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Friday, October 4, 2013

Be Aware: 7 Things to Know About Depression for adults over 65



The bad news: Millions of Americans over age 65 struggle with undiagnosed depression, and their suicide rates are high. The good news: When depression is diagnosed, therapy works


by Jodi Helmer, AARP, 

Consider: More than 6.5 million adults over age 65 struggle with depression, but fewer than 10 percent receive treatment.


Consider: More than 6.5 million adults over age 65 struggle with depression, but fewer than 10 percent receive treatment.


Add that suicide rates among older adults are up to seven times higher than in other age groups, and you can understand why finding some relief in any way — be it antidepressants or talk therapy — could prove life-saving.


But there's a problem. Doctors often miss the signs of depression in people 65-plus because the symptoms are different in younger patients. Instead of feeling sad or blue, seniors are apt to feel irritable or tired, have trouble sleeping, lose their appetite and be unable to concentrate, new research published in the Journal of Applied Gerontology finds.


In fact, Helen C. Kales, M.D., professor of psychiatry and researcher at the Veterans Affairs Ann Arbor Healthcare System, says research shows that up to 40 percent of older patients with depression — that's 2.6 million people — may have such symptoms. No wonder it's so much harder to diagnose depression in older adults.


But that's not a call for inaction. There are steps we can take to help both those suffering from depression and their friends or family members — if we know what to look for. Here are seven key things to keep in mind about this increasingly common condition:


1. You can get a free diagnosis


Depression screening is one of the free services offered under the Welcome to Medicare visit provided through the Affordable Care Act, and mental health experts say it's helping more older patients get treatment. In 2000, research showed that fewer than 25 percent of patients over age 65 with probable depression received a diagnosis and treatment, but by 2007 that had jumped to nearly 52 percent.


The increase in screening, says Mayo Clinic psychiatrist William Bobo, M.D., reflects a growing awareness that major depression is a common but treatable disorder in older people. Screening tools in a doctor's office "can give people a way to get the treatments they need to stop suffering."


2. Antidepressants aren't always the answer


Antidepressant use has skyrocketed — jumping 400 percent between 1988 and 2008, according to the National Center for Health Statistics — but they're far from a sure bet in beating depression.


While meds can be effective, "the belief that medications will solve the problem is too simple. Depressed patients who take medication and do nothing else are not very likely to have a full, lasting recovery," says psychologist Stephen Ilardi, Ph.D., associate professor of clinical psychology at the University of Kansas and author of The Depression Cure.


The other depressing news about antidepressants is that research shows they often don't perform any better than a placebo. And there's been little progress in developing new drugs. In 2010, GlaxoSmithKline, the pharma giant that makes antidepressants such as Paxil, stopped researching new drugs for depression.


To complicate matters, older adults are at higher risk for side effects from antidepressants, such as increased danger of falling and loss of bone density, as well as drug interactions with their other meds.


And Bobo cites another reason that finding the right medication may become trickier with age: Age changes a patient's ability to metabolize medication, and that increases susceptibility to side effects.


Mixed results with antidepressants have led researchers to explore other treatments for depression, including electromagnetic pulses to stimulate the brain.


Probably the simplest, healthiest and most effective treatment for depression in older adults is exercise, according to a 2013 study in the British Journal of Psychiatry. Going for a brisk walk every day, hitting the driving range or signing up for a dance class can be a natural mood elevator.


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