Is Someone You Know Secretly Depressed?

Depression is common in older adults but harder to spot.

Depression is painful. I know this from a lifetime of experience. On a beautiful, sunny day with birds singing gaily, a person afflicted with depression sees the world as dark, dull, and grim.  

Some people still believe that depression is inevitable when you grow older. It is not. But many older adults do suffer from depression, and their struggle is often not apparent to friends and family.

An estimated six million Americans ages 65 and older are clinically depressed. The Centers for Disease Control estimates depression afflicts from 1% to 5% of older adults living in the general community, 11.5% of those in hospitals, and 13.5% for those who require home health care.

Yet only 10% of depression sufferers get treatment.

Why?

There are at least three explanations for that.

1.       Depression doesn’t look the same in older people as it does in the young. The symptoms are different, and less obvious. An older adult with depression may feel tired, have insomnia, be grumpy or irritable, struggle to pay attention, feel confused, feel sad for extended periods, take no interest in activities they once enjoyed, or move more slowly. They may have a change in appetite, feel worthless or guilty, endure aches and pains, or have suicidal thoughts. Some of these behaviors can be confused with symptoms of dementia. Others might be caused by drug interactions.

2.       When older adults visit their primary care doctor, they often complain of their physical symptoms, which prompts the physician to run medical tests rather than refer them for a mental health checkup.

3.       To older adults, more than any other group, mental illness and psychiatric treatment still carry a stigma. Seeking help feels like admitting weakness, and admitting to having mental issues is just taboo. Despite major breakthroughs in treatment, many older adults cling to fears dating from an earlier period in their lives, when a diagnosis of mental illness automatically meant being consigned to an institution – possibly forever.

Retirement is a Risk Factor

While all older adults don’t get depressed, certain risk factors common to elders increase the chances of it occurring.  Insomnia, a common problem with advanced age, is both a risk factor and a symptom. Social isolation and loneliness frequently lead to depression. (The problem is so severe in Japan that the government has appointed a “Minister of Loneliness” to find solutions.)

Retirement is also a risk factor. A person who has always identified themselves with what they do in the work world may find it challenging to find a different identity or a new purpose when work stops.    

Medical science continues to grow more sophisticated in what it knows about the brain and how to treat its ills. These are the principal treatments for depression:

• Antidepressants work well for many older adults. Selective serotonin reuptake inhibitors (SSRIs) – which include Lexapro, Prozac, Paxil, Celexa, and Zoloft – are believed to balance serotonin and other hormones that affect mood. They are not habit forming.
   

• Counseling, or psychotherapy, helps patients identify negative thought patterns and learn to modify them, along with behaviors, to cope with challenges more productively. Counseling with a psychologist, psychiatrist, or other licensed mental health professional is often coupled with antidepressant medications.
  

• Electroconvulsive therapy (ECT) is used for severe depression that has not responded to other treatments. Unlike “shock therapy” of old, it uses only mild electrical impulses to stimulate the brain, and it has proven to be highly effective.

How You Can Help

• If you know someone who exhibits several of the indicators of depression, encourage them to see their primary care physician. The doctor can rule out other possible explanations for the symptoms, such as physical illness, dementia, or drug interactions, then make a referral to a mental health professional if appropriate.
  

• Encourage people to talk about how they feel. Many, especially males, are highly resistant to the concept, but expressing them aloud may help to untangle them. Moreover, the act of listening may reassure them that people do care.
  

• Older adults who normally live quiet lives may find the joyous celebration of a holiday unsettling. Be prepared to help a friend or loved one ease their way back from busy, noisy activity to a normal state of calm.
  

• Finally, encourage a friend or loved one to protect their mental health. Getting enough sleep, exercising, eating well, and maintaining social contacts all help build emotional resiliency.

No one should have to suffer with depression when treatments are available and effective. Help those you care about to see the sunshine, hear the birds, and enjoy all their days.

Still Seeking Retirees to Interview

For a research project, I’m looking for people who have retired within the past five years to talk about their experiences in transitioning from work to non-work (or less work). I’m also looking for people who plan to retire within three years. If you’re willing to be interviewed, please contact me at don@donakchin.com for details.