Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, February 15, 1994 TAG: 9402150039
SECTION: EXTRA PAGE: 1 EDITION: METRO
SOURCE: jane brody
DATELINE: LENGTH: Long
People over 60, who are more likely to suffer from depression than any other age group, including teen-agers, are the least likely to recognize or acknowledge that they are depressed.
Dr. Martiece Carson, a neuropsychiatrist at the University of Oklahoma Health Sciences Center in Oklahoma City, explained: "It's a cultural thing, a sign of their times. The elderly tend to consider depression to be a symptom of weakness, of laziness, not a medical illness."
Dr. Ari Kiev, an expert on depression at the Payne Whitney Psychiatric Clinic in New York, agreed. "The elderly haven't grasped that this is a medical condition, and that it is treatable," he said. "Old attitudes hang on."
Carson and other experts say that doctors generally do not help matters when they fail to look beyond physical complaints and to ask probing questions that would reveal depression as the real cause of a patient's symptoms.
"Often the doctor will work up a depressed older person for all kinds of physical illnesses and then turn the patient away, saying, `I don't find anything wrong with you,'" Carson said. "Or the doctor may find an unrelated physical problem and assume that to be the cause of the patient's symptoms, leaving the depression unrecognized and untreated."
Kiev said another common situation was for the doctor and others to recognize that the older person is depressed but then try to "explain it away by saying there's no reason to feel that way, `just snap out of it.'"
"Depression is a real condition, and denying it tends to make the depressed person feel worse, even suicidal," Kiev said.
According to the National Institute of Mental Health, 3 percent of Americans over 65 are clinically depressed, while 7 to 12 percent of the elderly suffer from milder forms of depression that impair their quality of life.
In nursing homes, Carson said, the situation is far worse, with 20 to 40 percent of patients very depressed.
Many people have a lifelong propensity to depression that does not become obvious until late in life when the condition is triggered by circumstances, which can range from retiring to developing a serious illness or facing the death of a friend or spouse.
But while it is natural for people to feel depressed after a traumatic loss, when that depression persists for months or years it is likely to have a biological cause as well.
Often, a physical illness itself causes depression in the elderly by altering the chemicals in the brain. Among the ailments that could touch off depression, Carson said, are diabetes, hypothyroidism, kidney or liver dysfunction and sometimes heart disease and infections.
In people with these ailments, treatment that controls the underlying disease usually eliminates the depression. But if the depression persists despite treatment of the physical illness, the emotional disorder should be considered an independent problem requiring its own therapy.
Sometimes medications prescribed for other conditions precipitate depression. In exploring the causes of depression, it is crucial to take a complete inventory of the prescription and over-the-counter medications that the person is using.
Diagnosing depression in the elderly often requires time and a careful and thorough workup. Carson pointed out that rarely do elderly people "come in carrying a sign saying `I'm depressed.'"
"More than likely," she said, "if they seek treatment, they may complain that they don't feel good, they hurt here or there or they're having trouble sleeping."
Depression often assumes the guise of physical, or psychosomatic, symptoms like headaches, backaches, digestive problems, joint pain or insomnia.
Just because the symptoms are psychosomatic does not mean they are imaginary, only that they are physical manifestations of an emotional disorder. The pain is real, but if the underlying emotional problem is treated, it will go away.
Some signs of depression, like memory lapses or difficulty concentrating, mimic symptoms of Alzheimer's disease. An older person who develops cognitive disorders should not be assumed to be becoming senile, nor should such symptoms be written off as an expected part of aging.
But in other cases, Kiev said, once the depression is treated, there may still be residual cognitive symptoms that may warrant treating the patient as an Alzheimer's sufferer.
Older people face many real-life problems that can compound a biological tendency to become depressed, including physical illness, financial burdens, deaths of friends and relations and loss of purpose.
Kiev said people "must prepare for making life meaningful or life will be tough and unfulfilling, and if you go through any kind of stress it can precipitate depression."
He suggests that older people get involved in things that are meaningful to them. He urges them to shed burdens and obligations and instead do something they really want to do.
Depression should be suspected in an older person who experiences frequent crying bouts, is continually sad or irritable, develops sleeping or eating problems, dwells on death or loses interest in previously pleasurable activities.
The first step in a workup for depression should be a thorough medical checkup to determine whether there is an underlying, undiagnosed physical disorder.
If none is found to account fully for the depressive symptoms, treatment with an antidepressant, perhaps in conjunction with counseling, is usually the next step.
Newer antidepressants like Prozac and Paxil are far less likely to cause disruptive or dangerous side effects in the elderly than older medications like Elavil. Participing in a regular exercise program and a support group for the elderly may also help.
The National Institute of Mental Health, through its Depression Awareness, Recognition and Treatment program, provides information on depression, its diagnosis and treatment.
The institute has also produced a booklet, "If You're Over 65 and Feeling Depressed . . . ". The booklet and other guidance can be obtained by writing to D/ART Public Inquiries, National Institute of Mental Health, 5600 Fishers Lane, Room 15C-05, Rockville, Md. 20857.
by CNB