Seeking Treatment for Depression in Older Adults
Depression isn’t just feeling sad, lonely or blue. It is a severe mood disorder that can have devastating consequences if left untreated.
Unfortunately, depression affects millions of older Americans every year. According to the Centers for Disease Control and Prevention (CDC), depression affects 1 to 5% of senior citizens who require home healthcare and 11.5% of older hospitalized patients.
Some people mistakenly believe that this mood disorder is a normal part of the aging process but it is not. Many older people are satisfied with their lives even though they may suffer from illnesses or medical conditions.
Some older adults are more vulnerable to depression due to physical or life changes that place them at an increased chance of developing clinical depression. If caught early, depression is highly treatable in seniors. Learn more about how you or a loved one can obtain treatment for this condition.
What Is Depression?
Depression is a chronic mood disorder that causes persistent feelings of sadness, feelings of emptiness and loss of interest in life. It is not the same emotional shifts that many people undergo daily. These moods typically last two weeks or longer.
There are several types of depression, but there are two that are most common in older adults:
Major depression: Seniors suffering from this condition may have negative moods that interfere with their daily lives. For example, they may be unable to work, eat or sleep. Some may only experience one period of depression. Others have sustained episodes.
Persistent depressive disorder (also called dysthymia): This condition causes a depressed mood that lasts two or more years. Older adults with PDD can suffer from intense periods of major depression, followed by less severe ones. These issues must persist two years or more to be classified as PDD.
How Do Older Adults Experience Depression?
This mood disorder impacts older people much differently than younger people. Here are several ways that depression affects seniors:
Older adults with depression have an increased chance of poor health outcomes. According to some nursing home studies, seniors that suffer from depression have an increased risk of dying from their health conditions such as heart attacks. These issues are why adults must get treated for their depression, even if they’re relatively mild.
Depressed seniors are often misdiagnosed and under-treated by their doctors. Some healthcare professionals can mistake an older person’s symptoms of depression as a reaction to their illness. Others mistake it for life changes that an older person experiences as they age; therefore, they don’t believe it’s a real illness that requires treatment. Some seniors share these beliefs and don’t seek help for their symptoms, because they don’t know that appropriate treatment can help them feel better.
Seniors have an increased risk of depression. According to the Centers for Disease Control and Prevention, almost 80 percent of older adults have at least one chronic health condition, and 50 percent have two or more. Illnesses, such as heart disease or cancer, place older people at an increased risk of depression when their physical health becomes impaired. The condition also lasts longer in the elderly population.
Depression can increase the risk of suicide. The National Institute of Mental Health says that depression in people over 65 is a major health problem. The suicide rate of people ages 80 to 84 is twice that of the general population due to a loss of social support systems, retirement, relocations or the deaths of relatives or spouses.
Differences between Depression and Dementia in Older Patients
Depression can also cause older people to suffer from memory problems similar to Alzheimer’s disease or dementia. These tips can help you distinguish the differences between these two conditions in seniors. Five characteristics of depression:
- Older adults with this mood disorder may experience a rapid mental decline.
- Patients can state facts correctly, including the date, time and place.
- They have difficulty concentrating on a topic.
- They have slow, but regular language and motor skills.
- These individuals worry that they have memory problems and confusion.
Five features of dementia:
- Patients have a gradual mental decline.
- They can become confused about facts, including the time and year.
- These patients suffer from short-term memory issues.
- They may have problems remembering where they are.
- They don’t seem to notice or realize they have memory issues.
Warning Signs of Depression in Older Adults
Recognizing the signs of depression is sometimes harder to identify in seniors since they may have less apparent symptoms than younger people.
Sadness is not the primary symptom in these people of advanced age. Older adults who suffer from depression may have trouble falling asleep at night. Others may appear annoyed, irritated or fatigued. Chronic health conditions and medications (with side effects) can also cause seniors to develop depression. Unfortunately, many do not receive treatment because of the stigma of being depressed. They are also unlikely to discuss their feelings with other people.
