Ask the Geriatrician: Depression

Carmel Dyer

Carmel Bitondo Dyer, MD, FACP, AGSF
Professor of Geriatric and Palliative Medicine
McGovern Medical School
The University of Texas Health Science Center at Houston

Depression is a common disease. There are warning signs and several effective treatments.

Q:  Is feeling depressed a normal part of growing older?

A:  It is easy to think that depression results from life events, such as the loss of loved ones. But, even with loss and difficulties, life offers pleasure and happiness. Being "down in the dumps" for a long time is not a part of normal aging.  Older persons without depression are able to bounce back from hard times and find joy in life. 

It's important to recognize that anyone can get depressed for a while, but when someone is depressed for a long time, he should be evaluated. When depression lasts for more than a week or two, it usually requires and responds to treatment.

Q:  What are common signs of depression?

A:  Some older adults recognize depression themselves. Yet others may deny feeling sad or depressed. For this reason, friends and family should watch for the following signs:

  • loss of interest in self-care and/or following medical advice
  • little interest in social activities
  • feeling "empty" inside
  • trouble sleeping and/or anxiety
  • trouble concentrating or remembering things
  • unexplained aches and pains
  • change in appetite and weight
  • feelings of helplessness
  • feelings of being a burden

Q:  What causes depression?

A:  There is no single cause of depression. Depression may be related to changes in brain chemistry that affect mood.  However, mood changes and signs of depression can be the result of medications that an older person is taking or can be the direct result of physical illnesses.

Q:  What are the risk factors for suicide in older persons?

A:  Thoughts of death are more common as people get older. But, some people may be at increased risk for suicide. These risk factors include:

  • Feeling hopeless or helpless
  • Feeling like life is a burden
  • Having a new physical illness
  • Living alone or being isolated from others
  • Regularly consuming alcohol

Giving away possessions, or making casual comments about "not being around," may be a sign that an evaluation is needed.

Q:  What can family members do if they suspect an older relative is depressed?

A:  Listen carefully if an older person complains about feeling depressed or says people don't care.  Family members who watch for warning signs make treatment more likely and more successful. 

Q:  What should the doctor do if depression is a concern?

A:  The doctor or other healthcare provider should take a history and perform a physical exam. Also, it is important to bring all medications the patient takes to the exam for the healthcare provider to review. These include prescriptions, over-the-counter medicines, and herbal remedies. This will help the healthcare provider narrow down the possible causes and decide whether a person needs to be seen by a specialist.

Q:  What if the patient resists seeing a mental health specialist?

A:  Seeing a mental health specialist is not something to dread.  Some may only need to see a specialist for a short period of time. Effective treatment can often be found in most communities and hospitalization is usually not needed. Older people may feel more comfortable going to a specialist if they understand that they will receive follow-up care with their own doctor. Sometimes, it is best to introduce the idea of a specialist over time, rather than forcing the issue.

Q:  What if older people or their families prefer to discuss the depression with a minister, priest, or rabbi, instead of going to their primary healthcare provider or a mental health specialist?

A:  Counseling from clergy can be very helpful for many people with mild or moderate depression. If this is not successful within 1-2 months, then going to a doctor or mental health specialist is advisable.

Q: What treatment options are available for depression?

A:  Good news about depression: treatment works! Counseling and medications are the primary methods of treatment. Counseling helps to undo negative thinking patterns and helps people sort out conflicts and problems, solve problems, and deal with interpersonal conflicts. Medications are helpful in correcting brain chemical imbalances.

Q:  How long does it take for medications to work?

A:  Doctors often start older people on low doses of medications. They may increase the medicines, as tolerated, to higher doses. Antidepressants should begin to make a difference by 4-6 weeks and have symptoms under control within 10-12 weeks. If this goal isn't met, the treatment may be intensified or adjusted. 

Q:  What else should I know about antidepressant medications?

A:  You should discuss any side effects with the doctor. Side effects vary depending on the particular antidepressant prescribed.  Those that do occur generally get better with continued treatment.  People who take medication should continue to take it, even after they start feeling better.  The decision to stop taking the medication should be made together with the healthcare provider, since it may take several months for best results.  Today's medications are not addicting. Some older medicines used to treat anxiety have the potential for abuse and addiction, but these are not usually given to treat depression.

Q:  What about St. John's Wort and other herbal remedies?

A:  It's unclear whether St. John's Wort is helpful for mild depression. People who want to take St. John's Wort or other supplements should speak to a healthcare provider.  The provider can help make sure that there are no medical reasons for depression and check that the depression is not more severe than it appears.

Q:  What can families do to help older people get the treatment they need?

A:  Treatment can be more successful in family members participate in care. Families can encourage older people to talk to their doctors or mental health providers about depression. Families can provide information about symptoms and the way that they affect day-to-day life.  During treatment, families can work with providers to monitor the effects.  Families can help make sure that medications are taken as directed, report on side effects they observe, and help doctors make treatment more effective.

 

Last Updated July 2019