

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Albert is 78. Two years ago, his wife of 54 years died. Shortly thereafter, his closest friend also died. Since then he has become increasingly forgetful and uninterested in family

activities. His children are concerned that "father has become senile."

Mrs. Jensen, 74, has always been active socially. However, in the last few months she's withdrawn into her home, isolating herself from family and friends. The easiest chore seems

impossible. Formerly pleasurable activities are no longer enjoyable. She's tired much of the time but has difficulty sleeping. Her daughter says,

"I feel like a big black cloud is hanging over Mother. I've asked whether she's depressed, but she says

no. I don't know what to do."

Mr. Jones's life revolved around his work. Since retiring 8 months ago, he feels lost and useless. He's neglecting

his appearance and drinking more.

Martha, 82, says, "My family would be better off without me." Although

she is mentally alert, her severe, crippling arthritis means she now must depend on others for assistance. She's always prided herself on being independent. Lately she's agitated much of the time and hostile toward family and friends. Her daughter often finds her still in bed at noon.

F or Albert, Mrs. Jensen, Mr. Jones, and Martha, life has lost its joy. They are suffering from depression. They may not recognize the symptoms of an underlying depression, may fear being labeled "crazy" or "weak" and therefore do not seek help, or may be too depressed and lack the energy to take action.

Depression is disabling. It can cause physical problems, and it can disrupt a marriage and a family. Living with a depressed person is not easy because depressed people tend to turn inward and not think about

DEPRESSION IN LATER LIFE: RECOGNITION AND TREATMENT

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This publication is designed to help you:

Understand depression and factors related to its onset in later life

Recognize signs of depression and potential suicide

Learn about treatments for depression

Know what you can do if you suspect an older family member or friend is depressed or contemplating suicide

others, and sometimes they become hostile. Family and friends might feel as if they are being driven away.

Severe depression can be life threatening. Health can fail rapidly. Depressed people appear to be more susceptible to infection and other illnesses, and they take longer to recover from illness than nondepressed people do.

Most people who commit suicide are depressed. Suicide is disturbingly common in the older population. Men over age 65 have the highest rate of suicide, three to four times greater than in the general population.

Recognizing the symptoms of depression is the first critical step in helping the depressed person. Unfortunately, depression often goes unrecognized in older people. It frequently is misdiagnosed or considered a natural part of aging. Sometimes people expect that to be old is to be depressed. However, depression is not inevitable, or even normal, in late life.

Depression is highly treatable. More than 80 percent of depressed people can be treated effectively and their symptoms alleviated within weeks. However, many depressed people never receive proper treatment, and undertreatment is a common problem. Without treatment,

depression can last for weeks, months, or even years.

In addition to a decreased quality of life, consequences of depression include higher rates of physical illness and death, increase in physician visits, and higher rates of hospitalization and institutionalization. The tragedy is not depression itself. The tragedy is ignored, undiagnosed, or untreated depression. People do not need to suffer its debilitating effects.

What is depression?

When faced with the challenge of helping a depressed person, it's important first to understand depression yourself. As you begin to understand what depression is and is not, you will be better able to respond in helpful and caring ways.

Depression is one of the most common emotional disorders. It can occur in anyone--young or old, male or female, rich or poor. The term "depression" is used to describe a range of conditions, from a simple mood to severe depression. Regardless, sadness is a predominant feeling. Occasional feelings of unhappiness, feeling down, or being in a blue mood are normal. But when the feeling goes beyond normal mood swings and adversely affects one's life, the problem is depression, which is an illness.

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DEPRESSION IN LATER LIFE: RECOGNITION AND TREATMENT

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Severity of depression

There are many ways to describe depression. One way is by its severity--mild, moderate, or severe. The number of symptoms and their impact determine the severity of depression. Mild depression is the most common, but it also requires attention because even mild depression can deepen or persist.

Mild depression Mild depression is a brief, temporary sadness that is a normal reaction to stress, tension, frustration, and disappointment. It does not seriously interfere with functioning or daily activities. Professional treatment may not be needed. Emotional support from others and an opportunity to talk, or a change of pace or situation, may be all that is needed.

Moderate depression A moderate depression is more intense and lasts longer. It usually is caused by a loss or an upsetting event. Daily activities become more difficult, but the person usually still meets daily responsibilities. Professional help may be needed.

Severe depression A severely depressed person shows marked behavior changes and loss of interest in the outside world. Often, a chemical imbalance is involved. Ability to

function and cope is impaired. Professional treatment is needed.

How depression differs from grief

Sometimes it's difficult to tell the difference between depression and grief. For example, both depressed and grieving people experience sadness, tearfulness, sleep problems, and appetite and weight changes. However, there are differences. Understanding them is important so that you can better recognize when a person may be depressed rather than grieving and you can offer the most appropriate support.

Characteristics of depression Depression may not have a specific trigger. Also, depressed people tend to be passive, remaining stuck in sadness for a long time. They have generalized feelings of helplessness, hopelessness, pessimism, and emptiness. They lack interest in previously enjoyed activities.

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Myths and facts about depression and suicide

Myth Depression is a normal part of aging.

Fact To be old is not to be depressed. An attitude of "I'd be depressed, too, if I were old" is a major barrier to helping a depressed older person. Depression should not be accepted as inevitable in later life. Unfortunately, the belief that late-life depression is normal stops many people from getting needed help.

Myth Older people cannot benefit from therapy.

Fact Depression is treatable at any age. Older people also respond well to shortterm psychotherapy.

Myth People who are depressed either lack willpower, are psychologically weak, or are "putting on an act."

Fact To be depressed is not the person's fault nor is it a sign of weakness. It's as real as a heart attack. Depression is an illness involving genetic, biological, and environmental factors. However, some older people believe depression is a character defect and feel ashamed.

Myth People could control their depression if they just had the right attitude.

Fact The causes of depression are complex. Depression is a condition that people can't simply will or wish away. They cannot just "pull themselves together" and get better. While some people can manage their depression through self-help, others need professional assistance.

Myth Older adults rarely commit suicide.

Fact Suicide rates of older adults are the highest of any age group in the United States. Twenty percent of all suicides are people age 65 and older.

Myth People who talk about suicide seldom take their lives.

Fact A person who talks about suicide is at high risk of doing so. Take suicidal statements and behaviors seriously.

Myth Asking a person whether she has thought about suicide increases the risk that she will attempt suicide.

Fact Asking about suicidal thoughts in depressed people does not increase the risk. In fact, by asking you are likely to save a life. Many people who have thought about suicide are relieved when asked.

Myth Older people who attempt suicide usually do so to gain attention or to manipulate family members.

Fact Older people seldom attempt suicide as a means to get attention or as a cry for help. Depression underlies up to two-thirds of their suicides. Most suicide attempts made by older people are well planned and completed.

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