If an older relative has several of these symptoms for more than two weeks, you should schedule an appointment with a doctor or psychologist to evaluate them for depression. These symptoms include:
- Chronic sadness, anxiety or feeling empty
- Persistent pessimism and hopelessness
- Fatigue and decreased energy
- Loss of interest in favorite activities or hobbies
- Restlessness, irritability and trouble sitting still
- Talking and moving slowly
- Having insomnia, waking up early or oversleeping
- Decreases or increases in appetite
- Gaining or losing weight
- Feeling guilty, worthless, or helpless
- Aches or pains, headaches, cramps, or digestive problems without a clear physical cause. These symptoms don’t ease, even with medical treatment.
- Thoughts of death, suicide (suicidal ideation) or suicide attempts
- Problems with memory, concentration or decision-making
- Frequent crying
Six Biological Causes of Depression
According to the National Alliance on Mental Health, several physical issues can contribute to depression in older people.
Biological differences – People with depression may undergo some physical changes in the brain. Currently, researchers are still trying to identify the cause of these changes.
Genes and inherited traits – People with a family history of depression have an increased risk of developing these disorders compared to those who don’t have these mental conditions in their bloodline.
High blood pressure – Some medical scans of older individuals show that there may be some spots within their brain that don’t receive adequate blood flow due to years of high blood pressure. These chemical changes can increase the chances of depression.
Brain changes - Older people with depression can have different brain chemistry than those without it. Illnesses such as Alzheimer’s disease and dementia can also cause depression in patients.
Vascular changes - Older adults can also develop depression later in their lives due to physical changes that occur in their brains and body as they age. Some adults can suffer from restricted blood flow in their brains caused by a condition called ischemia. Stiffening blood vessels can slow blood flow to their body’s organs, including their brains. When this happens, people of advanced age who have no history of depression can develop a condition called vascular depression. They can have a higher risk of heart disease, strokes, or other vascular-related illnesses.
Chronic illnesses and disabilities – Medical conditions such as strokes, hypertension, atrial fibrillation, diabetes, cancer, dementia and chronic pain can cause depression in seniors.
Situations that Can Cause Depression in Older Patients
Medical conditions aren’t the only issues that trigger depression in seniors: social and environmental conditions can cause this mood disorder. Here are a few situations that may lead to depression in older adults.
Sudden changes in a living situation – Some seniors become depressed when they move into new homes or assisted living communities.
History of depression – Young adults with depression have a higher risk of developing the condition as they age. Their chances also increase if an immediate family member was diagnosed with this mood disorder.
Major life changes, trauma, or stress – An older person may become depressed after the sudden loss of a relative or spouse.
Substance abuse problems – Older adults are more likely to suffer from depression if they have addiction issues.
Poor diet and malnutrition – Your diet can impact mental health at any age, so eating a nutritious diet to support brain health is important. Poor nutrition can cause depression symptoms.
Medication side effects – Some medicines can affect brain chemistry, triggering depression in patients.
Loss of social support systems – Socially-isolated people are more likely to suffer from depression.
Depression Can Occur with Other Health Conditions
In seniors, depression can develop along with other ailments, creating a dangerous combination. Clinical depression can also aggravate serious health issues because the person may no longer care for themselves. Medications can also alter brain chemistry and trigger a mental health decline. Disabilities after sudden medical crises, like strokes, may also cause depression. Depression can develop alongside the following comorbidities and worsen the disease(s):
- Heart disease
- Parkinson’s disease
- Dementia and Alzheimer’s
- Multiple Sclerosis.
An experienced doctor can develop an effective treatment strategy to help alleviate the effects of depression.
Treatments for Depression
You don’t have to suffer alone in silence. Depression can be treated. The earlier your treatment begins, the more effective it will be. Make an appointment to see your doctor or medical care provider. You can also seek help from a psychologist, psychiatrist or social worker.
A physician can give you a physical exam and lab tests to check for any medical conditions that may be causing your depression. Your doctor may also prescribe antidepressants and/or other medications. If there is no medical condition causing your depression, your doctor may ask for you to undergo a psychological evaluation.
Most doctors treat depression with medications, psychotherapy, or a combination of the two. Other options include brain stimulation therapies, such as electroconvulsive therapy (ECT).
