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DEPRESSION IN THE ELDERLY: HOW DOES IT LOOK

VANESSA THOMPSON, DNP, PMHNP-GNP

DIRECTOR BEHAVIORAL HEALTH SERVICES

SPARTANBURG MEDICAL CENTER

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NO FINANCIAL RELATIONSHIPS

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OBJECTIVES

At the end of this presentation, the participant should be able to:

Recognize 3 Symptoms of depression in the elderly

Verbalize the Effects of depression in the elderly

Identify 3 Medical conditions that mimics depression in the elderly

List 3 Ways to decrease the impact of depression in elderly

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PREVALENCE OF DEPRESSION IN THE ELDERLY

DEPRESSION IS ONE OF THE MOST COMMON MENTAL DISORDERS IN THE U.S.
ACCORDING TO THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)
DEPRESSION AFFECTS ABOUT 1%-5% OF THE GENERAL ELDERLY POPULATION
13.5% IN ELDERLY WHO REQUIRE HOME HEALTHCARE
11.5% IN OLDER HOSPITAL PATIENTS

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RISK FACTORS�

FEMALE
HAVE A CHRONIC MEDICAL ILLNESS, SUCH AS CANCER, DIABETES OR HEART DISEASE
HAVE A DISABILITY
SLEEP POORLY
ARE LONELY OR SOCIALLY ISOLATED (PANDEMIC, DEATH)

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YOU MAY ALSO BE AT A HIGHER RISK IF YOU:��

HAVE A PERSONAL OR FAMILY HISTORY OF DEPRESSION
USE CERTAIN MEDICATIONS
SUFFER FROM A BRAIN DISEASE
MISUSE ALCOHOL OR DRUGS
HAVE EXPERIENCED STRESSFUL LIFE EVENTS SUCH AS LOSS OF A SPOUSE, DIVORCE, OR TAKING CARE OF SOMEONE WITH A CHRONIC ILLNESS

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CAUSES OF DEPRESSION

GENETIC PREDISPOSING
DEPRESSIVE EPISODES DURING YOUNGER YEARS
BRAIN CHEMISTRY
STRESS (LOSS OF A LOVE ONE, INDEPENDENCE, HOME, CAR)

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WHAT DO WE KNOW ABOUT DEPRESSION

MANY OF THE SYMPTOMS OF DEPRESSION ARE THE SAME ACROSS ALL AGES
IT CAN OCCUR IN PEOPLE AT AGE
WHILE DEPRESSION IS COMMON IN OLDER PEOPLE, IT’S NOT CONSIDERED A NORMAL PART OF AGING.
DEPRESSION IS A MEDICAL CONDITION WHERE THE SYMPTOMS WON’T IMPROVE WITHOUT TREATMENT.

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WHAT DO WE KNOW ABOUT DEPRESSION

REGARDLESS OF HOW OLD YOU ARE WHEN YOU GET IT, YOU CAN’T JUST SHAKE IT OFF
ANHEDONIA LOSS OF INTEREST, REDUCTION IN MOTIVATION OR ABILITY TO EXPERIENCE PLEASURE
PSYCHOMOTOR RETARDATION ARE TYPICALLY PRESENT (SLOWING DOWN OF THOUGHT AND A REDUCTION OF PHYSICAL MOVEMENT, VISIBLE SLOWING OF PHYSICAL AND EMOTIONAL REACTIONS INCLUDING SPEECH)

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SYMPTOMS

NOTICEABLE CHANGES IN MOOD, ENERGY LEVEL, OR APPETITE

FEELING FLAT OR HAVING TROUBLE FEELING POSITIVE EMOTIONS

DIFFICULTY SLEEPING OR SLEEPING TOO MUCH

DIFFICULTY CONCENTRATING, FEELING RESTLESS, OR ON EDGE

INCREASED WORRY OR FEELING STRESSED

ANGER, IRRITABILITY OR AGGRESSIVENESS

ONGOING HEADACHES, DIGESTIVE ISSUES, OR PAIN

A NEED FOR ALCOHOL OR DRUGS

SADNESS OR HOPELESSNESS

SUICIDAL THOUGHTS

ENGAGING IN HIGH-RISK ACTIVITIES

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SYMPTOMS OF DEPRESSION IN ELDERLY: WHAT I SEE IN MY OFFICE�

MAIN SYMPTOM OF DEPRESSION IS SADNESS
OLDER PEOPLE MAY NOT ADMIT TO BEING SAD AND MAY NOT WANT TO TALK ABOUT IT
YOU MAY NOTICE THAT THEY’RE TIRED ALL THE TIME DURING THE DAY
TROUBLE SLEEPING AT NIGHT
PRIMARY SYMPTOM OF JUST BEING GRUMPY AND IRRITABLE OR COMPLAIN OF PAINS AND HEADACHES (ROS)

