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Depression Tip Sheet – Questions and Answers About Depression in Older Adults

Isn’t depression a normal part of aging?
What are the causes of depression among older adults? 
What are the symptoms of depression?
Can a person who is depressed snap themselves out of it?
Is depression treatable?
What is the treatment for depression?
I don’t want to take any more medications and risk side the effects.  What can I do?
Who can prescribe antidepressants?
How long does it take to feel better with antidepressant medication?
I am receiving a “happy pill” from my primary care doctor.  Do you think I have to worry about it?
I’ve been taking an antidepressant medication for a few months now and I don’t want to take it anymore.  Can I quit taking them on my own?
What can you do if someone you care about may be depressed?
How can I get help?  Who can help me?

Introduction

Depression is very common in our senior population.  Depression affects about six million Americans age 65 and older.  Unfortunately, only 10 percent receive treatment. Below are answers to some of the most frequently asked questions about depression in the older adults.

Q: Isn’t depression a normal part of getting older?

No. It is not a ‘normal' part of getting older. Depression is a very serious problem among the older adults. Older individuals with significant symptoms of depression have roughly 50 percent higher health care costs than seniors who are not depressed.

Q: What are the causes of depression among the older adults?

Getting older is often accompanied by loss of key social support systems, such as the death of a spouse, siblings or significant others, retirement, or a change of residence. Financial concerns can also contribute to depression.

Depression can also be triggered by long-term illnesses that are common in later life, such as: 

diabetes chronic lung disease
stroke Alzheimer’s disease
heart disease Parkinson’s disease
cancer arthritis

Q: What are the symptoms of depression?

Symptoms of depression include: 

  • sleeping either too much or having trouble sleeping 
  • change in appetite — weight gain or loss 
  • feeling sad or hopeless 
  • loss of interest or pleasure in things previously enjoyed 
  • trouble concentrating or memory loss 
  • lack of energy not attributed to a medical problem, and other possible symptoms.
Q: Can a person who is depressed snap themselves out of it?

Everyone has their "down" days that may resolve on their own. However, if the symptoms of depression continue most of the day for 2 weeks or more, the person may be suffering from a depression that needs treatment. A person can not just will themselves to "snap out of it."

Q: Is depression treatable?

It is important to realize that depression is very treatable. No one should have to suffer without trying to take advantage of the help that is available.

Unfortunately, doctors and family often miss the diagnosis of depression in older adults. This may result in no treatment or delays in treatment. Sometimes, symptoms of depression — such as decreases in mood, interest, energy, sleep, and concentration – are attributed to age-related medical conditions or to aging itself.

Q: What is the treatment for depression?

It has been consistently shown that a combination of antidepressant medication and counseling (also called "talk therapy") work better than either option alone. Talk therapy is a process in which a trained professional enters a relationship with a client to help the client address his or her issues.  For instance, meeting with a clinical social worker may provide an opportunity to receive emotional support and to express feelings in a safe environment with a person who is objective.  Often people prefer not to share their personal feelings and thoughts with family or friends.

Exercise has also shown to be helpful as has support groups and other ways to decrease the isolation that sometimes accompanies depression.

Q: I  don’t want to take any more medications and risk the side effects. What can I do?

Some people do not have any side effects from antidepressant medications. Other people do experience side effects initially and may find the side effects diminish as their body gets used to the new medication.  If, after talking to your doctor you decide you’d rather avoid medications totally, you can try seeing a clinical social worker for counseling.  This can give you the opportunity to talk about the changes and/or stressors in your life and other factors that may be contributing to your depression.

Q: Who can prescribe antidepressants?

Many primary care physicians and nurse practitioners will prescribe antidepressants. Unfortunately, if the initial prescription does not work, the medication is often discontinued rather than being adjusted as needed. If this is the case, seeing a psychiatrist may be helpful. Psychiatrists are medical doctors who specialize prescribing in these types of medications. They can start you on a suitable dosage and monitor you for any side effects. They can then adjust the medications accordingly to give maximum benefits.

Q: How long does it take to feel better with antidepressant medication?

Results of treatment using antidepressant medications vary depending on the individual. Treatment works gradually over several weeks. It is important to realize that you will not feel better 30 minutes after taking a pill for depression like you might with medications for other things. It may take a month before you and your doctor can begin to see the benefits of medication and how they are working for you. Ongoing monitoring is recommended.

Q: I am receiving a ‘happy pill' from my primary care doctor. Do you think I have to worry about it?

It is a good idea to keep your physician informed of how you are doing on this medication. Often the dosage may need to be adjusted in order to receive maximum benefit. Sometimes several medications need to be tried to find the best one for you.

Q: I’ve been taking an antidepressant medication for a few months now and don’t want to take it anymore. Can I quit taking them on my own?

As with most medications, you should consult the prescribing doctor before stopping the medications.

Q: What can you do if someone you care about may be depressed?

