August 2008 Most Seniors Are Happy, Some Are Sad Revvin’ Up to Win

Healthy Living Newsletter

Most Seniors Are Happy, Some Are Sad
Understanding Senior Depression

Agnes has many reasons to feel sad. Her husband of 42 years died last year after a painful battle with pancreatic cancer. Her daughter was seriously injured in an automobile crash last month, and her son, an alcoholic, has become estranged from her.

Although she suffers periods of intense sadness and grief, Agnes is actually doing quite well. She gets together regularly with neighbors and recently took an extended trip to the Grand Canyon with a group of friends.

Marie, by contrast, has suffered relatively few losses. She and her husband enjoy good health, and their children and grandchildren visit regularly. Yet she is chronically sad and in treatment for major depression.

Life after 60 is full of emotional challenges–the transition from work to retirement, declining health, decreasing mobility, financial stress and the loss of family and friends. It’s normal for anyone experiencing such emotional trauma to feel periods of grief and sadness. Yet most older persons are surprisingly resilient and able to move on with their lives.

The small number of seniors (about three percent) who become chronically sad do not need a reason. They have an illness that can and should be treated promptly

• persistent feelings of sadness, anxiety or emptiness;
• loss of interest in ordinary pleasures, including food and sex;
• decreased energy or a slow motion feeling;
• sleep problems such as insomnia, oversleeping or early morning awakening;
• loss of appetite or overeating;
• difficulty with concentration, memory or decision making;
• feelings of hopelessness, pessimism, guilt, worthlessness or helplessness;
• irritability;
• excessive crying;
• aches and pains;
• thoughts of death or suicide

In an older person, depression may present with a different profile. Some depressed seniors say they don't feel sad-just drained of energy and motivation coupled with physical complaints such as arthritis pain or headaches.

The person may be irritable or anxious, fretting obsessively about the weather, their health or the state of the world. The "grumpy" or "crotchety" old person is more than likely clinically depressed.

In many cases, medical conditions such as heart disease, diabetes, cancer, arthritis, Parkinson's disease or hormonal disorders contribute to the depression. This may be because of physical changes brought about by the disorder or frustrations involved in dealing with it.

Depression and dementia often go hand-in-hand; and, in some cases, it's difficult to distinguish between cause and effect. Some studies indicate that depression is an early sign of Alzheimer's and other dementias. A person who is aware of diminishing mental capacities may also become depressed because of concerns about the future.

Depression leads to deficits of attention, concentration and memory that are often mistaken for dementia, but, unlike those of Alzheimer's disease, can be treated.

Substance abuse (including alcoholism and abuse of prescription or non-prescription drugs) can cause symptoms of depression. It's usually necessary to treat the substance abuse first and then address any depression that lingers.

Medications (including Catapres, Aldomet, Inderal, L-dopa, bromocriptine, cortisone and prednisone) may also trigger depression or make depression worse. Some individuals are more likely than others to become depressed-either because of genetics or personal history.

Depression involves not only a mood but physical changes in certain areas of the brain that are also involved in learning, memory, pain, aggression, sexual function, eating behavior and mood regulation.

Whether you have a long history of depression or are experiencing it for the first time, it's important that you seek help promptly and get definitive treatment aimed at restoring normal brain function as well as easing symptoms.

Mild to moderate depression is frequently treated with selective serotonin reuptake inhibitors (SSRIs) such as Prozac and Paxil. However, a New England Journal of Medicine study found that seniors taking SSRIs had an 80 percent increased risk of falls. Other studies have linked SSRIs to rapid bone loss.

In 80 percent of cases, patients treated with medication and therapy over a three-year period recovered from their depression without recurrence, according to a Pittsburgh Medical Center study. On the other side, 90 percent of persons who did not get comprehensive treatment had continuing problems.

While the final act of life may come with many troubling scenes, it need not end in tragedy. With resilience and the help of family and friends, most seniors learn from their adversity, gaining deeper understanding of themselves and greater appreciation of family and friends.

To find out more, talk to your doctor today. If you would like a referral to a physician on staff at Mercy Hospital, visit the Find a Physician section of this website; or call toll-free 1 (888) MERCYME.

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Types of Depression

Everyone gets the blues from time to time, but depression is a more persistent and disabling disorder. It presents in several forms. Mild or moderate depression in reaction to stressful life events or significant loss is known as adjustment disorder with depressed mood.

Major depression is much more severe, with symptoms making it nearly impossible for the person to carry on. Bipolar disorder, which usually appears first during youth, involves mood swings - from extreme lows to extreme highs. Dysthymia is a low-level depression that persists over two years or longer.
Source: Donald J. Franklin, PhD, "Depression in Seniors," Psychology Information Online

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