Depression and the Elderly

Depression is a mental health condition. It is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with daily life for weeks or longer.

Depression in older adults is a widespread problem, but it is not a normal part of aging. It is often not recognized or treated.

Major depression (also known as clinical depression) is a medical illness. It is a chemical imbalance in the brain and can appear in people regardless of age, race or economic status. The illness can appear after a triggering event or for no apparent reason at all.

Depressive symptoms that occur in the older patient are similar to the symptoms in younger adults.

Signs & Symptoms

- Constant “blue” or sad mood that does not improve even with happy occurrences

- Reduced total sleep time

- Frequent waking during the night

- Frequent physical complaints (example: stomachaches, headaches, dizziness, and/or joint pain that does not respond or responds inconsistently to treatment, despite a thorough medical evaluation and therapy)

- Increased fatigue or lack of energy

- Decreased interest in usual pleasurable activities

- Withdrawal from social interaction · Hopelessness

- Thoughts of suicide

- Decreased appetite

- Guilt or preoccupation with past events

- Decreased concentration and/or increased forgetfulness

- Irritability

- Frequent tearfulness or crying without an obvious precipitating event.

A complete physical examination to rule out other problems is critical before a diagnosis of depression is made. A complete physical examination to rule out other problems is critical before a diagnosis of depression is made. Other physical diseases (Parkinson's, multiple sclerosis, diabetes, thyroid disorders, certain viral infections, strokes, tumors) and certain medications (steroids, hormones, blood pressure and arthritis medications) used to treat those illnesses can mimic the symptoms depression; they can cause a chemical imbalance in the brain. Therefore, a thorough exam is extremely important, as well as a complete medical history and list of medications currently being taken (both over-the-counter and prescription drugs). Family history of depressive illness should also be noted, due to the genetic component of brain illnesses.

Antidepressants For Anxiety Disorders

Depression and anxiety are two separate disorders. They are related in some ways - there is a high comorbidity between anxiety and depression, indicating that they have something in common - but they're technically different disorders that cause different symptoms and require different treatments.

There are a number of different medications that are currently used to treat anxiety disorders. Antidepressants, although originally intended to treat depression, have been found to be effective in relieving symptoms of anxiety. Medication does not “cure” anxiety. While some people may not feel relief from anxiety symptoms and some may not be able to tolerate side effects, the majority of people do find relief from the debilitating impact of anxiety in their lives.

There are a number of antidepressant medications on the market today used to treat different types of anxiety:

- Selective Serotonin Reuptake Inhibitors (SSRI) Examples include Lexapro (Escitalopram), Celexa (Citalopram), Fluox (Fluoxetine), and Zoloft (Sertraline).

- Serotonin-Norepinephrine Reuptake Inhibitors (SNRI) Examples include Cymbalta and Effexor.

- Tricyclic Antidepressants Examples include Adapin, Anafranil, and Elavil.

- Monoamine Oxidase Inhibitors (MAOI) Examples include Aurorix, and Emsam.

While the drugs themselves are all different, they all affect the serotonin system in the body. There is little medical reason to choose one over another. Most often, a doctor will choose based on their own personal preference, the history of side effects, the allergies of the person with anxiety, other medications, etc.

It should be noted that antidepressants can also take weeks to work and do not always affect everyone. Doctors may prefer a different course of treatment to provide immediate relief or to benefit those with a different type of anxiety disorder.

Why Antidepressants Take So Long To Work?

A common treatment for clinical depression is a type of medication called an antidepressant. Antidepressants come in a variety of forms, but all of them work by impacting certain neurochemicals in your brain, such as serotonin and norepinephrine. Antidepressants are most commonly prescribed by a psychiatrist, but may also be prescribed by a family physician or general practitioner to treat depression.

Antidepressants do not work immediately for many individuals hoping to get relief from their depression symptoms. In fact, the general consensus is that they take 4 to 6 weeks to kick in and for the antidepressant effect to take place. This basically means that most people should not get any relief from their depression until about a month into treatment.

Below are some factors that may influence the ability of an antidepressant to work immediately.

Reasons why antidepressants take so long to start working / kicking in

1. Low dose – Taking a low dose of an antidepressant may be part of the reason that it hasn’t kicked in yet. Many times it is actually a good idea to start low and work your way up via a process called titrating. So if you are in the early stages of titrating your medication upwards, the reason that it’s taking longer for you to feel the effects is due to the strength (usually in milligrams) of the dosage that you are taking.

2. Out of shape – If you are a bigger individual, out of shape, or bigger, any drug is usually going to take longer to kick in. This is simply because you have more mass and more overall body for the drug to be distributed. Additionally, the fact that you are out of shape may result in you having a slower baseline metabolism in comparison to someone who is in good shape and works out. Therefore the drug may not be cycling through your body at as quick of a rate for you to feel the effects.

