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Lately, Jim has noticed his 73-year-old mother is not herself. She isn't sleeping through the night, and is often irritable during the day. She doesn't want to play her weekly bridge game. In fact, she hardly seems interested in any of her usual routine. Her temper is short. Small annoyances set her off. When asked, she assures Jim she's fine, just a little down these days. Jim wonders if this is just normal for a senior citizen.
It is not normal, according to research supported by the National Institute of Mental Health (NIMH), one of the National Institutes of Health. Jim's mom is showing signs of depression, a common illness among elders. Depression is not a normal part of aging. After about two weeks of disinterest and insomnia, it is time to insist mom see her doctor, advises Dr. Charles Reynolds, director of the Late-Life Depression Clinic at the University of Pittsburgh, one of three Intervention Research Centers supported by NIMH.
"When an elder begins to have problems functioning, when he or she can no longer do his or her regular routine, that's when the problem has moved beyond normal toward a diagnosis of clinical depression," Dr. Reynolds says. "Typically, when an older person no longer feels engaged and seems to stop enjoying life for longer than two weeks, it's time to seek medical help."
Warning signals family and friends should look for include chronic sleep problems and inability to rest, excessive worrying, increasing dependency, withdrawal from friends and/or normal activities, hypochondria and complaints of chronic aches or pains that cannot be attributed to other disorders.
"Family members are key in getting elders into treatment, because too often elders don't recognize depression in themselves," Dr. Reynolds points out. In addition, he said, many senior citizens will not discuss a mental health problem with their doctors because they don't want the term "depression" associated with them. Also, Dr. Reynolds continues, many doctors may be too pressed for time to ask about a person's emotional state, and many of depression's symptoms are often mistakenly attributed to some other disorder.
"Another problem is the stigma of mental illness that is prevalent in the current generation of older persons," notes Dr. Barry Lebowitz, chief of the Adult/Geriatric Treatment and Prevention Research Branch, NIMH. Fortunately, negative perceptions traditionally associated with depression and other mental health issues are expected to decrease as Baby Boom-age Americans become senior citizens. "Future generations are thought to be more comfortable with the idea of mental illness as real illness," Dr. Lebowitz says.
Only one in six elders with clinical depression get diagnosed and treated for the illness, according to a 1997-updated NIH consensus development statement. Although research suggests that rates of depression decrease with age, Dr. Lebowitz says some researchers predict that "when the Boomer generation reaches older ages their rates of depression will be higher than the current generation of older persons. And, depressive symptoms — ones that are not as severe or ones that have not lasted long enough yet to qualify as major depression — do increase with age."
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Detect Depression, Prevent Suicide in the Elderly
Along with clinical depression among senior citizens comes a far more serious threat — suicide, points out Dr. Charles Reynolds, professor of psychiatry and director of the Late-Life Depression Clinic at the University of Pittsburgh. The clinic is one of three Intervention Research Centers (IRCs) supported by the National Institute of Mental Health.
The highest rates of suicide are among the elderly, he says, particularly white men between ages 80 to 85. In 1998, U.S. Surgeon General David Satcher named suicide prevention as one of his priorities in establishing a well-balanced health system. Recently, the IRCs launched PROSPECT*, a study to measure whether intervention by on-staff depression specialists can help depressed seniors get proper treatment and reduce suicide rates among the older population.
The most frequent forerunner to suicidal thoughts and suicide attempts is depression, Dr. Reynolds stresses. That's why recognizing the symptoms and getting proper treatment for an elderly person — preferably a geriatric specialist — is vital to prevent depression from escalating.
*PROSPECT (PRevention Of Suicide in Primary care Elderly Collaborative Trial) is being conducted by the NIMH Intervention Research Centers of Cornell University, University of Pennsylvania, and University of Pittsburgh. The intervention is being offered in metropolitan and suburban New York, Philadelphia, and Pittsburgh.
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