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Though Some Older Adults Don’t Respond to Initial Treatments for Depression, Most Eventually Find Treatment That Works: Trying New Treatments Until You Find the Right One is Essential Research in the Journal of the American Medical Association

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Depression is common among older adults, and while it is treatable, about half of older people with depression don’t get relief from the first treatment their healthcare provider prescribes. There are many treatments for depression, however, so when this happens, it’s important to let a healthcare provider know, so he or she can recommend another treatment. The good news is that most older people who didn’t get relief with their first treatment, do get relief with other treatments, according to a report in the September issue of the Journal of the American Medical Association (JAMA).   

About five percent of older adults who live in the community, and as many as half of those who are in long-term care, suffer from depression. Typical signs of depression include: feeling depressed or “low,” loss of interest and pleasure in life, sleeping too little or too much, unintentional weight gain or loss, low energy, difficulty concentrating, feeling guilty or worthless, and thoughts of death or suicide.

Some older adults, however, don’t have typical symptoms of depression. Instead, they have “atypical” symptoms. They may be anxious, feel uncomfortable around other people, or worry that they have physical or cognitive (thinking) problems, the JAMA article explains. Depression can sometimes make it difficult to think clearly, but thinking should return to normal once the depression is treated. Older adults with atypical symptoms need treatment too.

If you or an older adult you care for has symptoms of depression, talk to a healthcare provider as soon as possible and get help. Medicare and Medicaid cover depression screenings and the earlier depression is diagnosed and treated, the better.

When evaluating an older patient for depression, healthcare providers should ask if he or she has thoughts of harming himself or herself, or about committing suicide. If so, the healthcare professional should take steps to keep him or her safe, the report’s authors, Jürgen Unützer, MD, MPH, MA, and Mijung Park, PhD, RN,  explain. Even if a depressed older adult isn’t suicidal, he or she needs treatment, the authors add. If untreated, depression in later life can become long-lasting and disabling,

There are many effective treatments for depression. More than 25 medications have been approved for treatment of depression by the Food and Drug Administration, and there are a number of effective forms of psychotherapy (or “talk therapy”). Some patients benefit from combinations of medications and talk therapy. Because older adults are more likely to have side effects when taking drugs than younger adults are, healthcare providers should watch for adverse effects when treating older patients and adjust treatment as needed. Older adults should also alert their healthcare provider if they develop side effects.

If you are having trouble finding a treatment that works, your healthcare provider may refer you to a psychiatrist -- a physician who specializes in mental health. Some people who don’t benefit from medications, psychotherapy, or both may get relief with a treatment called “electroconvulsive therapy” (ECT), Drs. Unützer and Park note. When providing ECT, a specially trained healthcare provider briefly introduces a short, very low electrical current to the patient’s brain while he or she is anesthetized. 

Some older adults – including those who are seriously depressed, or who have severe depression and anxiety – may have a harder time finding effective treatments than other people. But even such ‘treatment-resistant’ forms of depression can be treated. The report in September’s JAMA describes a 69-year-old woman who suffered from severe treatment-resistant depression. She had been living independently in her own home but -- during a very difficult time in her life, when her son and husband both died -- she developed a depression so severe that she couldn’t take care of herself and had to be hospitalized and transferred to a nursing home. She continued to try new treatments, however, and finally got relief from a combination of medication, talk therapy, and ECT. The therapy was so successful that she was able to once again live independently at home and enjoy her life.

If a healthcare provider concludes that an older patient is depressed, he or she should also check whether the patient has ever had a period where they experienced symptoms of mania. , Drs. Unützer and Park note. People with mania have periods during which they have enormous energy, become excessively ‘hyper’ or irritable, have little need for sleep, speak very quickly and sometimes nonstop, and do things that seem risky. Patients with both depression and mania have what is called “manic depression,” or “bipolar disorder.”  The treatment for bipolar disorder – mood-stabilizing medications – is different than treatment for depression, so it’s very important that healthcare professionals check for a history of or current signs of mania in an older person who presents with symptoms of depression.

What Should You Do?

Remember: If you or someone for whom you care has symptoms of depression, contact a healthcare provider as soon as possible. If the treatment your provider prescribes doesn’t seem to be working, let him or her know. Again, most older adults eventually get relief from depression with treatment. Don’t give up until you find treatment that works for you. 

This summary is from the full report titled, “Older Adults With Severe, Treatment-Resistant Depression.” It appears in the September 5, 2012 issue of the Journal of the American Medical Association. The report is authored by Jürgen Unützer, MD, MPH, MA, and Mijung Park, PhD, RN.