How to Tackle Depression in Aged Patients?

Introduction:

Clinical depression is commonly seen in older individuals. This should not be neglected as a sign of aging. It can prove to be more serious or even a sign of an underlying medical illness. Late-life depression is seen in people who are 65 years and above. But it can also affect them at a younger age. Signs of depression are different in older people than in younger people. In older adults, depression might last longer and is often associated with other illnesses and medications. Depression decreases a person’s quality of life. It limits their daily activities.

Is Insomnia Associated With Depression?

Insomnia (difficulty falling asleep) is usually seen as a symptom of depression in old age. It is often seen in recurrent depression, particularly in older adults. Doctors recommend the hormone Melatonin or low-dose formulation of tricyclic antidepressants like Doxepin to treat insomnia. Benzodiazepines and new hypnotic drugs should be avoided in the treatment of depression involving insomnia. If the medications alone are working, then the psychiatrist can prescribe medication and psychotherapy.

What Are the Risk Factors for Depression in Older Patients?

• Females are more easily affected than males.

• Loneliness because of being separated from family, being divorced, or being unmarried can cause depression in old age.

• No other social support in society can cause depression.

• Any stressful events in the past life, like the loss of loved ones, can cause depression if not dealt with properly.

• Certain medications or combinations of medications can cause depression as a side effect.

• Fear of death in old age.

• Family history of a depressive disorder.

• Presence of chronic or severe pain.

• Presence of a disability.

• Any major illness like cancer can have a psychological effect also for those who find it difficult to accept it.

• A past history of depression or suicidal thoughts.

• Loss of independence and dependence on family or home healthcare centers.

What Are the Signs One Must Look For in Older Patients With Depression?

Older patients present with signs and symptoms that might vary from younger patients. Following are the signs and symptoms of older patients with depression:

• Inability to rehabilitate.

• Feeling tired all the time.

• Insomnia (lack of sleep).

• Feeling confused or unable to make decisions.

• Always grumpy and easily irritable.

• Feel lost and do not pay attention.

• Do not enjoy the activities they used to.

• Lose weight and reduced appetite.

• Feeling of guilt, worthlessness and hopelessness are always present.

• Work very slowly, as though they have lost interest in it.

• Feel constant physical pain and aches.

• Have suicidal thoughts.

How to Diagnose Depression?

Depression is often ignored in old age. This can worsen the depression and delay the diagnosis and treatment. Look for the above-mentioned signs in family members, and if present, report it to their healthcare providers immediately. Make regular visits to the doctor to avoid any delay in diagnosis. The doctor might run a couple of tests to eliminate other medical illnesses. They will ask questions related to the symptoms and take a full medical history. Screening for depression has now become a part of a routine medical check-up, as the number of cases of depression is rising in older patients.

What Are the Various Treatment Options for Depression?

Depression can be overcome. To get a proper treatment plan visit a specialized doctor at the earliest. The two major treatment options are medications and psychotherapy. Both are quite effective in resting depression. In psychotherapy, the patient is taught how to overcome his negative feelings and attitudes and return to normal life. Medications help to reduce the symptoms of depression, like mood swings, suicidal tendencies and anxiety, and improve behavior. It takes a couple of weeks for the medications to improve symptoms. Medications should be taken as prescribed and regularly. Following are the management protocols for depression in older patients:

• Medication: The antidepressants prescribed nowadays work by regulating serotonin levels. These are selective serotonin reuptake inhibitors (SSRIs), for example, Citalopram, and serotonin-norepinephrine reuptake inhibitors (SNRIs), for example, Desvenlafaxine. Other antidepressants include Bupropion and Mirtazapine. Some other drugs that can be prescribed for depression in older patients are tricyclic antidepressants (Amitriptyline), monoamine oxidase inhibitors (MAOIs) like Phenelzine, antipsychotics (Aripiprazole), L-methyl folate (Deplin), and Ketamine.

• Psychotherapy: This is an important part of the treatment. In cases of mild to moderate symptoms, psychotherapy can help relieve symptoms. In severe cases, it is used along with medications. Commonly used psychotherapy is cognitive, interpersonal, and behavioral therapy. It helps the patient to overcome negative feelings, changes behavior, and improves mood swings. The patient should share their feelings with the therapist openly in order to see better results.

• Electroconvulsive Therapy (ECT): This method involves the application of electric current using electrodes on the head. This is a pain-free treatment as the patient is given general anesthesia before the procedure. Symptoms improve after a course of several treatments with electroconvulsive therapy. This is usually done three times a week for two to four weeks.

• Repetitive Transcranial Magnetic Stimulation (rTMS): This is another treatment option used to treat depression by passing strong magnetic currents through the brain.

• Vagus Nerve Stimulation: This is a surgical procedure used to treat selective cases of depression like chronic depression or recurrent depression.

• Deep Brain Stimulation: This is an experimental procedure. The areas that control emotions in the brain are stimulated with the help of electrodes.

• Lifestyle Changes: Making changes in lifestyle can help overcome depression. Get at least eight hours of sound sleep. Involve oneself in physical activities. Join specific social help groups to overcome emotions like loss, sadness, fear, etc. Avoid habits like drinking alcohol and smoking. Consult a doctor and get underlying chronic diseases treated.

Conclusion:

Depression is not the end of a normal life. There are multiple steps that can be taken to cure depression. The first and most important step is verbalizing it and accepting it. Do not ignore it. Healthcare centers should aim at educating the family and patients about the disorder. With proper awareness, approach the doctor soon and start treatment at the earliest.