Depression is a state of being which defies definition. It may be a normal or abnormal mood state and range from a transient unpleasant feeling to a serious psychiatric illness. All of us become depressed at times, but feeling depressed means different things to different people.
It has been described as sadness, loneliness, boredom, apathy, despair, dejection, and numbness. It is normal for feelings like this to occur in people who are not psychiatrically ill. However, if these feelings persist for long periods of time and prevent an individual from carrying out normal activities, it is wise to obtain professional help.
Depression is said to be common among older people, although statistics are difficult to obtain. (There have been very few studies of depression in people over age 55.) It is unclear whether the incidence of depression is about equal for both sexes after age 55 or whether more women are diagnosed as depressed simply because they are more likely to seek professional help.
In any event, there are a number of life changes and stresses which can produce depression in older women. These include the losses which occur as one ages, such as loss of family and friends through death or distance and loss of health, employment, independence, and productivity.
Other stresses include widowhood, lack of money, social and cultural isolation, and role change as one ages. Such illnesses as influenza or heart attacks and certain medications used in the treatment of
high blood pressure can also cause depression.
The difference between normal grief or sadness and depression which requires treatment is one of degree. Common signs and symptoms are weight loss, decreased appetite, apathy, insomnia, fatigue,
loss of sex drive, indecisiveness, irritability, and inability to concentrate.
In an older person depression can be masked by a physical illness or can be confused with senility. Tragically, there are people who are labeled as “senile” who are actually suffering from depression, a treatable illness.
Treatment of depression varies with the type of illness. Reactive depression (usually a short term illness with a clearly cause) responds best to psychotherapy by a qualified professional. Drugs are not usually used.On the other hand, endogenous depression (usually a long term depression with no clear cut cause and more intense symptoms) depression is treated with antidepressant drug therapy or with electroconvulsive therapy (ECT).
The medications used to treat this type of depression are called tricycic antidepressants (examples are Elavil, Triavil, and others). Many experts are concerned about the use of these drugs by people over age 65, since there has been little research on the effects of these drugs on this age group. Al- though these medications can be quite helpful in the treatment of depression, they have a number of side effects which can prevent or limit their use among older people.
For example, they may cause drowsiness, constipation, urinary retention, or a sudden drop in blood pressure upon standing. They interfere with the action of medications for high blood pressure. In addition, the effect of these drugs is intensified by drinking alcohol. It usually takes from one to three weeks for the medication to take effect. Older people require a smaller dose than do others.
After years of disrepute in some circles, ECT has become a much safer and more acceptable form of treatment for certain types of depression. With improved methods of treatment, problems such as memory loss after ECT have been reduced. If it is recommended, it is an alternative that should at least be given consideration.