NewYork-Presbyterian Hospital

If one reaches old age in a relatively healthy condition, it is something to be thankful for. The company of good friends, a close knit family, and the interests and activities that make life interesting and fruitful, are what keep healthy people in good spirits in their senior years. But the absence of one or more of these advantages can lead to a life hindered by varying degrees of depression.

Dr. George Alexopoulos, a professor of psychiatry and Director of the Weill Cornell Institute of Geriatric Psychiatry, explains that “Depression is not necessarily a normal reaction to aging, but the risk of depression increases as people age and become more debilitated. The rate of depression in older people living in their own homes, who get around pretty well and are in fairly good health, is in the range of one to five percent. That number is higher for those living in nursing homes or assisted living facilities. Depressive symptoms are present in approximately 15 percent of adults, with more women being affected than men, regardless of race or ethnicity.”

How signs of depression can differ in seniors

Depression often looks different in seniors than it does in younger people. The elderly tend to focus more on physical symptoms and less on emotional ones. “With age there’s an increase in medical problems, cognitive (memory) impairment, bereavement and isolation,” explains Dr. Alexopoulos. “In addition to the emotional toll the condition takes, it can also take a physical one, with marked changes in a person’s appearance and health — such as losing weight, feeling a heightened sense of pain, extreme fatigue, and gastrointestinal complaints. Slow speech and a lack of attention to personal appearance may also be indicators of depression. Sometimes, depression is a continuation of a problem that existed when the person was younger.” Indeed, many medical problems get more complicated as a person ages, and depression is no exception. People who have had depressive episodes earlier in life may experience longer, more severe episodes as they age.

For family and friends: signs to watch for

• Social withdrawal — from activities and events previously enjoyed

• Decreased energy levels — often accompanied by fatigue

• Mood changes — including sadness, tearfulness, and irritability

• An increase in medical complaints – preoccupation with physical health

• Changes in appetite – usually accompanied by weight loss

• Changes in outlook: feelings of hopelessness and worthlessness, inability to concentrate, forgetfulness

There is help…and hope

Fortunately, there are treatments available for late-life depression. Says Dr. Alexopoulos, “The key is for the individual to find a doctor who will be diligent in getting to the source of the symptoms and develop a personalized treatment plan.” From a pharmacological standpoint, many antidepressants have been developed that can be safely used in most depressed older adults. “About 30 percent can achieve full remission and another 20 percent can improve significantly,” he says. “Because antidepressants benefit about 50 percent of patients, they should be used on a trial basis. If one does not work within a four to eight week period, it should be replaced with another antidepressant or some other type of treatment.”

In addition, psychotherapy is as effective and sometimes even more beneficial than antidepressants alone, providing a safe place to share experiences, advice, and encouragement. Psychotherapy, whether one-on-one or in a group setting, works well on depression because it can give direction, help a person deal with stressful life changes and losses, and process difficult emotions. It can also help change negative thinking patterns and develop better coping skills.

Dr. Alexopoulos adds, “My colleagues at the Weill Cornell Institute of Geriatric Psychiatry and I are developing models using findings from neurobiology to simplify psychotherapies to make them even more effective, so that they can be broadly used across the nation.” By taking advantage of accumulated knowledge on brain dysfunction during depression, the clinicians have been able to target psychotherapies that directly address the core problem behaviors of depressed patients, helping them make life changes that reduce depression and promote health.

These research studies are supported by the National Institutes of Health and offer free treatment and brain MRIs to depressed older adults who want to participate in clinical studies. The Weill Cornell Institute of Geriatric Psychiatry conducts ground breaking research aimed to reduce the burden of late- and mid-life mood disorders, train future research and clinical leaders in Geriatric Psychiatry, and provide high quality specialized care to older and middle-aged adults. For more information on the institute, please call 914-997-4331.

To find a physician please visit nyp.org or call 877-NYP-WELL.

This story is provided and presented by our sponsor: NewYork-Presbyterian Hospital.