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EFFECTS OF DEPRESSION IN THE ELDERLY

MENTAL DECLINE IS RAPID
PATIENTS CAN STATE THE CORRECT DATE, TIME, AND WHERE THEY ARE
PATIENTS HAVE DIFFICULTY CONCENTRATING
LANGUAGE AND MOTOR SKILLS ARE SLOW BUT NORMAL
PATIENTS NOTICE AND WORRY ABOUT MEMORY PROBLEMS AND CONFUSION

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MEDICAL CONDITIONS THAT MIMICS DEPRESSION

HEART DISEASE
STROKE
CANCER
PARKINSON’S DISEASE
LUPUS
DIABETES
DEMENTIA AND ALZHEIMER’S
MULTIPLE SCLEROSIS
MEDICATIONS SIDE EFFECTS

THESE MEDICATIONS INCLUDES: CARDIOVASCULAR DRUGS, CHEMOTHERAPEUTICS, ANTIPSYCHOTIC DRUGS, ANTIANXIETY MEDICATIONS AND SEDATIVES, ANTICONVULSANTS, ANTI-INFLAMMATORY/ANTI-INFECTIVE AGENTS, STIMULANTS, HORMONE DRUGS, AND OTHER DRUGS

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OTHER FACTORS FOR DEPRESSION IN THE ELDERLY

MEDICAL ISSUES
RETIREMENT
DEALING WITH THE DEATH OF A SPOUSE OR OTHER FAMILY/FRIENDS
HAVING TO MOVE TO A DIFFERENT LOCATION
OLDER PEOPLE TEND TO ADAPT BETTER TO LIFE’S TRIALS

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IF YOU HAVE EXPERIENCE SEVERAL OF THE FOLLOWING SYMPTOMS FOR 2 WEEKS YOU MAY BE SUFFERING FROM DEPRESSION

PERSISTENT SAD, ANXIOUS, OR “EMPTY” MOOD
LOSS OF INTEREST OR PLEASURE IN HOBBIES AND ACTIVITIES
FEELINGS OF HOPELESSNESS, PESSIMISM
FEELINGS OF GUILT, WORTHLESSNESS, HELPLESSNESS
DECREASED ENERGY, FATIGUE, BEING “SLOWED DOWN”
DIFFICULTY CONCENTRATING, REMEMBERING, MAKING DECISIONS
DIFFICULTY SLEEPING, EARLY-MORNING AWAKENING, OR OVERSLEEPING
APPETITE AND/OR UNINTENDED WEIGHT CHANGES
THOUGHTS OF DEATH OR SUICIDE, SUICIDE ATTEMPTS
RESTLESSNESS, IRRITABILITY
ACHES OR PAINS, HEADACHES, CRAMPS, OR DIGESTIVE PROBLEMS WITHOUT A CLEAR PHYSICAL CAUSE AND/OR THAT DO NOT EASE EVEN WITH TREATMENT

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TYPES OF DEPRESSION IN THE ELDERLY �

MAJOR DEPRESSIVE DISORDER
PERSISTENT DEPRESSIVE DISORDER
SEASONAL AFFECTIVE DISORDER (SAD)
PSYCHOTIC DEPRESSION

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MAJOR DEPRESSIVE DISORDER (MDD)

THE MOST COMMON TYPE OF DEPRESSION IN THE ELDERLY
MAY OCCUR DURING THE YOUNGER YEARS
MAY REAPPEAR DURING THE SENIOR YEARS
MAY EXIST CONTINUOUSLY THROUGHOUT LIFETIMES
THE SYMPTOMS OF MAJOR DEPRESSION INTERFERE WITH THEIR ABILITY TO

