Depression in the elderly tends to be far more difficult to diagnose than depression in other age groups. Often, this is because the situation is complicated by the presence of other physical illnesses. As many as 90% of depressed people over 65 fail to get help. Recent evidence, though, suggests that the treatment of depression in this age group does not follow with greater resistance than treatment in other age groups.
Family members and doctors often miss the earning signs for depression in elderly patients. Sometimes the common symptoms of clinical depression – headaches, stomach problems, joint problems – may resemble the symptoms of other illnesses. Many elderly patients tend to focus on their physical complaints as opposed to their feelings of sadness and anxiety1. Furthermore, mental health professionals sometimes overlook the symptoms of sadness and confusion because they see these emotions as the “norm” for elderly patients.
Depression is rife amongst the elderly. This is partly because many elderly people are impacted by significant negative life events such as the death of spouses, relatives or friends. Financial worries and loneliness are also contributing factors.
Dr Alan Mellow, director of geriatric psychiatry at the University of Michigan Medical School, claims that 65-70% of elderly patients respond to antidepressants just as well as younger patients2. As a guide to the use of antidepressants among older patients, one should always “start low and go slow”, he recommends. Thereafter once there is a response, the patient should remain on the medication for at least on year.
Dr Mellow also warns that where patients consistently experience headaches, insomnia, pain, fatigue or general arthritic-like symptoms, of which there is no known medical origin, depression should be considered, regardless of how old the patient is. Importantly, where the older patient has depression along with dementia, alcoholism or psychosis, it is necessary that a geriatric be consulted.
Dementia and other age-related illnesses, according to Dr Roman Amrein, together with the ageing process, may cause changes to how the body absorbs and uses the drugs. This further complicates the pharmacological treatment of elderly patients3.
There are a variety of antidepressants that can be used to treat elderly depression. SSRIs (Selective Serotonin Re-uptake Inhibitors) such as Prozac, Zoloft, Cipramil, Luvox, and Aropax, have found to be particularly useful because they are safe in overdose and they remain in the system longer than other drugs do, meaning that a missed dose won’t cause a relapse. Tricyclic drugs have also been found to be effective. RIMAs (Reversible Inhibitor of Monoamine oxidase isoenzyme A) such as Aurorix, are another fairly new family of drugs which can be very effective for treating depressed elderly patients.
Dr Amrein and colleagues recently conducted a clinical review of studies involving the usage of moclobemide (Aurorix) in elderly depressed patients. It was found to be just as effective as tricyclic antidepressants and SSRIs. A significant benefit which moclobemide provides to the elderly depressed patient is that it does result in a deterioration in cognitive function, and nor does it have sedative effects If diagnosed timeously, depression in the elderly can be treated effectively and promptly. Mental health professionals and family members should keep a wary eye out for any warning signs that could indicate depression in an elderly relative or patient.
SPOT THE DANGER SIGNS
According to the National Institute of Mental Health, a combination of four or more of the following symptoms, lasting more than two weeks, could indicate depression. If a loved one threatens or attempts suicide, make sure he or she sees a doctor immediately.
· Loss of interest in usual activities
· Persistent sadness, anxiety or feelings of emptiness
· Loss of appetite resulting in weight loss or weight gain
· Feelings of worthlessness, helplessness or guilt
· Concentration problems
· Trouble sleeping or sleeping too much
· Complaints of vague physical aches and pains with no medical basis.
1. Depression Awareness, Recognition and Treatment (D/Art) program. (1995). “If you’re over 65 and feeling depressed……Treatments Bring New Hope”. National Institute of Mental Health.
2. “Contrary to beliefs, depression in elderly not harder to treat”. Psycholink (Medical Chronicle), August 1998, 6-6. Sandton: Primedia Publishing.
3. “Moclobemide offers significant advantages in treatment of depression in elderly”. Psycholink (medical chronicle), August 1998, 2-2. Sandton: Primdedia Publishing.