Treatments for Depression in the Elderly

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While everyone feels sad or down from time to time, these feelings usually resolve after a while. Clinical depression, however, involves feeling persistently unhappy and hopeless for at least two weeks. Depression is a mental illness that will not go away on its own. Individuals with clinical depression require professional treatment, such as counseling, medication, or a combination of both to alleviate symptoms.

Everyone’s personal experiences and brain chemistry are unique, so it can take some trial and error to find an effective treatment plan for depression. Detecting and treating this condition in older individuals can be especially tricky. But, the first step is to make an appointment with a medical or mental health professional to begin piecing together a personalized plan of action.

Diagnosing Depression in Seniors

For many people, the hardest step is deciding to seek medical help for depression. It can be easier to start by making an appointment with one’s family doctor or primary care physician (PCP). Most people have a PCP and have been with the same one for many years. This rapport can make it a little easier for patients to broach the subject and easier for doctors to make initial recommendations based on a patient’s medical history and personality.

During the initial appointment, the doctor will ask about the patient’s symptoms, the medications they are taking and how their moods are impacting their day-to-day life. They should then perform a physical exam to see if the new or worsening depression could be caused by a health problem (such as hypothyroidism or a vitamin deficiency) or a medication the patient is taking.

After a complete exam, the doctor may provide a referral to a mental health worker, such as a social worker, mental health counselor, psychologist or psychiatrist. For many seniors, seeing a doctor who specializes in diagnosing and treating mental health issues in older people can be very beneficial. These physicians are called geriatric psychiatrists.

Therapy

Everyone needs someone trustworthy to talk to. While antidepressant medications are often thought of as the go-to treatment for depression, anxiety and some other mental health issues, therapy can be a very beneficial nonpharmaceutical treatment option. There are many different types of therapy, and certain methods seem to work better for different people. For instance, support groups can provide new coping skills and social support for someone who is struggling with a major life change, such as a serious medical diagnosis or the loss of a loved one.

Several kinds of talk therapy are useful as well. One method, called cognitive behavioral therapy (CBT), aims to help patients end destructive patterns of behavior and modify their thoughts to be more positive. Another method, called interpersonal therapy, helps patients work to improve their relationships with others and strengthen and expand their support systems.

Most mental health professionals tend to combine different methods and approaches in the therapy they provide. The best way to find the right therapist is to be honest about your goals for these sessions and find a therapist you are comfortable talking to. Referrals can come from physicians, family, friends or even online directories.

Antidepressant Medications

Antidepressant drugs can also help to improve mood, sleep, appetite and concentration. There are several types of these medications available. Many doctors start by prescribing a type of drug called a selective serotonin reuptake inhibitor (SSRI), such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil) or sertraline (Zoloft). SSRIs cause fewer side effects compared to other types of antidepressants, and they help regulate serotonin, a neurotransmitter in the brain that controls emotion.

Another class of antidepressants is serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs include venlafaxine (Effexor), desvenlafaxine (Pristiq) and duloxetine (Cymbalta). This type of antidepressant is similar to SSRIs but it also regulates another neurotransmitter in the brain called norepinephrine, which is responsible for controlling responses to stressors. Other classes include tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). In some cases, doctors prescribe atypical antidepressants that affect one’s brain chemistry but do not fit into the aforementioned categories.

Some of these medications can take up to 12 weeks to reach their full effectiveness. In addition, some older antidepressants (TCAs) can cause unwanted side effects, but newer medicines like SSRIs tend to have fewer drawbacks. To avoid this problem, the prescribing doctor must know about all prescription and over-the-counter medications, vitamins, and herbal supplements a patient is taking. The same goes for any physical and additional mental health issues. These factors are vital because they influence which antidepressant the doctor believes will be the most effective and yield the least serious side effects.

Exercise

People who suffer from depression can greatly benefit both mentally and physically from a regular exercise regimen. Even mild exercise like walking outdoors or in a shopping mall, gardening, dancing, and swimming are excellent options. Regular physical activity releases endorphins and increases blood flow to the brain, resulting in improved mood and lower anxiety levels. Exercise may not be wholly effective for every person experiencing depression, but being physically fit and eating a balanced diet can help.

Stay Busy

It can be difficult to be social and active when you’re depressed. Two of the hallmark symptoms of depression are a lack of energy and a loss of interest in activities. If your aging loved one is disengaged as well as depressed, it is important to encourage them to continue pursuing hobbies and activities they once loved. Whether it’s golf, a game of cards with friends, or watching a video with grandkids, having things to do can help keep negative thoughts at bay. Be sure to stay in touch with your loved one throughout the treatment process so they know they have someone who cares and is willing to listen and lend a helping hand. Social isolation often results when depressed individuals withdraw, but this lack of connection can also cause their condition to worsen.

With treatment, most people will find that positive thoughts will gradually replace the negative thoughts that resulted from depression. Usually, a combination of the above factors is the most effective. Feeling better takes time, but it can happen.

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3 Comments

I am currently caring for my 73 year old Aunt who is suffering from depression and recently tried to commit suicide. She is going to be release from the hospital soon after an evaluation and I don't think that I am able to take care of her any more. Are there facilities that take mental patients and what is the criteria for her to get assigned there?
You need to talk to the social worker in the hospital. It is important to resolve this before your aunt goes home. Sometimes there are more benefits if a referral is made directly from the hospital.
I am not sure what to do! My mother has been in rehab for months, she is 80 and has osteoporosis, memory loss, dementia (more so in the last 3 days) and confused. She has gone in a fetal position and refuses and does not understand to loosen up and straighten out her leg. They stopped physical therapy as she was not responding and stopped eating. she lives in florida and I live in North Carolina. My brother lives in her home and works out of the house, he is her main caregiver, but he is only able to visit once a day at dinner time. I came down 2 weeks ago after the facility called me to start considering hospice or a feeding tube, and I nor my brother want to do a feeding tube, so I headed down to asses the situation. I should also mention that she is a foreign woman, she can't read or write and not good with activities, picky eater, she was an amazing cook!
For the last 2 weeks, I spent time with her from the moment she got up, to the moment she laid down, we tried physical therapy again, and she showed interest and motivation, she gained 4 pounds and her appetite came back. A week ago, her new doctor as the previous one was never present prescribed a low dose of muscle relaxer baclofen, to take 3 times a day, a total of 15 milligrams a day. 3-4 days ago I noticed a lot of confusion, especially with eating and swallowing, she closes her mouth when I say open, spits out when I say swallow, she sleeps all the time and her dementia is constant. In addition, she vomits 1 to 2 out of her 3 meals and her stomach hurts. Because she was not improving as quickly as medicare would like in physical therapy, even though she met the goals they set, they stopped PT a few days ago. I looked up side effects and found out that all her symptoms are side effects, so I asked the nurse to stop baclofen and let her doctor know that I no longer wish her taking it. He came to see me a few hours after that and wanted to discuss putting her on antidepressants. I am really concerned with this, I don't want her dealing with more side effects, when I showed my concern he said that if he did not feel it was necessary, then he would not suggest it, he knows what he is doing and that most patients in here are on it, but they all look out of it all the time, non of them look happy and perky!
I am bringing her home on Wednesday to live here again, we are getting her a hoyer lift to help with transportation. I think being home and around family should help a bit, but what if the antidepressants will help? I am so confused! I am more prone to holistic approach and all natural supplements, but I don't want to impose my beliefs on her situation and I surely don't want her to be depressed in her late stage of living! What to do???