3. Other drugs – If you do other drugs, you may not be able to feel the effects of the antidepressant medication compared to people that are pure (i.e. not doing anything else). Other drugs can affect brain chemistry as well as other bodily functions and change your natural homeostatic state of functioning. If you don’t do other drugs, the likelihood is greater that you will feel an antidepressant sooner than someone who gets a buzz from other substances.

4. Alcohol – Drinking alcohol is a personal preference and many people do it to socialize. At the same time, many individuals don’t realize that it does affect mental performance and cognition. It can increase irritability and slow mental performance in certain situations even far after the alcohol has been consumed.

5. Chemistry – How your body reacts to the drug has a lot to do with your chemistry. One antidepressant may work well for your friend, but not for you. Additionally, something that works within the first week for one person may take another 3 weeks. A lot of this has to do with how your body responds to the medication.

Men and Depression

Depression is an illness that affects both men and women. But people working in mental health services see far fewer men with depression. It seems likely men suffer from depression just as often as women, but they are less likely to ask for help. Male depression is treatable and best treated as early as possible. 

Signs and symptoms of depression in men

Depression has a number of signs and symptoms. Men are each affected in different ways, but three of the most common signs are pain, risk taking, and anger.

Pain. 

Depression may show up as physical signs like constant headaches, stomach problems, or pain that doesn’t seem to be from other causes or that doesn’t respond to normal treatments.

Risk Taking. 

Sometimes depressed men will start taking risks like dangerous sports, compulsive gambling, reckless driving, and casual sex.

Anger. 

Anger can show itself in different ways like road rage, having a short temper, being easily upset by criticism, and even violence. 

Here are some other common signs, especially if they last for a few weeks or months: feeling guilty, worthless, or that you always fail; feeling restless and/or irritable; having no energy; problems sleeping (not sleeping or sleeping too much); feeling angry or violent; feeling like you can’t work or get things done; using alcohol or drugs to feel better; sexual inability; losing interest in hobbies, work, and/or sex; having problems focusing, remembering, or making choices; always feeling sad or nervous; feeling alone; being negative about everything; thinking about death or suicide.

Treatments for depression

There are effective treatments for depression. In fact, more than 80% of men respond to treatment for depression. Your primary care doctor or a psychiatrist can create a treatment plan for you. That plan for treating depression may include:

- Antidepressants. The medicines most often used for depression treatment today are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). These antidepressants increase the levels of specific chemicals in the brain.

- Talk therapy. Many kinds of psychotherapy or talk therapy are effective in treating depression. Cognitive therapy, also called cognitive-behavioral therapy (CBT), interpersonal psychotherapy (IPT), and "insight-oriented psychotherapy" are frequently used.

Depression in Women

Women experience depression twice as often as men. The diagnostic criteria for depression are the same for both sexes, but women with depression more frequently experience guilt, anxiety, increased appetite and sleep, weight gain and comorbid eating disorders. 

Causes of depression in women

Women are about twice as likely as men to suffer from depression. Many factors may contribute to the onset of depression, including genetic characteristics, changes in hormone levels, certain medical illnesses, stress, grief, or substance abuse. Any of these factors alone or in combination can bring about the specific changes in brain chemistry that lead to the many symptoms of depression, bipolar disorder and related conditions.

Signs and symptoms of depression in women

The symptoms of depression in women are the same as those for major depression. Common complaints include:

- Persistent sad, anxious, or "empty" mood

- Loss of interest or pleasure in activities, including sex

- Restlessness, irritability, or excessive crying

- Feelings of guilt, worthlessness, helplessness, hopelessness, pessimism

- Sleeping too much or too little, early-morning awakening

- Appetite and/or weight loss or overeating and weight gain

- Decreased energy, fatigue, feeling "slowed down"

- Thoughts of death or suicide, or suicide attempts

- Difficulty concentrating, remembering, or making decisions

- Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

Treating depression in women

In general, the severe depressive illnesses, particularly those that are recurrent, will require antidepressant medications (or ECT in severe cases) along with psychotherapy for the best outcome. Patience is required because the treatment of depression takes time. Sometimes, the doctor will need to try a variety of antidepressants before finding the medication or combination of medications that is most effective for the patient. Sometimes, the dosage must be increased to be effective.

Facts About Depression

What is depression?

Most people have felt sad or depressed at times. Feeling depressed can be a normal reaction to loss, life's struggles, or an injured self-esteem.

But when feelings of intense sadness including feeling helpless, hopeless, and worthless last for many days to weeks and keep you from functioning normally, your depression may be something more than sadness. It may very well be clinical depression - a treatable medical condition.

