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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