How is depression in seniors or the elderly treated?

Many people think that:

• depression will go away by itself
• they're too old to get help
• getting help is a sign of weakness.

Such views are simply wrong. Depression is a treatable psychological problem. Even the most seriously depressed person who feels hopeless and helpless can be treated successfully, often in a matter of weeks, and return to a happier and more fulfilling life.

The most common treatments for depression in the elderly are:

• treatment of underlying medical conditions
• counseling
• psychotherapy
• trauma-focused therapy
• a combination of antidepressants and therapy
• frequently monitored, low dose antidepressant medications
• ECT (electroconvulsive therapy) to "jump-start" the electrical activity in the brain
• hormone replacement therapy (now under investigation for the treatment of elderly depression)
• a change in prescription or dosage to alleviate some symptoms -- if the depression is a side effect of a medication taken for another condition.

Treatment depends on the cause and severity of the depression and, to some extent, on personal preference. In mild or moderate depression, psychotherapy is often the most appropriate treatment. But incapacitating depression may require medication for a limited time along with psychotherapy. In combined treatment, medication can relieve physical symptoms quickly, while psychotherapy enables the patient to learn more effective ways of handling his problems.

Counseling and psychotherapy

Counseling and psychotherapy can be particularly helpful in treating depression. There are several different modes of treatment:

• Supportive counseling includes religious and peer counseling. It can help ease the pain of loneliness and address the hopelessness of depression. Both peer counseling and pastoral counseling usually are provided at no cost.
• Cognitive Behavioral Therapy (CBT) helps people distinguish between problems that can and cannot be resolved, and develop better coping skills.
• Interpersonal psychotherapy can assist in resolving personal and relationship conflicts. For additional information on creating supportive intimate love relationships, see Helpguide's Somatic or Trauma Psychotherapy with a professional who is an expert in early life trauma can help bring about the resolution of traumatic experiences.

Antidepressant medication

Antidepressant medication can help depressed people feel better by controlling certain symptoms. For example, they can be particularly helpful in mobilizing people who survive the repair of a broken hip, but lose their will to get out of bed in the morning – even their will to live – and die soon afterwards. In addition, recent research has found lesions (hypertensities) in the fine white fibers beneath the cortex of the brain. These lesions, identified in age-related illnesses such as dementia and depression, show fewer increases in elders who have taken antidepressants than in those who continue to be depressed.

Some cautionary notes regarding the use of anti-depressant medications in the elderly include:

• Read package information carefully and ask questions, as there is a risk of side effects or potential reactions with other medicines.
• Antidepressants can be sedating and can cause a sudden drop in blood pressure when a person stands up, leading to falls and fractures.
• SSRI drugs can create dependency and may cause self-destructive thoughts, which, in at least 3.5% of cases, have led to suicide.
• In general, it takes longer to treat depression in the elderly than in younger patients.
  • Antidepressants may take longer to start working in the elderly than they do in a younger population.
  • Since seniors are more sensitive to medications, doctors may prescribe lower doses at first.
  • Seniors may forget to take their medicine.
  • Fear of side effects as well as cost increase the resistance of seniors to taking drugs.