While everyone feels sad or down from time to time, these feelings usually resolve after a while. However, clinical depression (major depressive disorder) involves feeling persistently unhappy and hopeless for at least two weeks, constituting a change in one’s prior level of functioning. Depression is a mental illness that will not go away on its own. Individuals with clinical depression require professional treatment, such as counseling, medication, or a combination of both to alleviate symptoms.
The first step is to make an appointment with a medical or mental health professional to begin piecing together a personalized care plan.
Diagnosing Depression in Seniors
Family members and caregivers should familiarize themselves with the signs of depression in seniors because mental health issues in older adults are commonly overlooked or mistaken for other health conditions. If you notice any warning signs, it’s important to encourage your loved one to seek medical help for depression.
While this first step is often intimidating, it’s easiest to start by making an appointment with a senior’s family doctor or primary care physician (PCP). Most older adults have a trusted PCP they have been seeing for many years. This rapport helps patients feel more comfortable broaching the subject and makes it easier for doctors to make initial recommendations based on a patient’s medical history and personality. This established baseline is very important for monitoring changes in an elder’s mood, behavior and functioning over time.
During the appointment, the doctor will ask about the senior’s symptoms, all medications they are taking and how changes in their mood impact their day-to-day life. They should then perform a physical exam to see if new or worsening symptoms of depression could be caused by an underlying health problem (such as hypothyroidism or a vitamin deficiency) or side effects of a medication the patient is taking.
After a complete exam, the doctor may provide a referral to a mental health professional, such as a clinical social worker, a mental health counselor, a psychologist or a psychiatrist. For many seniors, seeing a doctor who specializes in diagnosing and treating mental health issues in older people can be very beneficial. These physicians are called geriatric psychiatrists. Families can use the American Psychiatric Association’s Find a Psychiatrist Tool to search for a local mental health professional who is qualified to meet an aging loved one’s unique needs.
The Best Treatment for Depression in the Elderly
Detecting and treating mental health issues in older individuals can be especially tricky. Everyone’s personal experiences, physical health status, lifestyle and brain chemistry are unique, so it can take some trial and error to find an effective treatment plan for depression. Typically, a multifaceted approach is most effective.
Psychotherapy
Everyone needs someone trustworthy to talk to. While antidepressant medications are often thought of as the go-to treatment for depression, anxiety and some other mental health issues, therapy is a very beneficial nonpharmaceutical treatment option. There are many different types of therapy, and certain methods seem to work better for different people. For instance, support groups can provide new coping skills and social support for someone who is struggling with a major life change, such as a serious medical diagnosis or the loss of a loved one.
Several kinds of psychotherapy (also called talk therapy) are particularly useful for treating depression. One method called cognitive behavioral therapy (CBT) aims to help patients end destructive patterns of behavior and modify their thoughts to be more positive. Interpersonal therapy is another approach that helps patients work to improve their relationships with others and strengthen and expand their support systems.
Most mental health professionals tend to combine different methods and approaches in the services they provide. The best way to find the right therapist is for a patient to be honest about their goals for these sessions and look for an individual they are comfortable talking to. Referrals can come from physicians, family, friends or even online directories.
Unfortunately, talk therapy may not be an option for all seniors who are exhibiting symptoms of depression. While dementia is not a normal part of getting older, the risk of developing cognitive and behavioral changes increases with age. Dementia and depression frequently co-occur, but dementia patients in the later stages of the disease may lack the insight and capacity to participate in and/or fully benefit from traditional therapy sessions. However, research shows that several emerging psychotherapies for people with cognitive impairments may be promising treatments for depression and anxiety.
Antidepressant Medications
Antidepressant drugs can also help to improve mood, sleep, appetite and concentration. There are several types of these medications available. Many doctors start by prescribing a type of drug called a selective serotonin reuptake inhibitor (SSRI), such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil) or sertraline (Zoloft). SSRIs cause fewer side effects compared to other types of antidepressants, and they help regulate serotonin, a neurotransmitter in the brain that controls emotion.
Another class of antidepressants is serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs include venlafaxine (Effexor), desvenlafaxine (Pristiq) and duloxetine (Cymbalta). This type of antidepressant is similar to SSRIs but it also regulates another neurotransmitter in the brain called norepinephrine, which is responsible for controlling responses to stressors. Other older classes include tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). In some cases, doctors may prescribe atypical antidepressants like bupropion (Wellbutrin) and trazodone that affect one’s brain chemistry but do not fit into the aforementioned categories.
Some of these medications take up to 12 weeks to reach their full effectiveness. In addition, antidepressants can cause unwanted side effects, some of which may improve over time. When selecting the best medication to treat depression in a particular patient, the prescribing doctor must know about all other prescription and over-the-counter medications, vitamins, and herbal supplements they are taking. The same goes for any physical conditions and additional mental health issues. These factors are vital because they influence which antidepressant the doctor believes will be the most effective, cause the least serious side effects and not result in any adverse drug interactions.
Keep in mind that the first medication a doctor prescribes might not be the best fit. Sometimes these medications can actually cause a person’s symptoms to worsen. It’s important for patients (and their caregivers) to maintain frequent and honest communication with the prescribing physician after starting an antidepressant. Information about improvements in depressive symptoms (or lack thereof), side effects, treatment costs and other important details will guide the doctor in determining if the current dosage should be adjusted, if a new medication should be added to the existing regimen, or if they should discontinue the current medication and try a new one.
Exercising Regularly
According to the National Institute on Aging, “Research has shown that exercise is not only good for your physical health, it also supports emotional and mental health.” Even mild physical activity like walking outdoors or in a shopping mall, gardening, dancing, and swimming can be beneficial. Regular exercise releases endorphins and increases blood flow to the brain, resulting in improved mood and lower anxiety and stress levels. Exercise alone may not be wholly effective for every senior experiencing depression, but being physically fit and eating a balanced diet can help minimize symptoms.
Staying Busy
It’s often difficult for someone who is depressed to be social and active. Two of the hallmark symptoms of depression are a lack of energy and a loss of interest in activities. If your aging loved one is disengaged as well as depressed, it is important to encourage them to continue pursuing hobbies and activities they once loved. Whether it’s golf, a game of cards with friends or watching a movie with grandkids, having things to do can help keep negative thoughts at bay.
Be sure to stay in touch with your loved one throughout the treatment process so they know they have someone who cares and is willing to listen and lend a helping hand. Social isolation often results when depressed individuals withdraw, but this lack of connection can also cause their mental state to worsen.
With treatment, most elders will find that positive thoughts will gradually replace the negative thoughts that resulted from depression. A combination of the above treatment options is usually the most effective. Feeling better takes time, but it is possible with the right guidance.
Sources: What Is Depression? (https://www.psychiatry.org/patients-families/depression/what-is-depression); Depression and Older Adults (https://www.nia.nih.gov/health/depression-and-older-adults); Mental Health Medications (https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml)