Undoing Depression

Many treatment options exist for elderly depression.

Your dad, 66 years old and a retired widower, lives alone. Lately, he has bailed out of his weekly card games and no longer sees his friends.

Could It Be Depression?

Possibly. Given enough stress, anyone will develop depression, says George Grossberg, M.D., the Samual Fordyce Professor and Director of the Division of Geriatric Psychiatry at St. Louis School of Medicine. So perhaps it's no surprise that depression appears to affect between 13 and 27% of people 65 and older, and an even higher percentage of those confined to hospitals and nursing homes.

Underlying the Depression

"It's a major challenge to adapt to this final stage of life," says Grossberg. "For many there is no family around, there are financial worries, there is the loss of loved ones and friends. It's also a time of life when people reminisce and review their lives. Normally this is healthy, but some people are not able to accept their life as they lived it and their self-esteem plummets."

"If you think about it," adds Mary Pipher, Ph.D., a Lincoln, Neb., psychotherapist and author of Another Country: The Emotional Terrain of Our Elders (Riverhead Books, 1999), "they're really trauma victims. Many have lost their mates, friends, health, habits, and homes."

Researching her book led Pipher to conclude that many of the "old-old," the term she uses for those elderly people who have begun to lose their health, are depressed because of changes in our society. People are living longer, but often they live far away from their families. Grandma no longer has a room in the family home or a role to play tending the baby or preparing family meals. Instead, she lives by herself, isolated, lonely, and with little opportunity to feel useful or important in a youth-oriented culture.

"We're not nearly empathic enough toward our old-old,'' Pipher says. "We can understand somewhat our 14-year-olds because we can remember what it was like to be 14. But we've never been 85," she says, and "just contemplating what old age may be like makes us anxious."

The culture's emphasis on independence makes old age a particularly undignified experience. Our elderly may no longer be able to walk or drive, which makes them feel burdensome.

"What we must do individually and as a culture is figure out ways of saying, 'It's an honor for us to care for you,''' Pipher says.

Treatment Choices

If the interplay of biology, psychology, and society all play a role in the development of depression in the elderly, it makes sense that curing depression must take them all into account.

A physician may recommend antidepressant medication along with psychotherapy. Depression in the elderly is usually treated over a six- to 12-month period, says Charles Reynolds III, M.D., a professor of psychiatry and neuroscience at the University of Pittsburgh Medical Center. In his study, published in the January 5, 1999 issue of the Journal of the American Medical Association, Reynolds found that using both medication and therapy prevented recurrence in 80% of patients over a three-year period.

Pipher believes psychotherapy works best in elderly people who are lonely, verbal, and willing to try something new -- which, she acknowledges, doesn't often fit the profile of a depressed person. "Those elders for whom it has worked best in my experience have been bright but lonely, so the relationship with me was important to them,'' she says. "They treat me more like their daughter than a therapist."

Beyond Traditional Treatments

Medication and therapy may not be best for every one. "I pushed my mother, who had worked as a doctor, into therapy, when what she really needed was a sense of being useful and important in the community,'' Pipher says. ''I should have suggested getting involved in a program in the school where she was a reading buddy to a child, or doing more work with the senior center."

Depending on the level of depression, a variety of activities might help. Joining a support group (ask a physician for a referral) or helping to coach a sports team are some possible activities. Having pets and gardening can also ease mild depression, Pipher finds. "The trick is to connect older people to things they love and to let them feel useful,'' she says.