Category Archives: Mental Health

Elderly Depression Symptoms and Suicide Prevention

Elderly Depression Symptoms and Suicide Prevention: Introduction

The most severe depression symptoms among the elderly are often easily recognized by others. However, it is usually much more difficult to distinguish the milder forms of depression from the normal emotional reactions to sadness and grief in everyday life. Depression symptoms among the elderly are not different in many ways from the depressive symptoms experienced by the younger age groups. Major depressive disorder is the most severe form of depression, followed by dysthymia which is milder, grief and atypical depression.

Mental health disorders are very different from medical conditions in that there are no biological markers to objectively identify their existence or severity. There are no laboratory changes or tissue abnormalities that can be used to identify and diagnose depressive disorders among the elderly.

The system used by psychologists, psychiatrists and other mental health clinicians to diagnose specific mental disorders is referred as the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders Fifth Edition). The symptoms for a major depressive episode from the DSM-5 follow below.

Major Depressive Episode Symptoms:

A person may be suffering from a major depressive episode if they are experiencing a persistently low mood and/or loss of interest in normal activities continually for two weeks or more and five of the following symptoms. The symptoms must also differ from the individuals normal functioning and include:

• Low mood;
• lack of interest in daily activities;
• a significant change in appetite or weight gain:
• sleep disturbance, either insomnia or hypersomnia nearly every day;
• psychomotor agitation or retardation;
• loss of energy or fatigue;
• excessive or inappropriate guilt;
• reduced ability to concentrate;
• frequent suicidal thoughts or ideation.

A diagnosis of major depressive episode is the same for the elderly as for other age groups. The diagnosis is usually more certain when there is an apparent family history of prior episodes of depression or mania, or when there are precipitating factors such as the use of medications that are known to cause depression or the experience of a recent stroke.

Additional symptoms related to depression include delusions and disorganized thinking. Also, seniors will frequently have disturbances in cognition and bodily functions such as having constipation and a decreased sex drive.
Major depressive episodes may be mild, moderate or severe and are defined as “single episode” or “recurrent”. In the milder episodes there is very little change in daily functioning or functional impairment, and it may not be easily apparent whether a depressive episode is present. Severe major depressive episodes are distinguished by various debilitating symptoms including a significant decline in mood and interference with an individual’s social and job-related responsibilities. Severe depression can make it difficult to function in every aspect of an individual’s life including socializing, working and even getting out of bed in the morning. It can even become disabling to the point of being unable to feed and dress themselves and maintain normal hygiene.

Suicide Among the Elderly:

A major complicating factor associated with depression is suicide. It is the 11th leading cause of death in the United States with one out of every 16 people diagnosed with depression dying from suicide. Two thirds of people who die from suicide are depressed. Individuals most at risk for suicide in the United States are elderly white males who live alone, along with those who make prior attempts, individuals who abuse alcohol or drugs and/or refuse psychiatric evaluation and treatment. Although women attempt suicide 3 to 4 times the rate of males, men are actually 3 to 4 times more likely to be successful in their attempts.

An unfortunate factor associated with suicide is that possibly up to three quarters of people who die from suicide have visited the medical doctor in the prior month. This may indicate that they may have known something was wrong at the time, but they or their doctor did not identify or feel it was necessary to treat an existing depression. While it is not possible to accurately predict who will attempt suicide, there are warning signs that a depressed person may make an attempt. In many cases family and friends are unaware of the warning signs or the severity of the symptoms until it is too late.

Suicide Prevention Among the Elderly:

The most important step in preventing suicide among the elderly is to recognize risk factors and warning signs, and to take preventative steps to get appropriate evaluation and treatment by a trained mental health clinician. The basic signs include:

• A family history of suicide or previous attempts;
• verbal threats or statements about a desire to die;
• acquiring the means such as purchasing a gun;
• neglecting an individual’s home, pets or finances;
• personality changes and drastic changes in mood;
• self-imposed social isolation;
• frequent use of drugs or alcohol;
• putting an individual’s affairs in order and giving away important belongings;
• suddenly being cheerful or calm following a period of depression
• exaggerated complaints of pain or aching.

It is important to understand that many people have some or several of these symptoms but are not suicidal. Also, not all people who commit suicide have these risk factors.

Elderly Depression Symptoms and Suicide Prevention Conclusion:

It is very important to understand that the elderly may be just as susceptible to depression as younger people. The symptoms are about the same along with the relevant treatment which usually includes psychotherapy and/or depression medications. Treatment is equally successful as well. Suicide prevention is also very important to consider among the elderly, with the highest risk among elderly white males. Always take depression symptoms of the elderly seriously rather than considering them as a natural byproduct of getting older, being in a nursing home or having increased physical illness. Recommend them to a qualified psychologist, psychiatrist or other mental health clinician who has experience working with seniors in the community.

