Twice over the past few weeks I’ve heard a variation of the same story: An older adult tells her primary care doctor she is feeling severely depressed. Each time, the physician responds by saying depression is normal for seniors. Something like, “What do you expect? You’ve got aches and pains. Your friends are dying. It is what happens.”
That response is wrong. And it is yet another example of the agism that infects the medical profession and US society at large.
Depression is not normal
The National Institute on Aging published a valuable discussion of depression and older adults. In part, this is what is says: “Depression is a common problem among older adults, but clinical depression is not a normal part of aging.” In fact, adds NIA, “Studies show that most older adults feel satisfied with their lives, despite having more illnesses or physical problems than younger people.”
Yet, for too many seniors, severe depression is very real and often untreated. Yet it can be managed. You don’t have to suffer. You can get help.
NIA describes four types of depression that particularly affect older adults:
- Major Depressive Disorder – includes symptoms lasting at least two weeks that interfere with a person’s ability to perform daily tasks
- Persistent Depressive Disorder – a depressed mood that lasts more than two years, but the person may still be able to perform daily tasks, unlike someone with Major Depressive Disorder
- Substance/Medication-Induced Depressive Disorder – depression related to the use of substances, like alcohol or pain medication
- Depressive Disorder Due to A Medical Condition – depression related to a separate illness, like heart disease or multiple sclerosis.
It is complicated
Depression can be complicated because its symptoms are so varied. They can include feeling sad, anxious, hopeless, or “empty.” Symptoms might include irritability or restlessness, fatigue, difficulty concentrating or sleeping, or loss of interest in certain activities.
Some of these symptoms, such as fatigue or difficulty sleeping, can be signs of other conditions that are common among older adults. They may be side effects of medication. And, making matters more challenging, the effects of depression can be different for older adults than others. For example, that feeling of sadness is very common among younger people with depression but less frequent among seniors.
Depression and other psychiatric disorders all are confounded by dementia. Alzheimer’s Disease and similar conditions can cause depression. And depression may increase the risk of dementia.
At the same time, doctors sometimes confuse the symptoms of one with the other. An unskilled physician may incorrectly diagnose early-stage dementia as depression, or misdiagnose depression as early-stage dementia.
What should you do if you feel severely depressed?
Think about why. Is it caused by other medical conditions, such as ongoing pain or perhaps other medications you are taking? Is it due to the stress of being a caregiver for a spouse or parent? Is it the result of social isolation and loneliness?
You can get help managing some of these issues. Maybe you can use exercise to relieve pain, or get some respite from caregiving by hiring an aide for a few hours. Perhaps you can volunteer to help others or start attending programs at a local senior center.
Think about seeing a therapist or psychiatrist who specializes in helping older adults. A geriatric therapist or psychiatrist may be better than a mental health professional with a more general practice.
Anti-depressant medications can be a huge benefit. They may not cure depression but can do a lot to manage symptoms. They may come with risky or unpleasant side effects, however. And it is important to learn which of the many types of these drugs work best for you.
If you are taking several medications for other conditions, it is important to be sure your depression is not being caused by them, either alone or in combination. The relationship between pain medication and depression is very complicated. Pain meds may increase the risk of severe depression. But some anti-depressants may reduce pain.
If your doctor or pharmacist isn’t giving you clear answers, you can try working with a geriatric pharmacist, who is an expert in how seniors react to drugs. You can find one here.
Most important: If you are thinking about harming yourself, call the 24-hour 988 Suicide & Crisis Lifeline. Dial 988 or 800-273-TALK (800-273-8255). If you are hearing impaired, call 800-799-4TTY (800-799-4889).
No matter what, if a medical provider or even a friend tells you that clinical depression is a normal part of aging that you have to live with, don’t stop seeking help. Severe depression is not normal and you don’t have to live with it. You can get help.
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