Monday, June 24, 2024

The Truth Behind Depression In Older Adults Is Not Normal

Usually happy and outgoing, John Rake* was utterly bereft after his wife died last year, after 68 years of being together.

“He would tell me, ‘Life isn’t worth living. I just want to die,'” says his daughter Lisa from her home in Toronto. “He was scared. He thought he was losing his mind.”

It wasn’t just what he was saying that was concerning her. John, a retired mining executive who prided himself on being able to fix anything mechanical and electrical no matter how complex. “He had stopped paying attention to how he dressed. He didn’t want to eat, and anything I would ask him to do, like go for a walk around the block, or get out of bed so I could change the sheets, he would say no to,” she recalls.

Sadness is different than grief and depression. Photo: Flickr/Creative Commons,

It’s not uncommon for older people like John to become depressed, particularly if they are grieving or dealing with physical health problems. In fact, anywhere from five to 15 per cent of older adults experience depression.

“It’s not natural to be depressed as we get older,” says Dr. Daniel Blumberger, head of the Late-Life Mood Disorder Clinic at Toronto’s Centre for Addiction and Mental Health (CAMH). He says the condition is often under-diagnosed in part due to “ageist beliefs that getting old means you get depressed.… You shouldn’t get depressed because you’re getting older.”

He attributes under-diagnosis to a variety of causes. People may not report being depressed. They may be going through a difficult transition from working and having an active life to dealing with “physical insults.” And their depression tends to manifest as a lack of enjoyment or ability to experience pleasure, rather than the sadness that we often expect to see in someone who is depressed.

A variety of treatment options are available to address depression. Photo: Flickr/.Creative Commons, SalFalko.

Older adults may also be being treated for co-existing conditions that make them vulnerable to depression or could like depression, he says. For example, people on beta blockers can appear depressed because they are slowed down and may not seem to experience pleasure.

Dementia is another illness that can sometimes be confused with depression, particularly as early symptoms of dementia are apathy, which can look like depression, he says. However, depression tends to come on more quickly, while dementia is more likely to involve a slow deterioration in memory and functioning, he explains.

Successful treatment options

The good news is that depression can be treated successfully. Some treatment is medical, like antidepressants, such as Zoloft or sertraline.

Other treatments relate to lifestyle, such as having a strong social support network, eating well and exercising, if the person is able. And of course there is therapy. In particular, this refers to CBT, or cognitive-behavioural therapy, interpersonal therapy and what is referred to as problem-solving therapy. The latter can be carried out by allied health professionals.

Another treatment is repetitive transcranial magnetic stimulation, or rTMS, which involves applying brief magnetic pulses to parts of the brain involved in depressive symptoms. This is a treatment being conducted at CAMH’s Termerty Centre for Brain Intervention where Dr. Blumberger is medical head. But this is a more intensive treatment, it is conducted five days a week over four weeks and, in the case of depression, is only used with people who haven’t responded to less invasive forms of treatment.

Dr. Blumberger stresses the need to aggressively treat depression, since there is a link between poor cardiovascular health and depression, and also an increased risk of dementia among people who have experienced depression throughout their lives.

Dr. Blumberger stresses the need to aggressively treat depression, since there is a link between poor cardiovascular health and depression.

In Rake’s case, she and her brother Bernie mobilized quickly to put supports in place when they realized their dad was depressed. Bernie contacted his dad’s friends to tell them his dad was grieving and encouraged them to still reach out to him and understand that if he did not return calls because he felt he had nothing meaningful to contribute. Lisa called her father every evening at 7 p.m. for months and has let him know that she is always available by phone. And she or Bernie would go with their father to medical appointments.

Although her dad briefly went on an antidepressant, he stopped because of side effects were making him even more tired and lethargic. Lisa and Bernie had mixed feelings about his taking medication. They knew that grieving is normal after a huge loss and hoped it would improve with time, though his feelings of worthlessness seemed atypical as part of a grieving process.

Almost a year and a half since his wife died, John’s depression has lifted. He is now visiting friends, spending time with his three children and doing light chores around the house and back to enjoying the things again, like the occasional steak dinner at a local restaurant and a side of French fries. He’s found his footing again as he navigates his way through a new normal in life.

* Name has been changed to protect his privacy.

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