Depression In the Elderly
What Treatments Are Available for Depression In the Elderly?
There are several treatment options available for depression. They include medicine, psychotherapy or counseling, or electroconvulsive therapy. Sometimes, a combination of these treatments may be used.
How Do Antidepressants Relieve Depression In the Elderly?
Most of the available antidepressants are believed to be equally effective in elderly adults. But the risk of side effects or potential reactions with other medicines must be carefully considered. For example, certain older antidepressants such as amitriptyline and imipramine can be sedating or cause a sudden drop in blood pressure when a person stands up. That can lead to falls and fractures.
Antidepressants may take longer to start working in older people than they do in younger people. Since elderly people are more sensitive to medicines, doctors may prescribe lower doses at first. In general, the length of treatment for depression in the elderly is longer than it is in younger patients.
Can Psychotherapy Help Relieve Depression In the Elderly?
Most depressed people find that support from family and friends, involvement in self-help and support groups, and psychotherapy are helpful. Psychotherapy is especially beneficial for those who prefer not to take medicine and who have mild to moderate symptoms. It also is helpful for people who cannot take drugs because of side effects, interactions with other medicines, or other medical illnesses.
Psychotherapy in older adults can address a broad range of functional and social consequences of depression. Many doctors recommend the use of psychotherapy in combination with antidepressant medicines.
When Is Electroconvulsive therapy (ECT) Used?
ECT can play an important role in the treatment of depression in older adults. When older patients are unable to take traditional antidepressant medicines because of side effects or interactions with other medications, or when depression is very severe and interferes with basic daily functioning (such as eating, bathing and grooming), ECT is often a safe and effective treatment alternative.
What Problems Affect Treatment of Depression In the Elderly?
The stigma attached to mental illness and psychiatric treatment is even more powerful among the elderly than among younger people. This stigma can keep elderly people from acknowledging that they are depressed, even to themselves. Elderly people and their families sometimes also may wrongly misidentify depression symptoms as "normal" reactions to life stresses, losses, or the aging process.
Also, depression may be expressed through physical complaints rather than traditional symptoms. This delays appropriate treatment. In addition, depressed older people may not report their depression because they believe there is no hope for help.
Elderly people may also be unwilling to take their medicines because of side effects or cost. In addition, having certain other illnesses at the same time as depression can interfere with the effectiveness of antidepressant medicines. Alcoholism and abuse of other substances may cause or worsen depression and interfere with effective treatment. And unhappy life events including the death of family or friends, poverty, and isolation may also affect the person's motivation to continue with treatment.