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Depression In the Elderly

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What Are Risk Factors for Depression In the Elderly? continued...

Physical conditions like stroke, hypertension, atrial fibrillation, diabetes, cancer, dementia, and chronic pain further increase the risk of depression. Additionally, the following risk factors for depression are often seen in the elderly:

  • Certain medicines or combination of medicines
  • Damage to body image (from amputation, cancer surgery, or heart attack)
  • Family history of major depressive disorder
  • Fear of death
  • Living alone, social isolation
  • Other illnesses
  • Past suicide attempt(s)
  • Presence of chronic or severe pain
  • Previous history of depression
  • Recent loss of a loved one
  • Substance abuse

Brain scans of people who develop their first depression in old age often reveal spots in the brain that may not be receiving adequate blood flow, believed to result from years of high blood pressure. Chemical changes in these brain cells may enhance the likelihood of depression separate from any life stress.

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 or other newer forms of brain stimulation (such as repetitive transcranial magnetic stimulation (rTMS)). 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 have endured major life stresses (such as loss of friends and family, home relocations, and health problems) or who prefer not to take medicine and have only 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.

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