Depression is a common, serious illness and not a personal weakness. Depression can happen to anyone, at any age, and to people of any race or ethnic group.

Depression, which is treatable, can come from chemical imbalances in the brain, hormonal changes, medications or things going on in your life.

Women suffer from depression twice as often as men. One out of four women may have depression sometime during their lifetime. Many people suffer with depression but do not seek help.

What are the symptoms of depression?

According to the National Institute of Mental Health, people with depressive illnesses don't all experience the same symptoms. How severe they are, how frequent, and how long they last will vary depending on the individual and his or her particular illness. Here are common symptoms people with depression experience:

- Persistent sad, anxious or "empty" mood

- Sleeping too much or too little, middle of the night or early morning waking

- Reduced appetite and weight loss, or increased appetite and weight gain

- Loss of pleasure and interest in activities once enjoyed, including sex

- Restlessness, irritability

- Persistent physical symptoms that do not respond to treatment (such as chronic pain or digestive disorders)

- Difficulty concentrating, remembering or making decisions

- Fatigue or loss of energy

- Feeling guilty, hopeless or worthless

- Thoughts of suicide or death

What causes depression?

Depression isn’t a simple condition with a known cause. Some people are more susceptible to depressive episodes while others are not. It’s important to discuss symptoms with your doctor. There are several possible causes of depression.

• Genetic - Depression may be an inherited condition. You may have a higher likelihood of experiencing a depressive disorder at some point in your life if you have a family member with depression. The exact gene involved in this is unknown.
• Biological - People with depression may have too little or too much of certain brain chemicals. Changes in these brain chemicals may cause or play a role in clinical depression.
• Medications - Side effects of some medications can bring about depression.
• Cognitive - People with negative thinking patterns and low self-esteem are more likely to develop clinical depression.
• Situational - Difficult life events, including divorce, financial problems or the death of a loved one can contribute to depression.

How is depression treated?

Depression is very treatable, with the overwhelming majority of those who seek treatment showing improvement. The most commonly used treatments are antidepressant medication, psychotherapy or a combination of the two.  The choice of treatment depends on the pattern, severity, persistence of depressive symptoms and the history of the illness.  As with many illnesses, early treatment is more effective and helps prevent the likelihood of serious recurrences.  Depression must be treated by a physician or qualified mental health professional.

Antidepressant Medication

How do antidepressant medications help?

The main medical treatment for depression is antidepressant medications. Antidepressant medications help reduce the symptoms of depression, such as: feeling extremely sad for no clear reason; loss of interest or pleasure in things you usually enjoy; sleeping too much or too little; feelings of worthlessness or excessive guilt or worry, and difficulty in thinking, making decisions or concentration. Antidepressants may also be helpful in the treatment of anxiety-related disorders, such as generalised anxiety disorder and eating disorders, obsessive-compulsive disorder, social phobia, and post-traumatic stress disorder.

How do antidepressant medications work?

People with depression and anxiety disorders often have an imbalance in certain natural chemicals in the brain. Antidepressant medications help the brain to restore its usual chemical balance and so reduce symptoms.

What antidepressant medications are there?

There are many different kinds of antidepressants, including:

- Selective serotonin reuptake inhibitors (SSRIs)

- Tricyclic antidepressants (tricyclics)

- Novel antidepressants and others

Like most medicines, antidepressant drugs can cause side effects. Not all people get these side effects. Any side effects you have will depend on the medicine your doctor has chosen for you. Your doctor should talk to you about your medicine.

How long do they take to work?

Antidepressants are usually taken in tablet form. When they are prescribed, you will start on the lowest possible dose thought necessary to improve your symptoms. Like any medication, the length of time a person needs to take antidepressants for depends on how severe the illness is and how they respond to treatment. Some people only need to take them for a short time (usually 6–12 months), while others may need to take them over the long term. Stopping antidepressant medication should only be done gradually, on a doctor's recommendation and under supervision. Antidepressant medication is generally very effective. Around 70% of people with major depression start to feel better with the first type of antidepressant they are prescribed.

What are the possible side effects of antidepressants?

Different antidepressants can have a range of different side effects. Common side effects of antidepressants in general are usually mild and can include: diarrhoea or constipation; nausea; headaches; sleep disturbance; lower sexual responsiveness; dizziness or blurred vision; weight gain; dry mouth; sweating. Side effects should improve within a few days or weeks of treatment as the body gets used to the medication.

How do I know which one is right for me?
Choosing the best medication to prescribe is not always straightforward because the way people respond to medication is different. This means that finding the right one for you may involve trying one or more. However, there are some things you and your doctor can consider to work out what type of antidepressant medication is most likely to be right for you, including whether you have had any physical health problems and what symptoms you are having trouble with.