March 16, 2005 -- Elderly people who get treated for depression appear to benefit physically, as well as mentally.
Depression is "a common problem and it's treatable" in senior citizens, says Christopher Callahan, MD, of Indiana University's medical school, a specialist in research on aging.
"When we say it's treatable, we're suggesting that not only the depression symptoms themselves are treatable, but that it may also be accompanied with improved physical function," Callahan tells WebMD.
Callahan and colleagues have new evidence of that. They've just reported their results from a year-long study of about 1,000 depressed senior citizens nationwide. The findings showed improved physical function with depression treatment.
If you or someone you know is concerned with depression in old age, the study had several key findings. "First, it shows that even older adults with failing physical health can be successfully treated for depression. Second, it shows that treating the depression also helps slow the physical decline," they write in a news release.
It boils down to this:
- Get help
- Try the patient's primary care physician
- Consult the patient about treatment options
- Look for physical and mental improvement
- Be persistent
- Be sensitive to generational differences
"Once the concern is there, the best approach is to accompany that older adult to visit their primary care physician and raise the issue very directly," he tells WebMD.
Don't write off depression to the trials of old age or poor health. Depression is often a separate illness that's fixable, even when other conditions are also present, says Callahan.
Try the Patient's Primary Care Doctor
Some elderly people may feel more comfortable discussing depression with their regular doctor than with a psychiatric specialist, says Callahan.
"Older adults seem to prefer treatment for these common mental illnesses from their primary care physician," he says. Of course, there's nothing wrong with going to a specialist, if the patient is open to it. What matters is getting treatment from whomever the patient prefers.
Ask the Patient About Depression Treatment Choices
Give older patients a choice about what approach they would prefer to try first -- talk therapy or prescription antidepressants, suggests Callahan.
The patients in his study didn't have a clear preference. However, "we were surprised by the number who chose psychotherapy first," says Callahan. "I think that's an important lesson for us -- that a lot [of older people] would prefer to at least try that route first."
Look for Physical and Mental Results
In Callahan's study, half of the participants were assigned to depression specialists. The rest received standard care without a specialist.
The specialists coordinated depression treatment, working with the participants' primary care doctors. The specialists could also deliver talk therapy. "They were sort of one-stop shopping for depression [treatment]," says Callahan.
Patients assigned to specialists were more likely to improve in overall physical functioning and typical tasks of daily life, says Callahan. Specifically, managing money and managing medications improved.
"Those two [tasks] primarily explain the difference," says Callahan. Handling money and medications takes a higher level of thought than chores such as using a phone or bathing, he notes.
The findings came from patients' answers to well-accepted surveys of physical function, quality of life, and tasks of daily living.
In terms of depression symptoms, about half of the group assigned to depression clinical specialists improved significantly. So did 20% of the participants who didn't have a depression clinical specialist.
Physical function gains stood out in those whose depression improved, whether they had been assigned to a depression clinical specialist or not, says Callahan.
Sometimes, it takes a little time to find the right treatment. Keep trying until something works, says Callahan.
"If the first attempt at a treatment hasn't worked in the first six to 12 weeks, you need to try something else," he tells WebMD. "Stay with the idea that 'I might not get it right the first time, but as I pick alternatives, something is going to be able to get this person better.'"
Be Sensitive to Generational Differences
Depression is widespread in America in all age groups, affecting nearly 19 million people per year, according to the National Institute of Mental Health.
Many people never get help. But some of the reasons might be a bit different for senior citizens, Callahan suggests. They're more likely to be facing other health problems, and their views about mental illness may have been formed long ago.
"Older people lived through an era when mental illness was viewed as irreversible," says Callahan. "Then, they lived through an era where it was treatable, but the treatments had serious side effects. Now, we're in an era with treatments that are effective and have less severe side effects."
Of course, antidepressant medicines aren't totally trouble-free today, but they've come a long way over the years.
The findings could translate into how patients are treated for depression, says Callahan. If it's not practical for health care providers to hire a depression clinical specialist, similar strategies could help, he says. "Make an explicit diagnosis, allow negotiation with the patient, and ... try something else [if the first attempt doesn't work]."
The study appears in the March issue of the Journal of the American Geriatrics Society.