Dr. O'Neil Discusses Some of the Latest Research on Treating Depression
By Dr. Kevin O'Neil
All of us experience periods when we may feel blue or sad. However, when these feelings persist more than a few weeks, the likely diagnosis is clinical depression. Certain lifestyle changes that occur with aging may be triggering events. For example, the death of a spouse or a serious illness may upset a person’s emotional equilibrium. If the individual cannot adjust and regain emotional balance, depression may result.
Although depression is common, it is not a normal consequence of aging, and effective treatments are available. However, many older adults are reluctant to discuss how they are feeling. In addition, some of the early signs may be subtle and recognition of the problem may be elusive, even for physicians. Depression is common, affecting nearly two million of the 35 million persons over age 65. Another five million older adults may have milder degrees of depression. If untreated, depression can become more severe and lead to suicide. In fact, the suicide rate in the United States is highest among Caucasian males over 85 years old.
Depression affects many aspects of a person’s life including eating, sleeping, and work. Depressed persons find little enjoyment in activities they may have once considered pleasurable, such as sex. Common symptoms include tiredness, restlessness and irritability, feelings of worthlessness or guilt, crying, or just feeling empty inside.
Depression may cause the individual to eat a lot more or a lot less, so significant weight gain or weight loss may ensue. Abnormal sleeping patterns are common, such as insomnia or difficulty getting back to sleep after awakening early. Headaches, stomach aches, and other aches and pains are common. Although sadness is common, one does not have to feel sad to be depressed. Memory lapses may sometimes be severe enough that another diagnosis, such as Alzheimer’s disease, may be suggested. In extreme cases, a depressed person may contemplate death or suicide.
The most important first step for a person experiencing these or similar symptoms is an evaluation by a physician. Most primary care providers have the skills necessary to initiate the evaluation and subsequent treatment may be undertaken in collaboration with a psychologist, social worker or mental health counselor. However, if the depression is very severe, the primary care provider may refer immediately to a psychiatrist.
Treatment for depression needs to be individualized and usually involves a combination of medicine, counseling, and lifestyle changes. Different treatments may need to be tried until success is achieved. (An important part of the assessment is considering other disorders that can mimic depression such as decreased thyroid activity or certain nutritional deficiencies. Some medications, even those purchased over-the-counter, may have an adverse effect on mood, so it is important to look at all prescription and non-prescription medication and withdraw any that could potentially contribute to the problem.)
More than 80 percent of depressed persons are effectively treated with a combination of medication and counseling. However, for those who are unwilling or unable to take medication, counseling alone may be helpful. Very severely depressed persons may require hospitalization and consideration for ECT (electroconvulsive therapy). Although ECT has had its detractors over the years, the current practice of ECT is quite safe and it is often the most expedient treatment for very severe depression, especially where suicide risk is high. Antidepressant medication often takes several weeks to be effective and a suicidal individual may be too desperate to endure several more weeks of misery.
Recent research has also demonstrated that certain lifestyle factors not only are good for our general health but may have a powerful effect on mood. For example, regular exercise causes an increase in endorphin, a hormone that is not only a natural pain-reliever but a “feel good” hormone as well. Endorphin is thought to contribute to the “runner’s high,” the rush of euphoria that distance runners are reported to experience.
In addition, recent studies suggest that regular physical activity can help preserve brain levels of serotonin. Although the antidepressant drugs of the SSRI class (selective serotonin reuptake inhibitors include drugs such as Prozac, Zoloft, Paxil, and Effexor) increase brain serotonin levels chemically, regular exercise can do it naturally. This is not to say that exercise should replace the use of the drugs. Many individuals will need a “jumpstart” in order to quickly find relief for their depressed mood. However, perhaps by engaging in regular physical activity programs, the dose of the drugs can eventually be reduced and possibly discontinued.
Although the SSRI class of drugs are generally quite safe, research has suggested a higher risk of falls in older adults who take them. Falls are a major public health problem. Approximately one in three persons over age 65 and one in two over age 80 fall each year. Of those who fall, at least 5 percent will have a serious complication such as a fracture of the hip, spine, or pelvis, or a serious head injury.
Interestingly, recent research has shown that certain foods may reduce the risk of depression. Dr. William Carlezon and colleagues at Harvard-affiliated McLean Hospital have found that omega-3 fatty acids have antidepressant effects. Omega-3 fatty acids are also recommended for heart and brain health and are found in cold-water fish such as salmon, tuna, and sardines. Plant sources include walnuts, almonds, and vegetable oils such as canola and olive oil. High fish consumption may partially explain the lower rates of depression in Scandinavian and east Asian countries.
Recent research also suggests that supplemental vitamin D may help keep the blues away. This adds to the significant repertoire of benefits of this vitamin. Not only is vitamin D necessary for bone health, but studies have now shown a reduced risk of falls and even breast cancer. Many experts in geriatric medicine are now recommending 800-1000 units of vitamin D daily since the prevalence of vitamin D deficiency in the United States is quite high.
Food sources of vitamin D include fortified milk, breakfast cereals, cheese, yogurt, and margarine. Cold water fish and fish liver oil (Your mother was right about cod liver oil!) are also good sources of vitamin D. Checking vitamin D levels periodically in older adults may soon be recommended by many experts. If diet and a multivitamin alone are not enough to correct a deficiency, vitamin D supplements may be suggested.
Finally, let’s not forget the important roles of a positive mental attitude and humor. Our self-talk is very important. If the things we say to ourselves are negative, a depressed mood is a likely outcome. On the other hand, if our self-talk is positive and uplifting, it will have a similar effect on our mood. Humor can also be a natural antidote for depression. It feels good to laugh and research is showing a positive impact of humor and laughter not only on mood but on immune function. Humor distracts us from issues that bother us and helps get our minds on a more positive track.
Back to Senior Living Articles