One of the main therapies used to treat depression is antidepressant medications. They improve the way the brain uses chemicals that control stress or mood. Your therapist or doctor may have an older patient try several antidepressants before they identify one that manages symptoms without severe side effects. If a family member has had depression, a medication that helped them in the past may also help you. It will usually take two to four weeks for your antidepressants to start working. Other symptoms, such as appetite, sleep issues and concentration, will improve before your depression goes away.
When your physicians find the best medication for your depression, you need to take them exactly as your doctor prescribes them. Don’t stop taking your medicines abruptly.
Patients taking antidepressants should be monitored during the first few weeks of treatment. Although most are safe, the U.S. Food and Drug Administration requires some medications to carry black box warnings for possible side effects.
Depressed patients should use antidepressants as a complementary therapy. Many studies have found that older adults that take medications without other treatments, like therapy, are not likely to have a lasting recovery.
Counseling and Psychotherapy
You can speak with a counselor to identify the causes of your depression. Psychotherapy, or “talk therapy” can help older people manage their symptoms. Sometimes, treatments last a shorter-term from 10 to 20 weeks. For others, it may be longer. Most psychiatrists offer individual private sessions or group sessions.
There are several types of talk therapy that a counselor may use to alleviate your depression. Cognitive behavioral therapy is a popular form of talk therapy used to treat depression in older adults. It has techniques that allow people to change their negative thought patterns and behaviors that could worsen their depression. A counselor may also suggest interpersonal therapy to help individuals work through their relationship issues to improve their condition.
Older adults should connect with other seniors who are experiencing similar issues such as depression, health conditions and grief. Ask your doctor or therapist about senior support groups, which can help establish a safe place to talk about issues.
Another component that’s important for recovery is daily lifestyle changes. These additions can include healthy eating, increased social outings and assistance for medical issues. Families can help by doing the following:
- Create a system to help relatives freeze healthy meals for the senior.
- Have a system in place to simplify taking medication as prescribed.
- Arrange for the senior to take day trips and outings with other seniors.
- Provide them with transportation to doctor’s appointments.
Does Medicare Cover Treatment for Depression?
Medicare is a federal health insurance program for seniors 65 years and older and some younger people with specific illnesses and disabilities. Most older people will have Medicare coverage for mental health issues. Here are some mental health treatments this insurance covers.
Diagnostic screenings - Most seniors can use their Original Medicare (Part A and Part B) or Medicare Part C (Medicare Advantage) to receive a preventive screening for depression. Patients diagnosed with depression can receive follow-up treatment or referrals for treatment. Most people will pay no out-of-pocket costs if the health-care provider accepts Medicare.
Hospital stays for depression – If you need an inpatient stay in a hospital or psychiatric facility, Medicare Part A or Medicare Part C will cover these services.
Depression treatment centers – A physician may recommend that patients receive care in a treatment center specializing in depression. Whether a patient received coverage depends on the type of treatment center and whether it provides inpatient or outpatient services. Part A covers inpatient mental health coverage in general hospitals. Most Medicare Advantage plans would cover at least some expenses.
Some patients may receive treatment from centers that fall under the partial hospitalization category, which offers a structured, outpatient alternative to inpatient treatment centers. Medicare may cover some of these services. You’ll need a doctor to verify that you would otherwise need inpatient treatment to qualify for this service. Your doctor and the treatment center must both accept Medicare.
Outpatient Services - Medicare Part B and C covers outpatient mental health services, including treatment for depression. These services may include:
- Counseling and treatment on an outpatient basis from state-licensed mental health providers
- Diagnostic tests and psychiatric evaluations for patients
- Psychotherapy (both in an individual and group setting)
You’ll pay 20 percent of Medicare-approved insurance and the applicable deductible, maybe less if you have Medigap coverage or Medicare Advantage (Part C).
Medications: Original Medicare does not pay for medications. Most patients will need to purchase a Medicare Part D Prescription Drug Plan to get help paying for their medicines. You can also enroll in a Medicare Advantage plan, which provides coverage for prescription drugs.
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