Depression in the elderly is often misdiagnosed

Tracy Woolrich's picture
Depression in the elderly is often misdiagnosed
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Clinical depression in the elderly is common, yet frequently not diagnosed. Depression affects nearly 6 million Americans age 65 and older. Yet, only 10% receive treatment for depression. It does not have to be that way.

The most likely reason why depression in the elderly is not treated is because it is often not diagnosed. The symptoms of depression in the older population is often misdiagnosed and confused with other diseases. To make matters worse, the elderly display symptoms that are different from the younger generation.

I have recently experienced the tragedy of depression in an older person in my own family. I am up close and personal with this individual and have daily contact with him. I knew that he was still struggling with his depression and not feeling emotionally strong, yet I had no idea just how bad things were until the bottom dropped out last Wednesday.

Make sure that the older person you are concerned about is evaluated and treated, even if the depression is mild. His/her life may depend upon it.

Depression impacts elderly different
If over 65, depression often occurs along with other medical illnesses and tends to last longer.
It doubles their risk of heart diseases and also increases their risk of death from illness.
It also increases the risk of suicide, especially older white men. The National Institute of Mental Health has declared that depression in people age 65 and older to be a major public health problem. Although the elderly comprise about 13% of the U.S. population, they account for nearly 19% of all suicides. In fact, the suicide rate in individuals aged 80 to 84 is more than twice that of the rest of the population.

To complicate the situation further, there is often a loss of a support system due to the death of a partner, family member or friend. Top this off with retirement and possible living relocation and it is the perfect storm for depression.

Risk Factors
These appear to increase the risk of depression in the older generation and include:

  • Being single, divorced, or widowed
  • Social isolation
  • Lacking a strong support system
  • Experiencing numerous stressful life events
  • Recent loss of a significant person in their life
  • Previous history of depression
  • Family history of depression
  • Chronic disease or pain
  • Alcohol abuse

Some physical conditions like hypertension, diabetes, stroke, cancer, Parkinson’s, M.S. and chronic pain further increase the risk of depression as well. Also some medications that are commonly given to the older population may increase the risk of depression. They include blood pressure medication, hormones, steroids and arthritis medication.

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Additional Causes
As with any depression diagnosis there is often no single cause. It is often as a result of many factors that are biological, psychological and environmental. Research shows that some individuals are Scientists think that some people are prone to depression due to chemical Imbalances. These chemicals include serotonin, norepinephrine and dopamine.

Symptoms

  • Depression in older persons may be characterized by:
  • Social withdrawal
  • Loss of appetite and weight loss
  • Insomnia
  • Cognitive changes (Not thinking straight)
  • Memory issues
  • Increased complaints of pain
  • Visual or auditory hallucinations


Treatment

Once diagnosed, nearly 80 percent can be effectively treated through medication, counseling or even ECT (shock therapy).

There are several groups of antidepressant medications that have been used to effectively treat depressive illness in the elderly.They are (SSRI) selective serotonin re-uptake inhibitors, (NSRIs) and norepinephrine and serotonin reuptake inhibitors and older medications such as tricyclics and (MAOIs) monoamine oxidase inhibitors. One is not better than another and it is a very selective process to find the one or combination that will be effective.

Counseling plays an essential role in the care of older patients. That is especially true for those who are isolated and may lack coping skills to deal with their situations. If there is not adequate family to support the individual, other resources like through a local church may be helpful.

Take home message:
Just like any chronic disease like diabetes or arthritis, starting treatment is only part of the battle. Maintaining improvement is the goal, and this may be a major challenge. Generally, treatment should continue for 6-12 months after there is improvement. If there has been two or three episodes of depression in their lifetime treatment may need to continue for up to two years. If there are more than 3 recurrences treatment will probably be indefinite.

Sources:

NAMI

NCBI NIH

NIH

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