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Depression
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If You're Over 65 and Feeling Depressed...

Depression is a whole body disorder

Depression. The darkest moods. Feeling down, empty. Difficulty remembering. Many things just don't interest you any more. Aches and pains that keep coming back. Depression that goes on and on and on for weeks and months is called clinical depression.

Most people think of depression only as sadness and low mood, but clinical depression is far more than the ordinary "down" moods everyone experiences now and then, and which pass after a visit with a friend or a good movie.

Depression is also more than a feeling of grief after losing someone you love. Following such a loss, for many people, a depressed mood is a normal reaction to grief. And these people may find it helpful to join a mutual support group, such as widowed-persons, to talk with others experiencing similar feelings.

However, when a depressed mood continues for some time, whether following a particular event or for no apparent reason, the person may be suffering from clinical depression--an illness that can be treated effectively.

Clinical depression is a whole body disorder. It can affect the way you think and the way you feel, both physically and emotionally.

It isn't "normal" to feel depressed all the time when you get older; in fact, most older people feel satisfied with their lives. Nonetheless, among people 65 and over, as many as 3 out of 100 suffer from clinical depression. It can be serious and can even lead to suicide.

But there is good news. Nearly 80 percent of people with clinical depression can be treated successfully with medications, psychotherapy, or a combination of both. Even the most serious depressions usually respond rapidly to the right treatment. But first, depression has to be recognized.

Types of Clinical Depression

Two serious types of clinical depression are major depression and bipolar disorder.

• Major Depression:
• 
  Major depression makes it almost impossible to carry on usual activities, sleep, eat, or enjoy life. Pleasure seems a thing of the past. This type of depression can occur once in a lifetime or, for many people, it can recur several times. People with a major depression need professional treatment.
• Bipolar Disorder (Manic-Depressive Illness):
• 
  Another type of depression, bipolar disorder--or manic-depressive illness--leads to severe mood swings, from extreme "lows" to excessive "highs." These states of extreme elation and unbounded energy are called mania. This disorder usually starts when people are in their early twenties. Though unusual for this type of depression to start for the first time in later life, it requires medical treatment, whatever the person's age.

A Depression Checklist

Check any symptoms experienced for more than 2 weeks. If four or more of the symptoms for depression or mania have been checked, physical and psychological evaluation by a physician and/or mental health specialist should be sought.

Symptoms of Depression:

• A persistent sad, anxious or "empty" mood
• Loss of interest or pleasure in ordinary activities, including sex
• Decreased energy, fatigue, feeling "slowed down"
• Sleep problems (insomnia, oversleeping, early-morning waking)
• Eating problems (loss of appetite or weight, weight gain)
• Difficulty concentrating, remembering, or making decisions
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness
• Thoughts of death or suicide; a suicide attempt
• Irritability
• Excessive crying
• Recurring aches and pains that don't respond to treatment

If someone has recently experienced a loss, these feelings may be part of a normal grief reaction. But, if the feelings persist with no lifting mood, the person may need professional treatment.

Symptoms of Mania:

These symptoms may range from moderate to severe. When mania is moderate, only people close to the affected person may be able to spot the symptoms.

• Excessively "high" mood
• Irritability
• Decreased need for sleep
• Increased energy
• Increased talking, moving, and sexual activity
• Racing thoughts
• Disturbed ability to make decisions
• Grandiose notions
• Being easily distracted

Depression and Other Illnesses

Sometimes clinical depression can look like other illnesses with symptoms such as headaches, backaches, joint pain, stomach problems, or other physical discomforts. Older people, when depressed, often speak of these problems rather than of feeling anxious, tired, or sad.

Some signs of depression, such as memory lapses and difficulty concentrating, can mimic Alzheimer's disease or other medical disorders. Similar symptoms may also result from other physical problems or from medications commonly used by older people. Therefore, for a proper diagnosis, it is important to have a thorough medical examination to rule out other disorders.

If the symptoms are caused by depression, they will improve with the right treatment. Sometimes a person can have depression and another illness such as Alzheimer's disease at the same time. Even in such a case, treating the depression can relieve unnecessary suffering.

Causes of Depression

There are many causes of depression. Some people become depressed for a combination of reasons. For others, a single cause appears to trigger depression. Some become depressed for no apparent reason. Regardless of the cause, depression needs to be diagnosed and rated.

Some of the causes that are particularly important among older people are:

• Other Illnesses
• 
  Long-term or sudden illnesses can bring on or aggravate depression. Strokes, certain types of cancer, diabetes, Parkinson's disease, and hormonal disorders are examples of illnesses that may be related to depressive disorders.
• Medications
• 
  Some medicines cause depressive symptoms as side effects. Certain drugs used to treat high blood pressure and arthritis fall in this category. In addition, different drugs can interact in unforeseen ways when taken together. It is important that each doctor know all the different types and dosages of medicine being taken and discuss them with the patient.
• Genetics and Family History
• 
  Depression runs in families. Children of depressed parents have a higher risk of being depressed themselves. Some people probably have a biological make-up that makes them particularly vulnerable.
• Personality
• 
  Certain personalities--people with low self-esteem or who are very dependent on others--seem to be vulnerable to depression.
• Life Events
• 
  The death of a loved one, divorce, moving to a new place, money problems, or any sort of loss have all been linked to depression. People without relatives or friends to help may have even more difficulty coping with their losses. Sadness and grief are normal responses to loss, but if many symptoms of depression linger, professional help should be sought.

