Depression Over 65

a threat to relationships that is very treatable




The dangers associated with depression over 65 years of age, as well as those of depression in general, are laid out and discussed in detail at the website of the National Institute of Mental Health. Though the risk is important to those of us over 65 and to our relationships, note carefully that effective treatment is available and worthwhile.

So, first some facts.

Older Americans are disproportionately likely to die by suicide.

Although they comprise only 12 percent of the U.S. population, people age 65 and older are reported to have accounted for 16 percent of suicide deaths in 2004.

14.3 of every 100,000 people age 65 and older died by suicide in 2004, higher than the rate of about 11 per 100,000 in the general population.

Non-Hispanic white men age 85 and older were most likely to die by suicide. They had a rate of 49.8 suicide deaths per 100,000 persons in that age group.

The chances of suffering from depression over 65 go up when you have other illnesses and when your general ability to function becomes limited.

Estimates of major depression in older people living in the community range from less than 1 percent to about 5 percent, but rises to 13.5 percent in those who require home healthcare and to 11.5 percent in elderly hospital patients.

It is not a normal part of aging to experience depression over 65. It is not naturally part of aging.

Emotional experiences of sadness, grief, response to loss, and temporary “blue” moods are normal. Persistent depression that interferes significantly with a person's ability to function is not and the challenges of healthy aging and relationships are quite enough without having a treatable disorder to work through too.

It appears to be under-diagnosed and under-treated among older people and even more so among ethnic and racial minorities than among their white counterparts. 

Though many people, including health professionals and older people themselves, may conclude that persistently being depressed is an understandable, acceptable response to other serious illnesses and the social and financial hardships that often accompany aging, this is not true

Depression over 65 can and should be treated when it occurs at the same time as other medical illnesses.

Untreated depression can delay recovery or worsen the outcome of other illnesses.


Antidepressant medications or psychotherapy, or a combination of the two, can be effective treatments for late-life occurrence.

Medications

Antidepressant medications affect brain chemicals called neurotransmitters. For example, medications called SSRIs (selective serotonin reuptake inhibitors) affect the neurotransmitter serotonin. Different medications may affect different neurotransmitters.

Some older adults may find that newer antidepressant medications, including SSRIs, have fewer side effects than older medications, which include tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs). However, others may find that these older medications work well for them.


If you're considering taking antidepressants, it’s important to be aware that

  • there are several medications for depressive disorders
  • different medications are likely work best for different people
  • there is no completely certain way to choose the best medication for any particular individual of which I am aware and clinical judgement can play a big role in success
  • it takes four to eight weeks for the medications to be fully effective
  • if one medication doesn’t help, research shows that it is likely that there is a different one that will
  • to change medications you have to get the previous one out of your system before starting another one and this takes some time
  • getting it right can change your life and is worth the effort

However, if the first form of antidepressant you take isn't helping, the process of getting to one that works better can be difficult and frustrating both for you and your doctor because it is a drawn out process: 

  1. You have put in 4 to 8 weeks taking the first medicine as directed while noting any changes in your symptoms and side effects.
  2. You have discussed it with your doctor and decided what to do next. 
  3. If it's decided that changing medicines is called for, you have to be weaned off of the first medication before you can start the second one, ( all the while of course you're still depressed.) 
  4. Then it's another 4 to 8 weeks of following the regimen with the new medicine and noting the results and side effects.
  5. If the second one isn't helping, you have to repeat the whole process.

This can call for a lot patience in sticking with it long enough find the right one.  I attended an excellent presentation years ago in which a psychiatrist who specialized in depression said that though he strongly believed that there is some form of medication that will help most depressed people, he's only got three tries before most patients give up and given the time, discomfort, and frustration involved he didn't blame them though it was frustrating.


Also, persons experiencing depression over 65 for the first time should talk to their doctors about continuing medication even if their symptoms have disappeared with treatment. Studies showed that patients age 70 and older who became symptom-free and continued to take their medication for two more years were 60 percent less likely to relapse than those who discontinued their medications

Psychotherapy

In psychotherapy, people interact with a specially trained health professional to deal with mood changes, low energy, thoughts of suicide, and other problems. Research shows that certain types of psychotherapy are effective treatments in late-life.

For many older adults, especially those who are in good physical health, combining psychotherapy with antidepressant medication appears to provide the most benefit. A study showed that about 80 percent of older adults recovered with this kind of combined treatment  and had lower recurrence rates than with psychotherapy or medication alone.

Another study of depressed older adults with physical illnesses and problems with memory and thinking showed that combined treatment was no more effective than medication alone. Research can help further determine which older adults appear to be most likely to benefit from a combination of medication and psychotherapy or from either treatment alone.

For more information on depression over 65 and depression in general go to the National Institute of Mental Health website.



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