Everyone feels down, or “blue,” once in a while. The occasional blue feeling is a normal part of life. But feeling blue without relief can be a sign of what doctors call clinical depression.
According to the National Institute of Mental Health, depression is one of the most common mental disorders in the United States. In 2016, an estimated 16.2 million adults in the United States had at least one major depressive episode. Researchers believe that depression can be caused by a combination of genetic, biological, environmental and psychological factors. Depression can happen to anyone, but it most commonly occurs in adults.
While clinical depression is a common problem for older adults, it is not a normal part of aging. Common reasons why older adults show signs of depression include the loss of loved ones and ongoing medical conditions like diabetes, high blood pressure, cancer, heart disease and changes in memory. Chronic stressors like the loss of a job, worsening pain, disability and having to provide care for children and grandchildren also contribute to depression and feelings of excessive stress. When stress and depression become persistent, are present more days than not and start to negatively affect quality of life, relationships and daily functioning, these issues may indicate the person has clinical depression.
Depression in late-life often includes persistent sadness, inability to experience enjoyment in previously pleasurable activities (like spending time with grandchildren or going to church), irritability, low energy, insomnia, change in appetite, feeling slowed down and having trouble concentrating and remembering. Many older people with depression experience excessive worry and have a difficult time turning off their anxiety. Some older people with depression worry excessively about their health. People with depression cannot just “snap out of it.” Their feelings and changes in behavior can be overwhelming for family and friends who find their “moodiness” to be confusing, which can cause difficulty with relationships. When depression is more severe, some older adults have thoughts that life is not worth living or they would be better off dead. At times, the depression contributes to their feeling like a burden to their family. They may fantasize that their family would be better off if they were no longer around. When people become too hopeless or feel that their mood will never improve, they may consider actually taking their own lives. Suicide is the most tragic outcome of severe and untreated depression.
For some people, seeking help can be stressful or embarrassing. Some people find it challenging to find the words to describe how they are feeling, which further contributes to a sense of isolation. Primary care physicians (PCP) are often the first health professionals in whom older adults confide about their stress, mood and anxiety. In general, PCPs are educated about depression and anxiety in older patients and want their patients to bring this up during appointments. PCPs can evaluate patients for symptoms of depression and excessive stress. Then, they work with patients to decide whether a referral for counseling or a prescription for an antidepressant medication would be helpful. Both counseling and antidepressant medications are effective treatments for depression in older adults.
Many people get better with counseling or antidepressant medications. However, some people experience a more difficult-to-treat type of depression that requires switching or combining medications or more intensive counseling. Jordan Karp, MD, associate professor of psychiatry, of anesthesiology, and of clinical and translational science at the University of Pittsburgh School of Medicine, is leading a study focusing on the difficulty of treating late-life depression (see information on the OPTIMUM study elsewhere on the page).
“Treatment-resistant depression is really the norm, not the exception in older adults,” says Dr. Karp. “More than half of depressed adults do not respond to the antidepressant medications they take. Older adults may respond differently to medications than younger people. We are trying to learn what are the safest and most effective treatment options for these patients. With the OPTIMUM study, we’re trying to identify those differences and find the safest treatment without serious side effects.”
It is important to get depression treated because research shows that inadequately treated depression may cause memory problems, worsen other medical conditions, like diabetes and high blood pressure, and contributes to early death. As Dr. Karp says, “Depression kills. Treatment works. Get help.”
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