Suicide among the elderly is a major public health problem, and one that is increasing each year. The vast majority of these deaths result from undiagnosed and untreated depression. Research has shown that although 40 percent of the elderly who commit suicide visit their doctor during the week before they take their lives, their depression remains undetected and untreated. These disturbing facts are contained in a paper recently produced by Barry Leibowitz of the National Institute of Mental Health in the US, and other experts on mental health in the elderly.
“The failure to diagnose and treat depression in older people is tragic”, says Leibowitz, “because the condition is highly responsive to treatment”. A major reason practitioners fail to recognise depression is that elderly patients do not readily admit to suffering from depressed mood. They complain of sleeping and eating problems, lack of energy, loss of enjoyment, inability to concentrate as well as aches and pains. When these complaints present in an older person with physical ailments, the physician is likely to focus on the somatic problems and ignore the depressive symptoms. In South Africa, the problem is worsened by the fact that powerful stigmas regarding mental illness still pervade all aspects of social functioning, and make sufferers reluctant to seek treatment. Recent studies conducted in the USA report a one- to two percent prevalence of major depression among the elderly (possibly even greater among the underprivileged and rural population) , and a two percent prevalence of dysthymia (chronic, low-grade depression). Dr Ian Westmore, a respected Bloemfontein Psychiatrist in Private practice, believes this figure to be somewhat too low, and that the incidence is in fact significantly higher in South Africa.
The overall prevalence of depression is greatly increased by the occurrence of subsyndromal symptoms in between 13 and 27 percent of the population, where the symptoms do not meet the criteria to be diagnosed as depression or dysthymia. These symptoms are associated with increased risk of major depression, physical disability, medical illness and high utilisation of health services.
“As more people are living longer, and families are faced with responsibilities for long-term care of elderly parents, there is increasing interest in what can be done to improve their quality of life and overall health”, said Leibowitz. “Recognition and treatment of depression is one of the best investments we can make”, he added. The Depression and Anxiety Support Group can assist those who may be suffering from depression with advice regarding appropriate treatment options, and can provide referrals to specialists dealing with depression in the elderly.
Effective treatment for depression in the elderly may be medication or psychotherapy, although the most desirable treatment option is in fact a combination of the two treatment modalities. Like arthritis, depression requires long-term treatment, in order to prevent subsequent relapses once treatment has been successful. According to Dr Westmore, if the elderly are treated properly, the treatment programme can eventually be discontinued, and support given. “One should remember to take into account the role of physical ailments as causative factors for depression in the elderly, as physical illness greatly increases the risk of depression”, he added.
The new article points to the importance of studies in progress on the efficacy of Selective Serotonin Re-uptake Inhibitors (SSRIs) and short-term specific psychotherapies for older people. Findings from these studies will provide important data regarding the clinical course and treatment of late life depressions, particularly subsyndromal depressions. Further study is required to determine the role of hormonal factors in the developments of depression, and to find out whether hormone replacement therapy (HRT) with oestrogens and androgens may be of benefit in the treatment of depression in late life.