Depression and Ageing

Older adults frequently experience clinical depression. That doesn't imply that it's typical. Approximately 6 million Americans aged 65 and older suffer from late-life depression. However, just 10% receive care. The most likely explanation is that elderly persons frequently have various depressive symptoms. Elderly depression is sometimes mistaken for the side effects of many illnesses and medications used to treat them.

How Does Depression in Older People Differ From Depression in Younger Adults?

Depression affects older people differently than younger people. In older people, depression often goes along with other medical illnesses and disabilities and lasts longer.

An increased risk of heart disorders and illness-related death is associated with depression in older persons. Depression also hinders an elderly person's capacity for rehabilitation. Studies of nursing home residents with physical ailments have revealed that depression significantly raises the risk of passing away from those conditions. Additionally, depression has been connected to a higher risk of passing away following a heart attack. Therefore, even if the depression is moderate, it's crucial to make sure an older adult you are worried about gets assessed and treated.

It's possible that older individuals lack the overt signs of depression. They might instead:

• Feel tired
• Have trouble sleeping
• Be grumpy or irritable
• Feel confused
• Struggle to pay attention
• Not enjoy activities they used to
• Move more slowly
• Have a change in weight or appetite
• Feel hopeless, worthless, or guilty
• Endure aches and pains
• Have suicidal thoughts

Using a series of standard questions, a primary care doctor can check for depression, allowing for better diagnosis and treatment. Doctors are encouraged to routinely check for depression. This can happen during a visit for a chronic illness or at a wellness visit.

Suicide risk is significantly increased by depression, particularly among older white men. Ages 80 to 84 have a suicide rate that is more than twice as high as the general population. Depression among adults 65 and older is regarded by the National Institute of Mental Health as a serious public health issue.

In addition, growing older sometimes coincides with the loss of social support networks brought on by a spouse or sibling's passing, retirement, or migration. Doctors and family members could overlook depression symptoms due to changes in an older person's surroundings and the expectation that they will slow down. As a result, prompt treatment is frequently delayed, causing many elderly persons to experience needless despair.

How Is Insomnia Related to Depression in Older Adults?

Depression frequently has a symptom of insomnia. Studies have shown that insomnia, especially in older persons, increases the likelihood of developing new depression or relapsing depression.

Experts may advise avoiding or limiting the use of benzodiazepines (such as Ativan, Klonopin, or Xanax) or more recent "hypnotic" medications (such as Ambien or Lunesta) to treat insomnia because they may increase the risk of impaired alertness, respiratory depression, and falls, according to the American Geriatric Society.

Melatonin, a hormone, or doxepin, a tricyclic antidepressant in a low-dose formulation are frequently recommended by experts for the treatment of geriatric insomnia (Silenor). Both of these uses also occasionally call for the prescription of other, potentially sedating antidepressants like Remeron or trazodone. The sleep aid Belsomra has also been found to be effective and safe in older adults. If there's no improvement in the sleep disorder or depression, a psychiatrist or psychopharmacologist may prescribe other medications, psychotherapy, or both.

What Are the Risk Factors for Depression in Older Adults?

Things that raise the risk of depression in older people include:

• being female
• being unmarried, single, divorced, or widowed
• not having a strong social network
• stressful circumstances

Depression risk is also increased by physical illnesses such dementia, cancer, diabetes, atrial fibrillation, hypertension, stroke, and chronic pain. Additionally, older persons frequently exhibit these depression risk factors:

• certain medications or drug combinations
• Body image issues (from amputation, cancer surgery, or heart attack)
• Dependency, whether manifested by hospitalisation or the requirement for home health care
• Disability
• Major depressive disorder in the family
• dread of dying
• solitude and social exclusion
• Other ailments
• past attempt at suicide (s)
• existence of acute or persistent discomfort
• Previous depression history
• loss of a close one recently
• abusing drugs

Brain scans of people who develop their first depression in old age often reveal spots in the brain that may not get enough blood flow, believed to result from years of high blood pressure. Chemical changes in these brain cells may enhance the likelihood of depression separate from any life stress.

What Medicines Can Treat Depression in Older People?

Medicine, psychotherapy, counselling, electroconvulsive therapy, and other more recent types of brain stimulation are all modalities of treatment for depression (such as repetitive transcranial magnetic stimulation, or rTMS). These therapies may occasionally be combined. Among other things, a doctor's recommendation will rely on the type and intensity of depressive symptoms, previous therapies, and general health.

How Do Antidepressants Help Older People With Depression?

Antidepressants may assist older persons, according to studies, although they may not always work as well as they do for younger patients. A careful analysis of the possibility of adverse effects or potential interactions with other medications is also necessary. For example, certain older antidepressants such as amitriptyline and imipramine can be sedating, may cause confusion, or might cause a sudden drop in blood pressure when a person stands up. That can lead to falls and fractures.

Medications you might get include:

• Selective serotonin reuptake inhibitors (SSRIs) like citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs) like desvenlafaxine (Pristiq), duloxetine (Cymbalta), and venlafaxine (Effexor)
• Serotonin modulators and stimulators (SMS) including vilazodone (Viibryd) and vortioxetine (Trintellix)
• Atypical antidepressants, such as bupropion (Aplenzin, Wellbutrin), mirtazapine (Remeron), and trazodone (Oleptro ER)
• Monamine oxidase inhibitors (MAOIs), like isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate)

When compared to younger people, antidepressants may take longer to start working in older individuals. Doctors may first recommend lesser doses of medication because elderly patients are more sensitive to it. In general, older people require more time in treatment for depression than do younger patients.

Can Psychotherapy Help Older Adults With Depression?

Support from friends and family, participation in self-help and support groups, and psychotherapy are all beneficial in the opinion of the majority of depressed people. People who have had significant life events, such as the loss of friends and family, moving, and health issues, as well as those who would rather not take medication and only have mild to moderate symptoms, will benefit most from psychotherapy. Additionally, it is beneficial to those who are unable to take pharmaceuticals due to adverse effects, drug combinations, or other conditions.

The functional and social effects of depression can be addressed in a wide variety of ways through psychotherapy in older persons. Along with antidepressant medications, psychotherapy is frequently advised by doctors.

Uses for Electroconvulsive Therapy (ECT)

ECT can be quite helpful in treating depression in older persons. ECT is frequently a safe and effective treatment option for depression when older people cannot take traditional antidepressant medications due to side effects or interactions with other medications, when depression is very severe and interferes with basic daily functioning (such as eating, bathing, and grooming), or when risk for suicide is particularly high.

What Issues Impact Depression Treatment for Older Adults?

Among elderly adults, the stigma associated with mental illness and psychiatric care is much stronger. The stigma associated with being older can prevent people from even acknowledging to themselves that they are depressed. Additionally, it is possible for older adults and their family to mistakenly label depressive symptoms as "natural" responses to life's pressures, losses, or ageing process.

Additionally, bodily issues rather than the typical symptoms of depression may be used as an expression. This postpones necessary therapy. Additionally, older persons who are sad might not seek help because they mistakenly think they have no chance of getting it.

Due to adverse effects or cost, older persons may also refuse to take their prescribed medications. Additionally, using antidepressant medications along with some other conditions can reduce their effectiveness. Abuse of other drugs and alcohol can aggravate depression and make it more difficult to get well. Additionally, negative life experiences including the loss of family or friends, destitution, and solitude may lessen a person's desire to continue receiving therapy.