There was a time when depression was thought to almost exclusively affect older people. In fact we now know that depression tends to be less common in the older years than younger. Despite this, depression in senior citizens brings a unique set of issues, some of which are only just unraveling due to the fairly rapid increase of an elderly and longer living population. There are, for example, some indications that depression in the very old, age 85 and above, appears to be on the increase. This suggests late life as a time of increased depression risk. A clear indication that depression may be under diagnosed is the prevalence of suicide in the older age group.
Diagnosing Depression in Senior Citizens
Senior citizens have had something of a raw deal when it comes to diagnosing depression. It follows that treatment for major depressive disorder in senior citizens is not all it might be. Part of the problem has been that doctors tend to view the symptoms as an effect of increasing levels of physical impairment due to age. Senior citizens are also far less likely to use terms such as anxiety, stress or depression. Only when very concrete symptoms such as weight loss occur might depression be diagnosed as an issue in its own right.
In many ways treatment for major depressive disorder in senior citizens is similar to that for younger people but the effects and side effects may differ:
Antidepressant medication can be effective but it is known that the therapeutic effects can take much longer – up to 12 weeks compared with around 6 weeks in younger people. Antidepressant medications do have side effects. Unfortunately senior citizens are three times more likely to experience side effects. Perhaps because of this they are more likely to stop taking medication, or in some cases they may become confused over the dosage requirements, or they may simply forget.
Cognitive behavioral therapy (CBT) has been shown to be effective with only a few minor modifications needed. Similarly, Interpersonal Therapy, which aims to target interpersonal problems that serve to block wellbeing, has been shown to be effective. Issues such as grief and role transitions appear to be particular problems with many senior citizens, especially those with co-existing medical problems. Music also appears to work especially if combined with some basic relaxation therapy.
Electroconvulsive therapy (ECT) is very effective in cases of severe depression. It’s positive effects are far quicker than antidepressants and is likely to be the treatment of choice is suicide is perceived as a risk. Although side effects from ECT are less likely than those from antidepressants, if they do occur, they tend to be more severe. Increased levels of confusion, a greater likelihood of accidents such as falls, and cardiovascular and respiratory problems may occur.
Hammen, C. & Watkins, E. (2008) Depression (2nd ed) Psychology Press. Taylor & Francis Group.
Papalia, D.E., Sterns, H.L., Feldman, R.D., Camp, C.J (2007) Adult Development and Aging. McGraw-Hill, International Edition.