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Treating Grandma's DepressionIt can be challenging to get the elderly into therapy, but the result is well-worth the effortHer knees hurt, she’s constipated, she can’t hear, her mouth is dry. Some days, there’s no end to your elderly mother’s complaints. But the real problem may not be physical—it may be depression, says geriatrician Francis Salerno, M.D., of Lehigh Valley Hospital and Health Network.“This generation didn’t grow up talking about feelings,” he says. “When they’re depressed, you’re more likely to hear about physical ills. It’s one reason why depression is seriously underdiagnosed and undertreated in the elderly.” Even when the depression stems from a chronic medical condition, as it often does, that doesn’t mean you should just shrug off those bad feelings, says Salerno’s colleague, psychiatrist Kenneth Zemanek, M.D. “People often say, ‘Dad has a weak heart—of course he’s depressed.’ What they don’t realize is that Dad has a second illness, depression, that needs to be addressed.” The first step is diagnosing the problem. Besides physical symptoms, a depressed older adult may have changes in sleep or appetite, fatigue, social isolation, agitation, and trouble remembering or concentrating. Some of these symptoms can make the family suspect Alzheimer’s, Salerno says. “That can be the cause, but often we find it’s depression, and with treatment the person goes back to normal.” How to persuade him to get help? That’s one of the biggest challenges, especially with the stoic older man, says medical social worker Tom Smith of Lehigh Valley Home Care. “Consider asking your doctor to bring up the subject,” he says. “For older people, the physician is an authority figure whose opinions they respect.” The most effective treatment approach for depressed people of any age is a combination of antidepressant medication and talk therapy. The newer class of antidepressants (known as serotonin reuptake inhibitors) offers good choices because they have fewer side effects, which can be dangerous in the elderly, Salerno says. Many older people resist the idea of yet another drug, or worry they can’t afford it. “If we can persuade them to try, in a week or two they see it’s worth it,” says Smith’s colleague, psychiatric nurse specialist John Boos, R.N. “There are resources to ease the cost burden.” The older patient also may resist the idea of seeing a psychiatrist or therapist. A minister or rabbi can be a good alternative—and so can a skillful primary doctor. It may take time, but treatment is effective, Zemanek says. And the benefits of that are obvious. Older people who aren’t depressed are better able to work hard at cardiac rehabilitation, stay involved socially and make decisions about their future. Zemanek recalls a woman who attempted suicide “because she thought she was such a burden she’d be better off dead. After treatment she told me, ‘I can’t believe I felt like that. I have so many things to look forward to.’ ”
Want to Know More? For help finding the right therapist, call 610-402-CARE. This page last updated 2/12/08 04:08 PM
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