Treatment

Tips for Selecting a Therapist:

• Patients can locate a mental health professional in their area by asking their doctor for a referral or by contacting a mental health organization. [See Resources.]
• The patient should describe problems briefly but specifically over the phone to any prospective therapist to get a sense of whether he or she will suit the patient's needs.
• An advanced degree does not necessarily guarantee quality therapy. The patient's belief in their health care provider may be the most important component in recovery, as indicated by studies reporting that placebos relieve depression in about a third of patients and in some cases actually work better than psychotherapy.
• Patients should not be shy about considering a change in their therapist if they lack confidence in their current one.

Depression in the Elderly

Although depression in the elderly is very common, the aging process itself is unlikely to be the cause in most cases. An Italian study, for example, indicated that the very old (people who lived beyond 90 years of age) were no more likely to be depressed than younger adults. (The rate was 10% in both groups.) Studies on the cause or extent of depression in the elderly are not clear.

The severity of depression in elderly patients is strongly associated with poor health and less ability to function. In one study of older adults undergoing rehabilitation, half of whom were depressed, as their function improved so did their mood.

Anyone who experiences cumulative negative life events, physical illness, the death of a loved one, impaired functioning, or loss of independence can become deeply depressed. The elderly are at highest risk for such events, Interestingly, in this regard, one study suggested that pessimistic elderly people are less prone to depression than their optimistic peers -- possibly because pessimists are more likely expect and therefore adapt to negative experiences than those with an optimistic personality.

Diagnosing Depression in the Elderly

Because of the complex relationship between depression, drug interactions, and serious physical illness in the elderly, an accurate diagnosis in this group is important but not always straightforward. The characteristic symptoms of depression are not always present or readily apparent in older people:

• Some older people may be aware of their depression but believe that nothing can be done about it.
• Many elderly people who are depressed may report only physical symptoms (aches and pains) or other mood states (confusion, agitation, anxiety, and irritability) related to depression rather than depression itself.
• Often they are unable or unwilling to express their feelings or are even unaware that they are depressed.
• Their symptoms are often ignored or confused with other ailments common in the elderly, including Parkinson's or Alzheimer's disease, dementia, thyroid disorders, arthritis, stroke, cancer, heart disease, and other chronic conditions.
• Depression is also a side effect of many drugs that are commonly prescribed for the elderly. It is often very difficult, then, to determine if the patient's depression is a psychologic reaction to the illness, caused by the disease itself, or completely independent from the medical condition. Both physical and emotional conditions should be considered in making a diagnosis in older people.