Beating the blues
Dealing with depression is a serious matter and some seniors as well as family members may be in denial.
BY: Eleanor Yap
Depression is a condition many seniors are dealing with and sadly, some as well as their family members may be in denial. The statistics show the situation should not be ignored – according to the National University Health System (NUHS) survey last year, close to one in five of 412 elderly surveyed showed signs of depression. They were all aged 75 and above, and living at home. These numbers will likely increase with a growing ageing population.
This also could cause a spike in suicide rates. According to “The Straits Times” article, 41 people aged 75 and above killed themselves in 2010, compared to 2006 (the latest year for which data is available) when it was 34.
Ageless Online finds out more about depression from Dr Nelson Lee, medical director and psychiatrist of The Psychological Wellness Centre:
What are some common reasons older adults and the elderly suffer from depression?
The big issue could be loss – loss of physical function, loss of partners and friends, and loss of previous role as a breadwinner. Patients with chronic debilitating illnesses especially painful ones are also more prone to depression.
What are the signs and symptoms of depression?
Five or more of the following symptoms, one of which is depressed mood or anhedonia, must be present for at least two weeks for it to be called depression:
- Depressed mood.
- Loss of pleasure in usual activities (anhedonia).
- Feelings of worthlessness or inappropriate guilt.
- Inability to concentrate.
- Fatigue or loss of energy.
- Insomnia or hypersomnia (excessive tiredness).
- Psychomotor agitation or retardation.
- Significant weight loss or gain.
- Recurrent thoughts of death or suicide.
Can this often be grief? How does one differentiate from the two?
Grief has several symptoms in common with major depressive disorder including sadness, insomnia, poor appetite and weight loss. Where they differ is that grief tends to be trigger-related. In other words, the person may feel relatively better while in certain situations, such as when friends and family are around to support them. But triggers, like the deceased loved one’s birthday could cause the feelings to resurface more strongly. Major depression, on the other hand, tends to be more pervasive, with the person rarely getting any relief from their symptoms. Grief is also seldom accompanied by suicidal ideations.
What are some medications that may cause or worsen depression?
- Anticonvulsants – these are used to control epileptic seizures.
- Benzodiazepines – this group of central nervous system depressants is often used to treat anxiety and insomnia, and to relax muscles. Examples: Ativan, Dalmane, Halcion, Klonopin, Librium, Valium and Xanax.
- Beta-adrenergic blockers – also known as beta-blockers, these medicines are used to treat various heart problems, including high blood pressure. Examples: Propranolol and Atenolol.
- Bromocriptine – this medicine treats Parkinson’s disease.
- Estrogens – this class of female hormones is often used in hormone replacement therapy (HRT) to treat menopause symptoms and to prevent or treat osteoporosis. Example: Premarin.
- Fluoroquinolone antibiotics – examples: Cipro and Floxin.
- Interferon alfa – this drug is used to treat certain cancers as well as Hepatitis B and C.
- Opioids – this group of narcotics is used to relieve moderate to severe pain. These drugs have a high potential for abuse and addiction. Examples: codeine, morphine and OxyContin.
- Statin – these medicines are used to lower cholesterol and protect against damage from coronary artery disease, and prevent heart attacks. Examples: Zocor and Lipitor.
- Zovirax – doctors prescribe this drug to treat shingles and herpes.
Why are older adults more sensitive to these side effects?
The metabolism in the elderly is likely lower and brain reserves may also be diminished, hence they are more sensitive to these potential side effects.
I also understand dementia and depression share similar symptoms. How do you tell them apart?
Depression may look like a condition known as pseudodementia that occurs in depression. The history of disturbance in pseudodementia is often short and abrupt onset, while dementia is more often insidious. Clinically, people with pseudodementia differ from those with true dementia when their memory is tested. They will often answer that they don’t know the answer to a question, their attention and concentration are often intact, and they may appear upset or distressed. Those with true dementia will often give wrong answers, have poor attention and concentration, and appear indifferent or unconcerned.
Do you think that depression is often overlooked by the senior as well as his or her family members and why?
Yes, the onset is often insidious; there is also stigma and patients and their family often go into denial of the symptoms.
What are some things older adults and elderly can do to help themselves?
Keeping fit by exercising helps. Also it is good to be part of a social group and have more interaction and support. A hobby helps keep up one’s interest and even volunteering would help give a sense of purpose.
Antidepressants are a very effective choice in treatment. Most patients with clinical depression would expect to see improvements in two to four weeks. There are usually no long-term side effects but some people may find some short-term symptoms such as sedation, gastric discomfort or headaches. These tend to get better after the first few weeks of treatment.
What about alternative medicine like Omega-3, St John’s Wort, folic acid, etc?
St John’s Wort is a mild herbal antidepressant and may be helpful in mild depression. Omega-3 is useful as an add-on.
What about counselling and therapy, as well as support groups?
These are useful for milder depression or in combination with medical treatment.
How long does it usually take for someone to get out of their funk? Could they regress?
It can take several weeks to several months, actually most patients who come for treatment continue usually to get well. Occasionally, patients do relapse if stressors become high again. About a third may have another episode. For the second episode, we would treat with medications for about one to two years and if there are more than two relapses, long-term treatment may be recommended.
What can family members do to support their loved ones with depression?
Be as supportive as they can, listen when the patient wants to talk but don’t force them to. Avoid saying “be strong’” and “don’t think so much” as this is a disease that the patient has little control over. Encourage them to seek medical care.