What to Do When Grandma Gets the Blues

Depression can be especially hard on older people, but it’s often confused with other conditions. If you’re caring for an elderly relative, here’s how to get a correct diagnosis – and what you can do to help... Your 75-year-old mom, once so full of energy, is irritable and keeping to herself. Your octogenarian uncle, who used to crack jokes and love a good time, has lost his zest for life. You attribute their personality changes to aging and health issues. After all, getting depressed seems inevitable when knees ache, vision starts to go or blood pressure soars, right? Despite what you hear, “depression isn’t a normal part of aging,” says psychologist Amy Fiske, Ph.D., an expert on mental health and the elderly at West Virginia University. “In fact, older adults are less likely to have depressive disorders than are middle-aged adults.” According to a 2010 Centers for Disease Control and Prevention report, 8.6% of people age 35-44, and 10% of those 45-64, have symptoms of depression. By contrast, just 6.8% of people 65 and older are depressed. But when older people do develop depression, it hits them especially hard. It tends to last longer and is more likely to lead to suicide, according to the National Institutes of Mental Health. “The impact of depression shows more prominently in an older person than it does in someone younger,” says George Alexopoulous, M.D., founder and director of the Weill-Cornell Institute of Geriatric Psychiatry in White Plains, N.Y. And it can worsen any health issues they may have. The worse the depression, the more a person’s quality of life and physical and mental functioning diminished, according to 2004 study of people 60 and older with medical problems. Wondering if an aging relative or friend may be depressed? Here are some warning signs and what to do about them. The Diagnosis Dilemma Depression often goes unnoticed in the elderly. That’s partly because, rather than acting “sad,” an older person may complain about aches, pains or other ailments. “Older people tend to underreport depression symptoms and overreport physical [ones],” Alexopoulous says. If an elderly person has any of the following conditions, it may coexist with – or even mask – a case of depression. Illness: Health problems often accompany depression, and boost risk for the disorder. According to a 2009 report in the Annual Review of Clinical Psychology, co-authored by Fiske, 20%-35% of older adults with cardiovascular disease report symptoms of depression. Up to 15% with Parkinson’s disease have major depression. Insomnia: Sleep problems, which are common in the elderly, can also increase the risk of depression. A 2006 study at the University of Rochester (N.Y.) Medical Center found that elderly people with persistent insomnia have a greater likelihood of developing depression. A second University of Rochester study, of more than 1,800 people age 60 and over, found that people with insomnia were 1.8-3.5 times more likely to remain depressed than those who didn’t have trouble sleeping. A two-year UCLA study of 350 people age 60 and older, published in the American Journal of Psychiatry in 2008, found that people with a prior episode of depression were more likely to have a second bout if they suffered from sleep disturbances. Forgetfulness: A hallmark of depression, this may be incorrectly attributed to mild cognitive impairment or even Alzheimer’s disease. But unlike people who truly suffer from some form of dementia, a depressed person is more likely to complain and be upset about their forgetfulness. “One of the cardinal rules is that people with dementia tend to minimize memory problems, whereas people with depression maximize them,” says psychiatrist Nada L. Stotland, M.D., a professor at Rush University Medical Center in Chicago and former president of the American Psychiatric Association. “Dementia shouldn’t make you feel guilty, affect your appetite and take away your zest for living,” Stotland adds. “Those are all symptoms of depression.” Life stressors: Common situations faced by older people – losing a loved one, caring for a sick relative, financial setbacks, trouble with family members, too little (or too much) support from others, loneliness, a change in living situation, or getting ill – all increase the likelihood of depression. A 2003 meta-analysis of people 50 and older published in the American Journal of Psychiatry reported that bereavement more than tripled the risk. Previous depression: Even if someone was treated and recovered from an earlier depressed period, there’s a chance the condition will return. “Depression is an episodic disease,” Fiske says. “If you’ve been depressed earlier in life, it’s more likely you’ll be depressed later in life.” Taking Action If you suspect your elderly relative is depressed, take him or her to a primary-care doctor or geriatric psychiatrist. “Once you do, you’re 80% of the way toward diagnosing or ruling out depression,” says developmental psychologist Adam Davey, Ph.D., associate professor of public health at Temple University in Philadelphia. Here’s how to handle the appointment: Bring up the D-word. Tell the physician why you think it’s depression. Otherwise, it may go unnoticed. “Older patients often won’t share their symptoms with the doctor,” Stotland says. A 2008 Texas A&M study found that doctors spent an average of just two minutes discussing mental health during visits with elderly patients. And more than half the patients with symptoms of depression never mentioned them. List all medicines. Tell the doctor about every medication and supplement your elderly relative takes, from statins to aspirin and vitamins, as well as the dosage. Medications - such as beta blockers, central nervous system drugs, calcium channel blockers, hormones and corticosteroids - can cause depression-like symptoms. Also, the doctor needs to ensure none of the patient's current meds will interact with an antidepressant. Speak up. The doctor should take a detailed medical history to rule out illnesses that could be causing depression. Since many elderly people see different doctors, make sure to list every diagnosis, including a history of depression. Getting Treatment Once diagnosed, depression is treatable – no matter the age. The doctor may prescribe antidepressants, especially selective serotonin reuptake inhibitors (SSRIs). A 2006 British research review found that seniors who take SSRIs are less likely to discontinue them due to side effects than those who take tricyclics, a class of medications that affects a wider range of brain chemicals. Psychotherapy may also be recommended – particularly cognitive behavioral therapy (CBT), in which a therapist helps the patient examine and change thoughts that influence negative feelings and behaviors. A 2009 study published in Archives of General Psychiatry found that CBT provided a significant benefit to depressed patients over 65, whether or not they were taking medication. “Instead of feeling like their life has ended because they can’t do what they used to do, therapy can give the patient a way to appreciate alternatives,” Alexopoulous says. If insomnia is at the root of your loved one’s depression, a combination of sleep medication and CBT may be prescribed, Fiske says. And if your relative has lost a spouse and is still mourning months later, bereavement therapy can help with the healing process. How can you help? Ask, Stotland advises. “Often the most useful thing you can do is listen.” Also, encourage them to do things, Stotland says. “It’s better to get outside than lie in bed all day.” If your relative used to enjoy going to the symphony or movies or on long drives, offer to take them. But if they turn you down, don’t push, Stotland adds. You can also make sure they have transportation to see friends or family, or encourage visits. And if certain activities or social groups have become too difficult, help find alternatives. Socializing can make a big difference: A 2009 study published in the Journal of Health and Social Behavior found that older people who feel the most isolated report 65% more depression symptoms than people who feel the least. And people with the most social connections are three times as likely to have good or excellent health. For more information, visit our Depression Health Center. Could You Be Depressed? Depression affects 20 million people in any given year and is a serious enough disorder to compromise one’s ability to function normally day to day.