By Paul Susic Ph.D. Licensed Psychologist

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Cause of Depression Among the Elderly

Cause of Depression Among the Elderly: Introduction

The cause of depression among the elderly can be from a multitude of factors. Frequently, family and friends see a senior that has had a recent setback and is sad and they say that they are depressed. Sadness is a very normal response to adverse circumstances and is usually transitory, short-lived and defined by those circumstances. But, when sadness becomes much more severe, longer-lasting and debilitating it may become a significant cause of depression among the elderly. The main symptoms of depression for all groups of individuals including seniors is when you have a persistently low or sad mood, decreased interest in normal activities, loss of self-confidence, feelings of worthlessness, changes in eating and sleeping patterns and difficulty concentrating. Fortunately, depression tends to be episodic with some level of recovery in between.

Some studies have concluded that as many as 18 million Americans suffer from depression at any given time and is believed to be the primary cause of disability in the U.S. Although mood disturbances can occur at any time including having the initial episode in the senior years, it most often first occurs between the ages of 20 and 30. Mental health practitioners believe that the usual untreated episode of major depressive disorder most often lasts about 8 to 9 months. Fortunately, the depressive episode can be shortened, and symptoms can be improved significantly with successful treatment resulting in much less suffering and disability.

Causes of Depression Among the Elderly: Brain Changes

Some researchers and clinicians believe that some of the primary causes of depression among the elderly as well as other individuals are related to chemical changes within the brain. They believe that these chemical changes are linked to the various symptoms of depression.

The brain is composed of various regions involved in specific physical and psychological functions. These regions also have networks of nerve cells referred to as neurons that communicate with each other through chemical messengers referred to as neurotransmitters. One of the main regions of the brain involved in depression is the limbic system which is believed to be involved in emotional experiences and behaviors. Another important functional area of the brain is the hypothalamus which is involved in regulating the pituitary gland, which is involved in regulating hormones in the body which can become out of balance when an individual is depressed. An important result or cause of depression among the elderly is when the biochemistry of the body is no longer in the state of equilibrium that is required to function properly.

These neurons in the brain are separated by small gaps referred to as synaptic clefts. Neurons then communicate with each other as we think or participate in activities by releasing neurotransmitters across the synaptic cleft to other neurons that then react to the neurotransmission. This neurotransmission is very fundamental to understanding the biochemical aspects of depression. There are specific neurotransmitters that are believed to be affected by depression, which can also be a means of intervention as they are increased with depression medications. Some of the main neurotransmitters involved in depression are serotonin, norepinephrine and dopamine. Psychiatrists believe that imbalances in these substances in the brain can be a main cause of depression among the elderly.

Genetic Factors Associated with Depression Among Seniors:

It is believed that there are genetic factors that may predispose seniors as well as others to depression. Researchers have found that among twins, if one of the twins develops depression there is approximately a 50% chance the other will develop depression sometime during their lifetime. It is believed that genetic factors may also play a role in the treatment of depression. Clinicians have found that if an antidepressant medication has been found to be effective with an individual, frequently a first degree relative (parents, children and siblings), may also respond favorably to the same depression medication.

These genetic factors identify some of the reasons that it is important to consider family history for depression. However, just because one close family member has had depression does not mean that others will inevitably develop the condition. In many or possibly in most circumstances, depression is frequently triggered by some type of psychological stress or medical condition. This is often the case even if there is some underlying susceptibility to the development of depression.

Medications and Other Causes of Depression Among the Elderly:

It is believed that as many as 10% to 15% of depressive episodes as well as other mood disorders may be caused by medication, medical and neurological conditions, and both legal and illegal drugs. An example may be when depression is caused by the use of beta blockers over a long period of time, reserpine derivatives (which are used for high blood pressure), benzodiazepines (for anxiety disorders), steroids such as prednisone (Deltasone), and medications used to treat cancer. Also, withdrawal from amphetamines or other medications that stimulate the central nervous system such as cocaine can also cause depression.

It is also recognized that patients who experience Alzheimer’s disease and other forms of dementia such as Huntington’s disease related dementia are more susceptible to depression than others. Depression can also be a natural byproduct of having a stroke. It has been found that depression may be experienced by at least 25% of individuals who have had a stroke in the left frontal area of the brain. Also, people who have been diagnosed with hypoactive thyroid frequently are depressed. Patients who have Cushing’s syndrome which causes an overproduction of the steroidal hormone cortisol more easily experience mood disorders, which could include mania as well as being at a higher risk for depression.

Vitamin deficiencies such as inadequate consumption of B-6 or vitamin B-12 have been known to be linked to depression. A study conducted in 2000 of 700 women who were deficient in vitamin B-12 were twice as likely to be depressed as those who did not have a vitamin B-12 deficiency.

Seasonal Affective Disorder Among the Elderly:

Some individuals have been found to experience depression more often during the colder months in which there is less sunlight. For many individuals, this seasonal affective disorder may begin in November and has been referred to by some as “winter depression”. One theory is that the decreased level of sunlight may reduce certain levels of mood elevating hormonal substances such as melatonin.

Depression Among the Elderly Conclusion:

The most important thing to understand about depression is that it is not sadness. It is more severe, longer-lasting and debilitating. It can increase the risk for suicide significantly and should be taken very seriously. The rate of depression among the elderly is similar to many of the other age populations. Treatment for depression among the elderly is just as effective as with the other age groups and should be initiated as soon as possible.

By Paul Susic Ph.D. Licensed Psychologist

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