Recognizing depression in someone else
For reasons that aren’t fully understood, depressed older people are less likely than younger people to report feeling depressed when asked. However, one sign that an older person may be depressed is a change in his usual activities or a lack of interest in things that used to give him pleasure. For example, if you ask your older neighbor why he hasn’t been gardening as much as usual and he says something like, “I just don’t seem to feel like doing it anymore,” he may be depressed. (Don’t assume, however, that a change in activities is due to depression. Your neighbor may be gardening less because his back hurts or he can’t afford new plants or other materials. Be sure to ask before making any conclusions.)
When assessing mood disorders in older people, health-care professionals often use the Geriatric Depression Scale, a tool specifically designed to screen older people for depression. It consists of anywhere from 5 to 30 yes-or-no questions, such as the following:
1. Are you basically satisfied with your life?
2. Do you often get bored?
3. Do you often feel helpless?
4. Do you prefer to stay at home, rather than going out and doing new things?
5. Do you feel pretty worthless the way you are now?
Of these five questions, a “no” in response to the first question and a “yes” in response to any of the others is worth one point. A score of two or higher indicates that a person may be depressed. However, depression shares many symptoms with other conditions, including dementia. If you are concerned about an older friend or relative’s mood or behavior, share your concerns with that person’s doctor, if possible. In some cases, a primary-care doctor may decide to refer a potentially depressed older person to a psychiatrist for further evaluation.
Treating depression in older people
Medicine and psychotherapy are the two major ways to treat depression in people of any age. Either one can be effective in older people, but in the long run, it’s generally best to have both forms of treatment. Some primary-care providers feel comfortable prescribing antidepressants themselves, while others prefer to refer patients who need antidepressants to a psychiatrist. Unfortunately, some antidepressant medicines can interact with diabetes drugs, interfere with blood glucose control, or cause side effects such as weight gain and lethargy. Drug interactions with other medicines are also a concern, since many older people take numerous medicines. Additionally, the cost of medicines must be considered when prescribing them for a person on a fixed income.
When prescribing antidepressants, many health-care providers start a person on a low dose of medicine and slowly increase it to an effective dose. This helps to lower the risk of serious side effects. How long a person continues to take antidepressants once an effective dose is reached is a decision to be made by that person and his physician. However, some studies have suggested that older people are more likely than younger people to have a recurrence of depression if their medicine is stopped altogether. For this reason, physicians often continue to treat older people with a low dose of antidepressants even after they report feeling better. Having a depression care manager on your health-care team to provide education, emotional support, help with solving problems, and reminders to take any prescribed antidepressants can also be an effective way to prevent a recurrence of depression.
As mentioned, psychotherapy is also helpful for dealing with depression. Some therapists focus on thoughts, others on feelings, and still others on interpersonal relationships, day-to-day problems, or issues from the past. The key is to find someone with whom you feel comfortable sharing your thoughts and feelings so that honest communication can take place. While it is often believed that older people prefer medication to psychotherapy, research shows the opposite is true: Older people are accepting of therapy and at times even prefer it to treatment with medicine.