

             IF YOU'RE OVER 65 AND FEELING DEPRESSED. . . .

                     Treatment Brings New Hope

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                National Institute of Mental Health

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             U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

                        Public Health Service

          Alcohol, Drug Abuse, and Mental Health Administration

                 DHHS Publication No. (ADM)90-1653

                            Printed 1990

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Cover photographs -- courtesy of Aging Magazine and National
Institute on Aging.


"Depression that goes on and on and on for weeks and months is
called clinical depression."


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.


Learning is a life-long adventure.

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     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.

     Ann's daughter thought her 73-year-old widowed mother was
getting senile because she was so confused and forgetful. Ann
had seemed to recover well from the death of her husband three
years before, but lately she cried about him almost every day.
Her daughter arranged for Ann to see a geriatric specialist who
diagnosed Ann's condition as depression, not senility. He put
her on medication and suggested that she join a widow-to-widow
support group. Before long, Ann's memory improved along with
her mood.


"It isn't 'normal' to feel depressed all the time when you get
older; in fact, most older people feel satisfied with their
lives."


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.


Effective treatments are available.

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A DEPRESSION CHECKLIST


     Check any symptoms () experienced for more than two
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


"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."


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 fight 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.

A Healty life involves the joy of caring relationships.

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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.


"For a proper diagnosis, it is important to have a thorough
medical examination to rule out other disorders."


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.


Older people can gain satisfaction from new activities.

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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: psychotherapy, medication, and, 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.


"Different treatments may be used in combination."


Medication


     There are many very effective mediations, 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. Shortterm 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.


Most older people live active outgoing lives.

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

     For years, Tom had been looking forward to his
retirement--with more time to fish. But after the first few
months, not only had he stopped going fishing with his friends,
he often did not go out of the house for days. Tom also
complained to his wife about not sleeping well and about
different aches and pains each day. Fortunately, his wife took
him to a doctor who recognized Tom was depressed. After a few
weeks of treatment, Tom began to enjoy his retirement as much
as he had expected.


"Trained professionals in numerous settings diagnose and treat
clinical 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
1909 K Street, N.W.
Washington, D.C. 20049
(2O2) 7284370

National Alliance for the Mentally Ill
2101 Wilson Boulevard
Suite 302
Arlington, VA 22201
(7O3) 524-7600

National Depressive and Manic Depressive Association
53 w. Jackson Boulevard
Suite 505
Chicago, IL 60604
(312) 939-2442

National Mental Health Association
1021 Prince Street
Alexandria, VA 22314-2971
(703) 684-7722


INFORMATION ON DEPRESSION


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

D/ART Public Inquiries
National Institute of Mental Health
5600 Fishers Lane
Room 15C-05
Rockville, MD 20857


     "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 14C-02,
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 Alcohol, Drug Abuse, and Mental Health Administration, a
component of the U.S. Department of Health and Human Services.


Lewis L. Judd, M.D.
Director
National Institute of Mental Health

Alcohol, Drug Abuse, and Mental Health Administration

