Unusual Factors Producing Depression in the Elderly
by Lisa DiFalco
Depression can occur in populations without any previous history and can stem from grief, co-occurring conditions and medication. The affect displayed in the elderly makes diagnosis harder as seniors may become apathetic and irritable rather than sad and work to push through their feelings without seeking professional help. This population of American seniors with either a mental health condition or a substance abuse disorder, projected to grow to as much as 14 million by 2030, is often subject to conditions and medications that can play a factor in the development and progress of depressive symptoms and other mental health conditions. Healthcare providers, family members and friends can be the first to recognize unusual changes in behavior. Understand the less typical factors that can produce depressive symptoms in the elderly.
What Medical Problems Cause or Exacerbate Depression?
In How to Support Senior Citizens with Depression, the extent of the condition in the population and potential programs for treatment are discussed. However, more needs to be understood about the medical conditions and medications that can result in and worsen depression. Finding out the root cause of the condition helps in providing effective relief to older populations. There are a number of chronic conditions, often life-threatening or disabling, that are tied to producing or worsening depression symptoms. The following medical conditions can produce depression in aging populations:
- Multiple sclerosis
- Dementia and Alzheimer’s Disease
- Vitamin B12 deficiency
- Thyroid disorder
- Heart disease
- Parkinson’s disease
Those that recognize changes in behavior may want to inquire into a person’s history with such conditions, when appropriate, or facilitate an appointment for an affected person with a healthcare professional to properly diagnose all factors and medical conditions currently present and recommend a treatment program. Certain co-occurring conditions can increase the risk of death at an earlier age. A 2014 study from UCLA researchers showed that depressed seniors with diabetes had a 78 percent increase in experiencing an early death when compared to diabetics of comparable age without depression.
In addition, many are given prescription medications that may induce side effects including depression. Medications for other medical conditions that can cause symptoms of depression include:
- Estrogens such as Premarin and Prempro
- Painkillers and arthritis drugs
- High-cholesterol drugs including Lipitor, Mevacor and Zocor
- Steroids such as cortisone and prednisone
- Heart drugs containing reserpine
- Ulcer medication such as Zantac and Tagamet
- Medication for Parkinson’s disease
- Calcium-channel blockers
- Tranquilizers including Halcion, Xanax and Valium
- Sleeping pills
- Beta-blockers such as Lopressor and Inderal
- Blood pressure medication such as clonidine
Caregivers, family members and friends can help the individual compose a list of current medications and write down when the changes in behavior began to inform an individual’s physician. Changing a medication may help to alleviate the symptoms commonly associated with depression.
Overlap of Symptoms with Dementia
Both depression and dementia can develop in the elderly and both conditions can share some symptoms. Symptoms common in both depression and dementia include:
- Low motivation
- Sluggish speech and movement
- Memory problems
In either case, it is important to schedule an appointment with a health professional to determine the cause and appropriate treatment. Treatment can help an affected person to recover their energy, motivation and memory in those with depression. Effective treatment can also slow the progression of certain types of dementia.
A layperson can see symptoms of a medical condition and not know whether or not they are a result of depression or dementia. Some guidance includes:
- Rapid mental decline is a symptom of depression whereas gradual mental decline is often associated with dementia
- Knowledge of the correct time, date and where they are is seen in those with depression, but those with dementia become confused and can become lost in a familiar place
- Difficulty with concentration is seen in those with depression, whereas those with dementia often experience short-term memory problems
Affected individuals and those that notice the change in behavior should note down what they have seen or experienced to present to a healthcare professional. A discussion with a physician should include the changes in behaviors, potential onset of the changes, a list of all medications and supplements and any questions to adjust treatment and hopefully alleviate the symptoms of depression or reduce the progress of dementia.
Help for Seniors with Depression
Antidepressant medications are often suggested for those with depression. A number of medications can improve mood and reduce levels of stress. Types of antidepressants include monoamine oxidase inhibitors, tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors and unique antidepressants such as Bupropion and Mirtazapine.
All medications produce side effects and now carry black box warnings required by the FDA. Patients of any age that take an antidepressant should be monitored closely for the first few weeks. Side effects from nausea, weight gain, sexual problems to seizures, heart problems or suicidal thoughts may occur from use of a specific antidepressant. Anti-depressants may pose challenges for this population: side effects may be more harmful to seniors; there is an increase in potential drug interactions with seniors on multiple prescribed medications; and drugs may work slower in seniors.
For seniors that are severely depressed or feel suicidal, the National Suicide Prevention Lifeline can be contacted at 1-800-273-TALK (8255). The National Institute of Mental Health offers a free booklet, “Depression: What You Need to Know,” offering an overview on depression and covering the various populations that can be affected by depression. It is possible to download a copy or order a free hardcopy for review.
Case managers, health professionals, and delivery of services through “high-touch, high tech” methods can identify and provide additional methods of treatment to seniors with depression. There is more that needs to be understood about proper identification of depression and effective treatment of depression among the elderly.