SLEEP
CONCENTRATE
EAT
WORK
ENJOY LIFE

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PERSISTENT DEPRESSIVE DISORDER (PDD)

LASTS FOR AT LEAST TWO YEARS (DYSTHYMIA)
ALTERNATE BETWEEN MILD AND MODERATE DEPRESSION
SYMPTOMS

SADNESS, HOPELESSNESS OR FEELINGS OF GUILT (MOSTLY EVERY DAY AT LEAST 2 YEARS)
WORRY ABOUT THE PAST
SYMPTOMS RANGE IN SEVERITY

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SEASONAL AFFECTIVE DISORDER (SAD)

OCCURS WHEN THE WEATHER GETS COLD AND GLOOMY
SHORTER HOURS OF SUNLIGHT
THE SYMPTOMS ARE THE SAME AS FOR CLINICAL DEPRESSION AND THEY MAY IMPROVE WHEN THE WEATHER TURNS WARMER AND THERE IS MORE SUNLIGHT.
SAD TYPICALLY ACCOMPANIED BY

SOCIAL WITHDRAWAL
INCREASED SLEEP
WEIGHT GAIN
PREDICTABLY RETURNS EVERY YEAR IN SEASONAL AFFECTIVE DISORDER.

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PSYCHOTIC DEPRESSION

DEPRESSIVE PSYCHOSIS
EXPERIENCE SYMPTOMS OF MDD ALONG WITH ONE OR MORE PSYCHOTIC SYMPTOM
PSYCHOSIS MAY BE IN THE FORM OF HALLUCINATIONS, DELUSIONS, OR SOME OTHER TYPE OF BREAK WITH REALITY
HALLUCINATIONS MAY CAUSE THEM TO HEAR OR SEE THINGS THAT DON’T EXIST. (AUDITORY, VISUAL OLFACTORY)
DELUSIONS MAY MANIFEST AS HAVING FEELINGS OF GUILT, PERSECUTION, PUNISHMENT , WORTHLESSNESS (STOLE MY MONEY)
PARANOIA FEAR THAT SOMEONE OR SOMETHING IS GOING TO HARM THEM
THIS CAN BE CAUSED BY A TRAUMATIC EVENT OR IF YOU HAVE ALREADY HAD A FORM OF DEPRESSION IN THE PAST.

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WHAT CAN YOU DO PRIOR TO A REFERRAL

LAB WORK UP (CBC, CMP, TSH, B12, VITAMIN D, THERAPEUTIC DRUG LEVELS)
UA AND UDS
START TREATMENT (SSRI, SRNI)
AVOID BENZO
SCALES (PHQ-9, GAD-7)

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BRAIN CHANGES WITH DEPRESSION

BRAIN SIZE

HERE’S GROWING EVIDENCE THAT SEVERAL PARTS OF THE BRAIN SHRINK IN PEOPLE WITH DEPRESSION.
THESE AREAS LOSE GRAY MATTER VOLUME (GMV).
GMV LOSS SEEMS TO BE HIGHER IN PEOPLE WHO HAVE REGULAR OR ONGOING DEPRESSION WITH SERIOUS SYMPTOMS

PREFRONTAL CORTEX. THIS AREA PLAYS A ROLE IN YOUR HIGHER-LEVEL THINKING AND PLANNING. THERE’S ALSO EVIDENCE THESE PARTS OF YOUR BRAIN GET SMALLER:
HIPPOCAMPUS. THAT PART OF YOUR BRAIN IS IMPORTANT FOR LEARNING AND MEMORY. IT CONNECTS TO OTHER PARTS OF YOUR BRAIN THAT CONTROL EMOTION AND IS RESPONSIVE TO STRESS HORMONES. THAT MAKES IT VULNERABLE TO DEPRESSION.

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Shown here are PET scans of the brain showing different activity levels in a person with depression, compared to a person without depression

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IS IT GRIEF OR DEPRESSION?�

GRIEF AFTER LOSS OF A LOVED ONE IS A NORMAL REACTION TO LOSS AND GENERALLY DOES NOT REQUIRE MENTAL HEALTH TREATMENT.
HOWEVER, GRIEF THAT LASTS A VERY LONG TIME OR IS UNUSUALLY SEVERE FOLLOWING A LOSS MAY REQUIRE TREATMENT.

