Subject Contents

Depression - elderly

Depression is a medical illness characterized by persistent sadness , discouragement , and loss of self-worth. These feelings are accompanied by reduced energy and concentration, sleep problems (insomnia), decreased appetite and weight loss. In the elderly, it also frequently presents with excessive concerns about bodily aches and pains.
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Alternative Names

Causes, incidence, and risk factors
Detecting depression in the elderly may be complicated by several factors. Often the symptoms of depression such as fatigue , loss of appetite , and sleeping difficulties are associated with the aging process or a medical condition rather than with major depressive disorder . Contributing factors include the loss of a spouse or close friends, chronic pain and illness, difficulty with mobility, frustration with memory loss , difficulty adapting to changing circumstances such as moving from a home to a retirement facility, or changes within the family. depression can also be a sign of a medical problem. It may be complicated by brain disorders associated with the aging process such as Alzheimer's disease . depression in the elderly is a widespread problem that is often not diagnosed and frequently undertreated. Many older individuals will not admit to signs and symptoms of depression for fear of being seen as weak or crazy.
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  • depressed or irritable mood
  • feelings of worthlessness or
  • sadness
  • loss of interest or pleasure in daily activities
  • temper,
  • agitation
  • change in appetite
  • , usually a
  • loss of appetite
  • change in weight
  • unintentional
  • weight loss (most frequent)
  • weight gain
  • difficulty sleeping
  • daytime
  • sleepiness
  • difficulty falling asleep
  • (initial insomnia)
  • multiple awakenings through the night (middle
  • insomnia )
  • early morning awakening (terminal insomnia)
  • fatigue
  • (
  • tiredness or weariness )
  • difficulty concentrating
  • memory loss
  • abnormal thoughts, excessive or inappropriate guilt
  • excessively irresponsible behavior pattern
  • abnormal thoughts about death
  • thoughts about
  • suicide
  • plans to commit suicide or actual suicide attempts
  • If these symptoms are present every day for more than 2 weeks, then depression is likely present.
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    Signs and tests
  • a
  • physical examination will help determine if there is a medical illness causing the depression
  • psychological evaluation
  • blood tests: CBC or blood differential, thyroid function tests, liver or kidney function tests
  • a variety of other tests may be indicated
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    Sometimes depression can be alleviated by social interventions to help with isolation or loneliness such as group outings, volunteer work for the healthy elderly, or regular visits from concerned people. Treatment of underlying medical conditions or the discontinuation of certain medications may alleviate symptoms. Antidepressant drug therapy has been shown to increase quality of life in depressed elderly patients. These medications are carefully monitored for side effects, and doses are usually lower and increased slower than in adults. Neuroleptic medications may help treat agitation in some individuals. Electroconvulsive therapy (ECT) may be indicated in the severely depressed if other measures are unsuccessful.
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    Support Groups

    Expectations (prognosis)
    If detected, depression may respond to medical treatment. Undetected, it may lead to complications. The outcome is usually worse for those who have limited access to social services, or family or friends who can help promote an interest in activities.
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    Depression may be complicated by Alzheimer's disease or other forms of dementia. It may also complicate other medical conditions in the elderly. Untreated Depression '>Depression in the elderly is associated with a high rate of suicide.
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    Calling your health care provider
    Call your health care provider if you are feeling worthless or hopeless or if you are crying frequently. Also call if you feel that you are having difficulty coping with stresses in your life and want a referral for counseling. Go to the nearest emergency room or call your local emergency number (such as 911) if you are having thoughts of suicide or of taking your own life. If you are caring for an aging family member and think they might be suffering from depression, contact their health care provider. Often, older patients will not admit to signs and symptoms of depression out of pride.
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    Prevention is related to the contributing factors. Social supports that help deal with losses, mobility changes, and so on can be helpful. In many cases, there is no effective prevention.
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    Depression signs in teenagers


    Alternative Names
    Teenagers and depression
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    Question: What are some serious signs of teenage depression ? Answer: A change in appetite and sleep patterns, loss of interest or enjoyment in usual activities, prolonged sadness , withdrawal from friends, feelings of worthlessness, lack of energy, and poor school performance are all signs that should alert you to a problem that may need professional counseling (especially if they persist and don't respond to encouragement). See depression .
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    Depression - resources