Help for Depression

One of the biggest obstacles to getting help for clinical depression can be a person's attitude. Many people think that depression will go away by itself, or that they're too old to get help, or that getting help is a sign of weakness or moral failing. Such views are simply wrong.

Depression is a treatable disorder. Even the most seriously depressed person can be treated successfully, often in a matter of weeks, and return to a happier and more fulfilling life. Such outcomes are a common story, even when people feel hopeless and helpless.

There are three major types of treatment for clinical depression:

1. psychotherapy,
2. medication, and,
3. in some cases, other biological treatments.

At times, different treatments may be used in combination.

Individuals respond differently to treatments. If after several weeks symptoms have not improved, the treatment plan should be reevaluated. Also, the procedures and possible side effects of all treatments should be fully discussed with the doctor.

People may find that mutual support groups are helpful when combined with other treatments.

Medication

There are many very effective medications, but the three types of drugs most often used to treat depression are tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), and lithium. Lithium is very effective in the treatment of bipolar disorder and is also sometimes used to treat major depression.

• All medications alter the action of brain chemicals to improve mood, sleep, appetite, energy levels, and concentration.
• Different people may need different medications, and sometimes more than one medication is needed to treat clinical depression.
• Improvement usually occurs within weeks.

Psychotherapy

Talking with a trained therapist can also be effective in treating certain depressions, particularly those that are less severe. Short-term therapies (usually 12-20 sessions) developed to treat depression focus on the specific symptoms of depression.

• Cognitive therapy aims to help the patient recognize and change negative thinking patterns that contribute to depression.
• Interpersonal therapy focuses on dealing more effectively with other people; improved relationships can reduce depressive symptoms.

Biological Treatments

Some depressions may respond best to electroconvulsive therapy. ECT is an effective treatment that is used in extremely severe cases of major depression when very rapid improvement is necessary, or when medications cannot be used or have not worked. Improved procedures make this treatment much safer than in previous years. During treatment, anesthesia and a muscle relaxant protect patients from physical harm and pain.

Research is also being done on the use of light for the treatment of depression.

Where to get help

Trained professionals in numerous settings diagnose and treat clinical depression:

Family physicians, clinics, and health maintenance organizations can provide treatment or make referrals to mental health specialists.

Mental health specialists include psychiatrists, psychologists, family therapists, and social workers. Psychiatrists can
prescribe antidepressant drugs because they are physicians.Other mental health specialists, however, often work with physicians to ensure that their patients receive the medications they need.

Community mental health centers, which often provide treatment based on the patient's ability to pay, usually have a variety of mental health specialists.

Hospitals and university medical schools may have research centers that study and treat depression.

Advocacy Organizations

National advocacy or consumer organizations provide information about depression, sources of treatment, and local community support groups:

American Association of Retired Persons (AARP)
Widowed Persons Services
Social Outreach and Support
601 E St. NW
Washington, DC 20049
(202) 434-2260

National Alliance for the Mentally Ill
200 N. Glebe Rd. Suite 1015
Arlington, VA 22203-3754
1-800-950-NAMI

National Depressive and Manic Depressive Association
730 North Franklin Street, Suite 501
Chicago, IL 60610
1-800-82-NDMDA

National Mental Health Association
1021 Prince Street
Alexandria, VA 22314-2971
1-800-969-NMHA

Information on Depression

For more information on depression, diagnosis, and treatments, write to the DEPRESSION Awareness, Recognition, and Treatment (D/ART) Program:

D/ART
National Institute of Mental Health
5600 Fishers Lane, Room 10-85
Rockville, MD 20857

or call:
1-800-421-4211
for a free brocure.

"If You're Over 65 and Feeling Depressed. Treatments Bring New Hope" was developed for the DEPRESSION Awareness, Recognition, and Treatment (D/ART) program. D/ART is a professional and public education program sponsored by NIMH in collaboration with private organizations and citizens. D/ART's goals include the alleviation of symptoms through effective treatment for the millions of Americans who suffer from depressive disorders each year. The program is based on more than 40 years of research on the diagnosis and treatment of depressive disorders. For more information about the D/ART Program, write: D/ART, NIMH, 5600 Fishers Lane, Room 10-85, Rockville, MD 20857.

This booklet was produced by the National Institute of Mental Health (NIMH), the U.S. Government agency that supports and conducts research to improve the diagnosis, treatment, and prevention of mental illness. NIMH-supported studies alleviate suffering and bring hope to people who have a mental disorder, to those who are at risk of developing one, and to their families, friends and coworkers. Thus mental health research benefits millions of Americans and reduces the burden that mental disorders impose on society as a whole. NIMH is part of the National Institutes of Health, a component of the U.S. Department of Health and Human Services.

Director
National Institute of Mental Health
All material appearing in this brochure is in the public domain and may be reproduced or copied without permission from the Institute; citation of the source is appreciated
U.S. Department of Health and Human Services
Public Health Service
National Institutes of Health
National Institute of Mental Health
NIH Publication No. 95-4033
Printed 1990, Revised and reprinted 1995
Bulk sales (Stock No. 017-024-01398-6) by the U.S. Government Printing Office, Superintendent of Documents, Mail Stop: SSOP, Washington, DC 20402-9328.

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