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Depression Health Center

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Elderly Depression Often Unnoticed

Tough to Diagnose

Treatment With Antidepressants

Both Julia and Al went to their primary care physicians for treatment. Both got complete physical exams and laboratory workups.

Julia chose to try antidepressant medication and asked her doctor to refer her for psychotherapy, as these had both worked well for her when she had become depressed in the past -- after the death of her sister 30 years ago and then again after she retired from teaching third grade. The doctor was also able to improve the treatment of Julia's arthritis, and with her niece's help she began to increase her social and physical activity.

Al's doctor referred him to a psychiatrist. Like Julia, he decided to try antidepressant medication. He also joined a support group for retired men run by his senior center, which he enjoyed a lot.

Choosing an antidepressant for an older patient can be complex. They're often already on many different medications for other medical problems. Doctors need to take into account drug interactions and side effects and the slower metabolisms of older patients when considering which antidepressant drug to choose.

This is why, if you're an older patient, it's especially important to let your doctor know about all medications you're taking -- including vitamins, herbs, supplements, and over-the-counter drugs. And it's important to remember that all antidepressants can take from four to six weeks to provide relief and that they have to be taken as prescribed in order to work.

'Start Low, Go Slow'

There are many more antidepressants available now than 10 or 15 years ago. The most commonly prescribed class of antidepressants is the selective serotonin reuptake inhibitors (SSRIs), which include

  • Prozac (fluoxetine)
  • Zoloft (sertraline)
  • Paxil (paroxetine)
  • Celexa (citalopram)

Celexa, the newest, is especially useful because it has fewer drug interactions than the others.

Common side effects of SSRIs include jitteriness, insomnia, and sexual dysfunction. Most of the time, though, these side effects are mild, and a doctor can help reduce them and even prevent many of them by simply following a guiding principle of geriatric medicine: "Start low and go slow."

Psychotherapy is also an important treatment for depression, though it is often overlooked in older patients. Whether someone is sad about the past or the present, having a trained professional to listen and provide support can be extremely important.

Besides all of the treatments mentioned above, both social and physical activities are essential. Both Julia and Al found ways to add activities to their routine as they began to recover from their depressions. With treatment, they were both able to be productive members of their families and communities again.

Rebecca Lundquist, MD, is a staff psychiatrist in the department of psychiatry of Beth Israel Deaconess Medical Center and an instructor in psychiatry at Harvard Medical School.

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