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| Depression in the elderly |
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Written by Dr Alan Thomas, lecturer and honorary specialist registrar in psychiatry
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| Anxiety is one of the most common features of depression in
the elderly |
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Depression is the
most common mental illness found in old people and the second commonest single
underlying cause for all GP consultations for people over 70 years of age.
Symptoms of depression in the elderly
Generally the pattern of depression is similar in elderly people
and younger adults and they suffer the same symptoms. However, certain symptoms
are more common and some are less common in the elderly than in
others.
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The elderly often do not complain of low mood.
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Elderly people often experience depression as physical
symptoms.
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Anxiety is a common feature of depression in the elderly.
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Forgetfulness and confusion occur because of depression in the
elderly.
The elderly are less likely to complain of low mood than younger
people. When depressed, they may complain of increased aches and pains or other
physical symptoms. These can be a way of expressing their depression rather
than of the development of any new physical disease.
Many people who are suffering from a depressive illness
experience symptoms of anxiety (such as feeling tense, on edge, panicky). The
elderly are even more at risk of experiencing these symptoms. The anxiety may
be more obvious than a 'low' mood.
Some older people with depression may become confused and
forgetful and, in severe cases of depression, they can appear as if they have
dementia. This is obviously very frightening for both the person with
depression and others who are looking after them. However, it must be
remembered that when the depression is treated these symptoms will go away.
Causes of depression in the elderly
Depression in old age may be triggered by adverse life events
including:
bereavement; loss of
health; threat of bereavement or loss of health in a loved one. Such events are
clearly more common experiences for elderly people.
In general, the elderly appear to be better able to cope with
such losses than younger people, and so do not develop depression more often.
However, as with younger adults, being single and having no close friends makes
elderly people more vulnerable to such losses.
More recently, evidence has emerged suggesting that depression
occurring for the first time in the elderly can be associated with subtle brain
abnormalities, which may be detected by special brain scans. These changes may
reflect hidden or undetected vascular (blood vessel) disease in the brain.
Treatment of depression in the elderly
Treatment is broadly similar to
treatment in younger adults, and the majority of people respond well to the
same antidepressant treatments, which need at least two to four weeks to begin
to work. These may be supplemented by supportive counselling by your
GP.
People with more severe depression, or those who do not respond
to such treatment, may need to be referred to a psychiatrist skilled in
treating the elderly. They may respond to another antidepressant or to a
combination of antidepressants and other medicines.
Electroconvulsive therapy (ECT) can
also be very effective in elderly people with severe depression and can be life
transforming.
Why it is important to recognise depression in the elderly
Too often, depression is dismissed as normal for old people or
it is thought it is not severe enough to need antidepressant treatment. Sadly
it is often not recognised and so no consideration is given to treatment. This
can lead to many months of unnecessary misery and, in some cases, to death from
suicide or the physical illnesses,
which can be made worse by untreated depression. Since the depression can be
expected to respond to treatment, it is tragic if it is not recognised or
properly treated.
Recognising depression in the elderly
As elderly people often have physical illnesses, it can be
difficult to know whether some of the symptoms (tiredness, poor sleep, poor
appetite, weight loss) are due to the illness or depression. In addition,
elderly people are less likely to complain of feeling sad. However, the
following symptoms may suggest a depressive illness.
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Persistent sadness that does not lift with happy
experiences.
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Lack of interest in activities and hobbies that are normally
enjoyed.
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A loss of interest in friends and socialising.
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Feelings of guilt and self-blame.
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Marked pessimism about the future.
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Suicidal thoughts and talk of wishing
one were dead.
If a few of these have developed over several weeks, then help
should be sought, in the first instance from the family doctor. This is
extremely important if the person has expressed any suicidal thoughts.
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Last updated 04.01.2005
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