    Alternative Names
    Resources - depression
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    The following organizations are good resources for depression : American Psychological Association 750 First Street N.E. Washington, D.C. 20002-4242 (800) 374-2721 (202) 336-5510 www.apa.org American Psychiatric Association 1400 K Street N.W. Washington, D.C. 20005 (888) 357-7924 www.psych.org Depression and Bipolar Support Alliance (formerly the National Depressive and Manic-Depressive Association) 730 N. Franklin St., Suite 501 Chicago, Illinois 60610-7204 (800) 826-3632 www.ndmda.org Additional resources can be found through local libraries, your health care provider, and the yellow pages under "social service organizations."
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    Feelings of depression are synonymous with feeling sad, blue, down in the dumps, unhappy, and miserable. Depression is a term that people commonly use to refer to states involving sadness, dejection, lack of self-esteem, and lack of energy. In this overview, several types of depression are identified: *Depressed mood: An emotional state dominated by feelings of sadness, gloominess, or emptiness, which may be associated with lack of energy. This mood state may be a temporary response to an unhappy or stressful event, or it may be persistent. *Chronic low-grade depression, also known as dysthymia: Depressed mood is present most of the time for a period of two years, and is accompanied by changes in energy, appetite, or sleep, as well as low self-esteem and feelings of hopelessness. These symptoms cause distress and difficulty in functioning, but are not as severe as in major depression '>major depression (see dysthymia for further information). People who suffer from dysthymia are at increased risk for episodes of major depression. This produces a situation in which mild depression is present most of the time, with occasional periods of more severe depressive symptoms. This is commonly called "double depression." *Major depression: Severe, persistent depressed mood and loss of interest or pleasure in normal activities, accompanied by decreased energy, changes in sleep and appetite, and feelings of guilt or hopelessness. These symptoms must be present for at least two weeks, cause significant distress, and be severe enough to interfere with functioning. If the depression is very severe, it may be accompanied by psychotic symptoms or by suicidal thoughts or behaviors (see major depression '>major depression for more information). See also major depression '>major depression ; depression in the elderly and adolescent depression .
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    Alternative Names
    Blues; Dejection; Discouragement; Gloom; Mood changes; Sadness
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    Most feelings of depression are a reaction to an unhappy event. It is natural to have some feelings of sadness after a loss such as the death of a relative, or after a major disappointment at home or at work. Depression is more prevalent in women than men and is especially common among adolescents. Mild depression comes and goes and is characterized by downheartedness, sadness, and dejection. Short-term episodes of depression or other mood changes can occur with hormone changes, including those that accompany pregnancy or premenstrual syndrome (PMS) , and those occurring shortly after the birth of a baby (postpartum "blues"). Sleep disruption and lack of sunlight during the winter months are other biological factors that can precipitate depressive symptoms. Distorted thought patterns, characterized by feelings of worthlessness, helplessness, and hopelessness are part of the "cognitive triad of depression," and can be a risk factor for depression. It appears that a tendency toward depression is often genetic, but that stressful life circumstances usually play a major role in bringing on depressive episodes. Problems with depression usually begin in adolescence, and are about twice as common in women as in men. Noticeably disturbed thought processes, poor communication and socialization, and sensory dysfunction indicate moderate depression. People with severe depression are withdrawn, indifferent toward their surroundings, and may show signs of delusional thinking and limited physical activity .
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    Common Causes
  • loss of a friend or relative
  • substantial disappointment at home or at work
  • prolonged or
  • chronic illness or pain
  • medical conditions, such as hypothyroidism, cancer, or hepatitis
  • drugs such as tranquilizers,
  • high blood pressure medications, steroids (prednisone), codeine, and indomethacin
  • alcohol intoxication
  • alcohol withdrawal
  • drug intoxication
  • drug withdrawal
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    Home Care
    For mild depressive symptoms, improving health habits to provide adequate and regular sleep and good nutrition may bring relief. Regular exercise is also helpful. Decreasing the use of alcohol and other drugs is also recommended, since these can aggravate depressive symptoms. Involvement in healthy pleasures such as recreation and creative activities, and staying involved with family and friends helps to lift a person's mood. It is recommended to get support from people in the person's family and social network. Being reminded that other people care helps to relieve the isolation that often accompanies depressed feelings. Discussion with clergy or spiritual advisers may give meaning to painful experiences, and prayer or meditation can access internal sources of strength. If you recognize that you are chronically pessimistic and self-critical, self-help workbooks to combat depressive thinking may be helpful. These usually involve a program of exercises to identify distorted perceptions and substitute more realistic ones. But when you or a loved one cannot shake these feelings within a few weeks or with help from sources above mentioned, you may need to contact your doctor, because you may be suffering from major depression.
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    Call your health care provider if
  • depression disrupts work and family life for more than two weeks
  • depression is so severe that
  • suicide is contemplated. Do not hesitate to call for help immediately! If your primary health-care provider can't be reached, many communities have telephone hotlines for such situations. If there is no such service nearby, call the nearest emergency room or health-care facility
  • you think that current medication may be causing depression
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    What to expect at your health care provider's office
    A complete history, a psychiatric interview and a physical examination will be performed to determine if the cause of depression is physical or psychological. Hospitalization is usually recommended if suicide seems possible. Expect some exploration of the issues and events associated with your feelings of depression. Your doctor will ask you in detail about your depressive state and other associated symptoms (sleep, appetite, concentration, energy). He/she will ask you about any current stressors, and support system. You will be asked if thoughts about ending your life have ever crossed your mind. You will also be asked about drug and alcohol use, and about the medications you are currently taking, if any. Your doctor may recommend medication, but treatment will vary according to the cause and severity of the depressive symptoms, as well as your preference. If you are taking other medications medications that could cause depression, these may need to be changed. DO NOT CHANGE YOUR MEDICATIONS WITHOUT CONSULTING WITH YOUR HEALTH-CARE PROVIDER. For mild depressive symptoms, counseling may be recommended, as well as some of the self-care measures mentioned above. For moderate to severe depression, antidepressant medication may be prescribed (see major depression for more information about antidepressants). Psychotherapy may also be recommended. Several types of focused psychotherapies have been developed that are as effective as medication in treating depression. The choice of medications, psychotherapy, or both can be made based on patient's preference and the availability of these treatments. In order to avoid recurrent bouts of depression, it is important to finish the course of treatment. For people who are so severely depressed as to be unable to function, or who are so acutely suicidal they cannot be safely cared for in the community, psychiatric hospitalization may be necessary.
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