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Depression In the Elderly

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Clinical depression in the elderly is common. That doesn't mean it's normal. Late-life depression affects about 6 million Americans age 65 and older. But only 10% receive treatment for depression. The likely reason is that the elderly often display symptoms of depression differently. Depression in the elderly is also frequently confused with the effects of multiple illnesses and the medicines used to treat them.

How Does Depression In the Elderly Differ From Depression in Younger Adults?

Depression impacts older people differently than younger people. In the elderly, depression often occurs with other medical illnesses and disabilities and lasts longer.

Depression in the elderly often increases their risk of cardiac diseases. Depression doubles an elderly person's risk of cardiac diseases and increases their risk of death from illness. At the same time, depression reduces an elderly person's ability to rehabilitate. Studies of nursing home patients with physical illnesses have shown that the presence of depression substantially increases the likelihood of death from those illnesses. Depression also has been associated with increased risk of death following a heart attack. For that reason, making sure that an elderly person you are concerned about is evaluated and treated is important, even if the depression is mild.

Depression also increases the risk of suicide, especially in elderly white men. The suicide rate in people ages 80 to 84 is more than twice that of the general population. The National Institute of Mental Health considers depression in people age 65 and older to be a major public health problem.

In addition, advancing age is often accompanied by loss of social support systems due to the death of a spouse or siblings, retirement, or relocation of residence. Because of changes in an elderly person's circumstances and the fact that elderly people are expected to slow down, doctors and family may miss the signs of depression. As a result, effective treatment often gets delayed, forcing many elderly people to struggle unnecessarily with depression.

How Is Insomnia Related to Depression in the Elderly?

Insomnia is usually a symptom of depression. New studies reveal that insomnia is also a risk factor for depression onset and recurrence -- particularly in the elderly.

To treat insomnia, experts sometimes recommend the newer "hypnotic" drugs (such as Ambien or Lunesta) that are safer than older benzodiazepines (such as Ativan or Klonopin or Xanax) and effective in elderly people. Some antidepressants also can be sedating (such as Remeron) and are sometimes prescribes for both purposes.  If there's no improvement in the sleep disorder or depression, a psychiatrist or psychopharmacologist may prescribe medications, psychotherapy, or both.

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