Late-life depression is a mental health issue that is given relatively little attention and is often missed and under treated in older adults. It refers to a major depressive episode occurring for the first time in people 50 years of age and older. It is estimated that over 6 million Americans over the age of 65 are affected by late-life depression, while only 10% may receive treatment. Late-life depression is often under diagnosed because older adults are less likely to report depressed mood or loss of interest in activities to their physician. They are more likely to complain of somatic problems such as chronic pain and fatigue or the so-called ‘vegetative’ symptoms of depression such as insomnia and poor appetite. Contrary to what we may think, anorexia and weight loss are not a normal part of aging. Memory and concentration problems--other symptoms of depression--are symptoms we associate with aging, in general, and therefore may go unnoticed by physicians. Our attitudes toward aging also contribute to under treatment of depression in the elderly. As a society, we tend to regard old age as depressing and assume that it is logical for old people to be depressed. This attitude prevents us from properly ministering to them, leaving many older adults to live out their final days in unnecessary and extreme emotional pain. (Solomon, 2001)
Physical and psycho-social issues also contribute to the rise of depression in the elderly. People are living longer than at any time in our history. Older adults are likely to have experienced medical problems such as stroke, hypertension, atrial fibrillation, diabetes, cancer, dementia or chronic pain—all of which are highly correlated with depression. From a psycho-social perspective, older adults have experienced many losses in life. Many have lost their spouse, a child, and other family members. The loss of work through retirement often leads to a loss of meaning, identity, and social connection. Additionally, older adults who have lost the ability to drive experience a loss of independence and personal agency.
Several treatment options are available for depression in the elderly. Psychotherapy and medication are two very common treatment approaches—but treatment relies on first acknowledging the problem. The stigma attached to mental illness is very powerful in the elderly and can keep them from acknowledging that they are depressed. For this reason, it may be best to address problems with sleep and appetite first. Insomnia is a common symptom in late-life depression. It is commonly treated by physicians with the hormone melatonin as it is safer than the benzodiazepines (such as Ativan or Xanax) or the hypnotics (such as Ambien and Xanax) which may lead to increased confusion or falls. Antidepressants are generally prescribed by physicians in low doses at first due to potential side effects or interactions with other medications. Many physicians opt to treat patients with a low dose of the tricyclic anti-depressant dozepin (Silenor) or sedating anti-depressants such as Remeron or Trazadone. Psychotherapy can be particularly helpful in treating late-life depression especially for those who have experienced major life stressors such as loss of family and friends, health problems, or home relocation. Older adults often have more positive responses to psychotherapy than younger patients and it can offer relief from suffering without the potential risks of medication. If you or a loved one is experiencing late-life depression, it is important to receive treatment. Please give me a call as I would be happy to talk with you about how I may be able to help.