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By admin, June 22, 2010 12:20 pm

Medical advances that help people live long lives may not be so great if those extra years are miserable ones. In a recent survey, 81% of respondents said they would rather die than be miserable in their later years. Depression is a growing problem among America’s elderly.  I recently learned from an expert why so:  Getting old sucks, to be very blunt.   Advancing age simply brings more stuff about which to be depressed. Awareness of this important health problem is an important first step to greater understanding and better treatments, ensuring that, however unintended, the consequence of a longer life is not misery.

The National Institute of Mental Health (NIMH) has awarded New York City’s Weill Cornell Institute of Geriatric Psychiatry its largest grant ever — $10 million — to study treatments for geriatric depression.  The lead researcher on that project, George Alexopoulos, MD, founder and director of Weill Cornell’s Institute of Geriatric Psychiatry at New York-Presbyterian/Westchester, is currently conducting research about how best to help elderly patients suffering from depression.

How Many Suffer?

You may or may not agree with the study’s definition of “elderly” (65 years old or older), but this population is surging and is predicted to grow by 73% in the next decade. Dr. Alexopoulos said that experts estimate that about 15% of the elderly will suffer from clinical depression.  Many will struggle for years, even decades, with chronic diseases and the accompanying disabilities that exacerbate their depression. Depression sours everything else, often making poor health situations poorer. “Depression is like breathing bad air, it makes whatever you have worse,” he said.

In elderly people, depression can be triggered by Alzheimer’s disease.  The symptoms of dementia and depression are often confused, Dr. Alexopoulos explained. Also, elderly patients with depression are likely to have unique symptoms that lead the diagnosis astray, including agitation and difficulties with mental processing (including memory, speech, hearing and understanding). Their complaints of aches and pains that do not have another obvious cause may be dismissed, misdiagnosed or improperly treated. And all these other issues occur in addition to the typical symptoms of depression that younger people have, too, such as sadness, an inability to experience pleasure, excessive or inappropriate feelings of guilt, changes in appetite, negative mood, sleep difficulties and physical complaints, such as fatigue, headaches and heart palpitations. It’s hardly any wonder that elderly depressed people have both a higher rate of suicidal thoughts and higher rates of suicide than younger people with the same condition.

The bottom line is, when you’re over 65 and depressed, the condition is much more difficult to address than it is for a younger patient.

Brighter Days are Here

There is some not depressing news to report though: Studying these depressing details can provide context for better diagnosis and treatment which is, of course, where the $10 million grant is aimed. Dr. Alexopoulos stated that doctors have already learned a great deal about effective treatment of depression in vulnerable elderly people. Many, he says, can be helped by psychotherapy, medication or a combination of both that incorporates the latest new findings. Among the new developments:

New approaches in psychotherapy can be tailored to provide what elderly patients need most. According to Dr. Alexopoulos, that means specifically helping them to address and find solutions for their new mental and/or physical limitations. For instance, effective therapy for an elderly patient may focus less on personal growth or relationship issues and more on achieving a better understanding of their nutritional needs so they’ll eat better, which will improve mood and energy level. They may need help figuring out how to solve mobility issues, including how to get around their homes as well as making arrangements for transportation for shopping, doctor visits and seeing friends and family. And they may need to explore other ways to adjust their living circumstances so that they can feel better emotionally and physically.

It’s now known that inadequate blood supply to the brain can cause chemical changes associated with depression and doctors can use modern brain imaging techniques to identify specific regions where this is occurring. They can then utilize corrective treatment if blood flow is found to be blocked or insufficient among elderly patients when they first show signs of depression.

Doctors have gotten better at fine-tuning medications for their elderly patients, for example, it’s now known that elderly patients do better with certain antidepressants (such as sertraline, citalopram andesctitalopram) that aren’t as likely to interact dangerously with other medications.

According to Dr. Alexopoulos, the goal is to help elderly patients with depression to take an honest look at the things they can no longer do, explore how they feel about these limitations, and then learn better ways to work around them, with the ultimate goal of finding a way to accept them.

If you or someone you love faces this problem and these new approaches aren’t being incorporated into treatment, bring this article along to your next appointment and discuss them with your doctor. These are heartening steps in the right direction toward a life that isn’t just merely longer, but joyfully so.

Source(s):

George S. Alexopoulos, MD, founder and director, Weill Cornell Institute of Geriatric Psychiatry, NewYork-Presbyterian/Weill Cornell Medical College, Westchester Division, and director, NIMH-supported Advanced Center for Interventions and Services Research (ACISR) in Late-Life Depression, White Plains, New York.

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