Let them know you are concerned about them and what changes you have noticed. Help them realize that it is not a sign of weakness to accept the assistance of others. Tell them that help is available.

Q: How can I get help? Who can help me?

There are several sources of help in the area. It may be a good idea to discuss how you feel with your primary physician who can check to see if there are any underlying medical issues.

Clinical social workers experienced in counseling are available to meet with seniors either in an office or in their own homes. Many accept Medicare assignment. Some people also find support from their clergy. If you decide to try medications, seeing a psychiatrist specifically experienced in working with the older adults is suggested.

The National Institute of Mental Health considers depression in people age 65 and older to be a major public health problem.

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Related Articles:

Depression – Your Options

Introduction

Depression – Your Options: Talk Therapy and Medications

Introduction
Benefits of Antidepressants
Benefits of Talk Therapy
How Social Workers Help
What to Expect of Talk Therapy
Conclusion

Introduction

As a social worker specializing in mental health issues, I spend most of my week working in the public mental health system, where I see firsthand how helpful our newer antidepressants and antipsychotic medications are.

Because of these medications, combined with various rehabilitation, case management, and psychotherapy services, more patients are able to enjoy a far more robust quality of life outside of hospitals than ever before.

Benefits of Antidepressants

Antidepressant medications have been lifesaving to countless patients. However, there are possible side effects and health consequences to taking any medication. Each individual situation should be weighed carefully in consultation with an experienced health care provider. And every person who is considering taking medication to treat depression should be fully informed of those potential side effects and health consequences, as well as of the potential benefits.

Antidepressants have helped millions of people but patients also should consider the option of psychotherapy to treat their depression.

Benefits of Talk Therapy

Psychotherapy, often referred to as talk therapy, can work in many cases as well or better than medications, at lower cost, with fewer side effects and more lasting benefits. For many patients, psychotherapy can be a first choice treatment option. For others, a combination of medication and psychotherapy is indicated.

All mental health providers generally are able to provide psychotherapy – social workers, counselors, nurse specialists, psychologists, and psychiatrists. Psychologists generally do more testing and psychiatrists prescribe medications.

Since most mental health services, especially for children and families, in this country are provided by social workers, it is very likely that clients will have an opportunity to work with a highly trained and qualified social worker in some treatment or counseling setting. Social workers can help people change quickly and reliably through psychotherapy or counseling.

How Social Workers Help

Social work psychotherapists, often called clinical social workers, have a full 60 credit Master's degree with extensive coursework in the diagnosis and treatment of psychopathology. Social workers, perhaps more than other disciplines, also consider the person-in-environment most fully and the ways in which social, family, community, and other stressors impact functioning.

Clinical social workers must obtain advanced licensure in most states which requires at least two years, fulltime, supervised work experience and are required to stay current by obtaining continuing professional education each year. Many social work psychotherapists have additional advanced training in psychotherapy techniques.

One type of therapist is not necessarily likely to be better than another because all therapies and therapists work some of the time with some clients. The best predictor of a good result in therapy is the quality of the relationship that the client has with his or her therapist, not what type of therapy they practice, or what type of degree they have.

Research confirms repeatedly that psychotherapy is a safe and effective treatment for many psychiatric disorders and problems of living and is currently being extended with promise into the treatment of major mood disorders and psychosis.

Clients will generally be able to find a therapist with whom they work well, and since social workers are so prevalent in many settings, it will likely be a trained social worker. Unfortunately, many people do not believe that therapy can help them change, or are worried about the stigma of talking to a therapist. But therapy can and does help.

Unless a prospective therapy client has a very specific type of treatment in mind, which most do not, a potential therapy customer would expect to review some of what's bringing them to treatment, what they hope to get from treatment and what better might look like, as well as the types of strategies that have helped them cope before.

What to Expect of Talk Therapy

Generally speaking, if nothing positive is happening in therapy after three to six sessions, clients should discuss this with their therapist. If no change persists, it may be time to find another therapist.

Therapy is not necessarily long term or short term – it should continue as long as it is being helpful – but we know that if it is not proving to be helpful early, it is not likely to be helpful later with this particular therapist.

Other tips for a good therapy outcome include finding a therapist who you like and feel comfortable with and whom you think understands and appreciates you and your point of view. Clients will also want to work with a therapist with whom they share goals for treatment and whose opinions and feedback they find helpful. If you are asking for something and not getting it, or if your therapist believes your problem inevitably will require years to change, you also may want to look for another one.

Conclusion

There is a time and a place for medications. A careful evaluation is essential, to assess each individual situation and to consider the possible health consequences and outcomes of medication. But it is equally as important to know that therapy works too. And sometimes it can work better and should be considered as a first line treatment option in many instances. And for other persons, a combination of medication and therapy is the best option. There is a good therapist match for every client to ensure a positive outcome. Every social worker should be able to help their clients evaluate what is right with themselves as well as what's not working, and what the best treatment options may be. Therapy works. Change happens.


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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.

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