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DECREASING THE IMPACT OF DEPRESSION

COMMUNICATION AND HONESTY (IF AN ELDERLY PERSON NEEDS TO DOWNSIZE THEIR HOME)
HEALTHY DIET
REGULAR EXERCISE (PHYSICAL ACTIVITY RELEASES ENDORPHINS AND LINK TO HIGHER SELF ESTEEM BETTER SLEEP AND LESS STRESS AND MORE ENERGY) (5 DAY PER WEEK FOR 20-30 MINUTES)
ADDRESS PHYSICAL ILLNESS ASAP
SOCIALIZATION

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HOW DO I HELP SOMEONE WITH DEPRESSION?�

FIRST HELP HIM OR HER SEE A DOCTOR OR MENTAL HEALTH PROFESSIONAL.
OFFER SUPPORT, UNDERSTANDING, PATIENCE, AND ENCOURAGEMENT.
HELP KEEP TRACK OF HIS OR HER APPOINTMENTS AND WEEKLY “PILLBOX” IF POSSIBLE BECAUSE MANY OLDER ADULTS WITH DEPRESSION MAY NOT BE THINKING CLEARLY.
TRY TO MAKE SURE HE OR SHE HAS A WAY OF GETTING TO DOCTOR VISITS.

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HOW DO I HELP SOMEONE WITH DEPRESSION?�

TALK TO HIM OR HER, AND LISTEN CAREFULLY.
NEVER IGNORE COMMENTS ABOUT SUICIDE, AND REPORT THEM TO YOUR LOVED ONE’S THERAPIST OR DOCTOR.
INVITE HIM OR HER OUT FOR WALKS OR OUTINGS, OR TO ENGAGE IN INDOOR ACTIVITIES WITH YOU.
REMIND HIM OR HER THAT, WITH TIME AND TREATMENT, THE DEPRESSION WILL IMPOVE

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TREATMENT

MEDICATION
PSYCHOTHERAPY (TALK THERAPY)
ONLINE THERAPY (PSYCHOLOYTODAY.COM)
ESTABLISH A SUPPORT NETWORK (PREVENT ISOLATION)
ALLOW YOURSELF TIME TO CHANGE

INSOMNIA (SLEEP HYGIENE)
HEALTHY DIET
EXERCISE PLAN

ANTIDEPRESSANTS

SSRI

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MEDICATION�

MEDICATIONS CALLED ANTIDEPRESSANTS CAN WORK WELL TO TREAT DEPRESSION
WHILE SOME SYMPTOMS USUALLY BEGIN TO IMPROVE WITHIN A WEEK OR TWO, THEY CAN TAKE SEVERAL WEEKS TO WORK FULLY.
AS WITH MOST MEDICATIONS, MANY PEOPLE EXPERIENCE SOME SIDE EFFECTS, WHICH IN MOST CASES CAN BE MANAGED OR MINIMIZED.

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MEDICATION IN THE ELDERLY

PEOPLE OVER 65 HAVE TO BE CAREFUL WHEN TAKING MEDICATIONS, ESPECIALLY WHEN THEY’RE TAKING MEDICATIONS FOR DIFFERENT CONDITIONS.
OLDER ADULTS HAVE A HIGHER RISK FOR EXPERIENCING BAD DRUG INTERACTIONS,
MISSING DOSES, OR OVERDOSING.
BE SURE TO TELL EVERY DOCTOR YOU SEE ABOUT ALL OF THE MEDICATIONS YOU ARE BEING PRESCRIBED.
IT IS ALSO A GOOD IDEA TO GET ALL OF YOUR MEDICATIONS FROM THE SAME PHARMACY
PHARMACISTS ARE EXCELLENT SOURCES OF INFORMATION ABOUT MEDICATIONS AND WILL ALERT YOU AND YOUR DOCTORS IF THERE ARE CONCERNS ABOUT A POSSIBLE INTERACTION BETWEEN MEDICATIONS—WHICH CAN HAPPEN INADVERTENTLY WHEN A DOCTOR IS NOT FAMILIAR WITH A MEDICATION BEING PRESCRIBED FOR A DIFFERENT CONDITION BY A DIFFERENT HEALTH CARE PROVIDER.

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