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Is depression a natural part of aging?
And how common is the condition among older people?
The answer to the first question is no.
The answer to the second depends on whether you’re talking about individuals living in the community or those who reside in personal- or nursing-care facilities, said R. Scott DeLong, M.D., a physician specializing in family medicine and geriatrics at Lancaster General Health.
“In the community, [the rate of depression] is 1 to 2 percent,” he said. “In facilities, it may be as high as 10 percent.”
Other data suggest that the rates go up to 13.5 percent in individuals who require home healthcare and 11.5 percent in older hospital patients.
But whatever the percentages of depression in older populations, the National Institute of Mental Health considers it a major public health problem. It is one that increases a person’s risk for heart disease and other illnesses, as well as suicide
Aside from addressing the question of frequency, we have to first distinguish between grief and depression.
“In grief, an individual experiences both good and bad days, whereas depression is a constant feeling of emptiness and despair,” DeLong said.
Changes in sleep and appetite patterns may be part of the picture.
Other signs of depression include anxieties, worries, and irritability; a pervasive sense of guilt; memory problems; slowed movement and speech; thoughts of suicide or a preoccupation with dying; and an inability to function or the neglect of personal hygiene, skipping meals, and forgetting medications.
How is depression diagnosed? There are screening tools doctors can use, but mostly, the diagnosis derives from clinical impressions gathered by observing and speaking with the patient.
“You have to have two key components to diagnose the illness,” DeLong said. “They are depressed mood and the loss of interest in things the person enjoyed previously, which is known as anhedonia.”
One diagnostic tool often used is the PHQ9, or patient health quotient, which contains nine items to determine depression. The test isn’t time intensive and can even be administered by the nursing staff while a patient is being housed at a facility.
The symptoms of depression are often confused with other illnesses or the side effects of medications.
Although everyone would like there to be a definitive test that demonstrates depression, there isn’t—yet.
“Lab work can help. But it doesn’t so much confirm depression as it rules out other physical causes associated with or mimicking the mood disorder,” DeLong said.
One such condition is thyroid illness, especially severe hypothyroidism. Other conditions that mimic depression are vitamin B12 deficiency, electrolyte imbalances in sodium and magnesium, and anemia.
To rule out physical conditions that might cause or mimic depression, a physician might also do a CBC (complete blood count) or a comprehensive metabolic panel.
If symptoms seem to extend beyond those of depression—perhaps including memory loss or confusion—images of the brain can be taken, such as a CT scan or MRI. These can rule out depression and may point toward dementia.
Depression is not inevitable or a normal part of aging.
“Depression is a true and treatable medical condition,” DeLong said. “People can live vibrant and meaningful lives at any age.”
Once diagnosed, how is depression treated? That depends somewhat on the setting, DeLong commented.
“In an outpatient setting, we look toward medications,” he said.
Generally, physicians turn to the category of antidepressants known as SSRIs (selective serotonin reuptake inhibitors). Lexapro, Celexa, and Zoloft are commonly prescribed as they are better tolerated.
In nursing homes, ironically—since people may resist going there—there may be less need for medication.
“They have a much more robust therapy department, with clinical psychologists and psychiatrists coming in frequently,” DeLong added.
“It may be more challenging in one’s own home to make appointments with doctors and therapists. There may not be a lot of services available in the community, and if a person lives alone, symptoms of depression might not be picked up.”
In theory, though, the best treatment for depression is a combination of medication and psychotherapy, or talk therapy.
Although a link exists between dementia and depression, there’s “much better treatment for depression than for dementia at this point,” DeLong said. “We’re trying to figure out which develops first or which precipitates the other. It may not be a matter of which came first.”
In addition to treatment, preventative measures can be taken to avoid depression. Among them is staying active physically, a measure that’s true for dementia as well.
While exercise is a wonderful form of prevention, it doesn’t have to be aggressive; even doing it two to four times a week for 30 minutes each time is effective.
Being active socially is also helpful. In fact, DeLong calls staying connected with people “the best non-pharmaceutical treatment.”
Since older adults are sometimes misdiagnosed or undertreated for depression, it’s important if you suspect the condition in yourself or in loved ones to see a healthcare provider.
Older adults themselves often share the belief that depression is a natural consequence of illness or life changes that occur as we age and don’t understand that they can feel better with appropriate treatment.
The good news, though, is that the majority of older adults are not depressed. And if some are, there’s help available.