Seniors and Depression

with Eric W. Kaplan, M.D., Columbia St. Mary’s

Last Updated: July 1, 2003

Depression is often thought of as a midlife problem. However, seniors have an even higher risk. According to Dr. Eric Kaplan, a specialist in geriatric psychiatry with Columbia St. Mary’s, around 30% of elderly patients report depressive symptoms to their primary care physicians, and about half of these may be suffering from minor depression.

Eric W. Kaplan, M.D., Columbia St. Mary's "Untreated elderly with depression tend to have longer hospital stays and a higher death rate."

Know the signs
Common symptoms of depression in the elderly include decreased concentration, loss of appetite, decreased energy and altered sleep patterns (either too little or too much) and withdrawing from friends and family.

In addition, older people suffering from depression visit their physicians more often than their health problems would usually require. "Those elderly with depression tend to have longer hospital stays and a higher death rate," Dr. Kaplan said.

What is insidious about these symptoms is that they are often considered "natural" for someone who is elderly. As a result, it is common for the elderly to deny these symptoms or not report them to physicians.

However, seniors face unique problems that contribute to depression. As a person ages, they are also likely to begin experiencing the loss of loved ones and close friends. As that circle of support diminishes, people may become lonely and isolated.

"And if they become medically ill, particularly from heart disease or a stroke, it greatly increases their risk of depression. This risk is particularly high among elderly stroke victims. Nearly 50 percent of stroke victims suffer from depression," Dr. Kaplan said.

Many depressions are minor but Dr. Kaplan notes that 25% of elderly with minor depression will develop major depression within two years. Treating depression is important because the elderly have the highest rate of suicide of any group. Overall, one third of all suicides in the United States are among the elderly. Twenty percent of elderly suicide victims saw their physicians within a day of their deaths, and 70% were found to have an illness that directly contributed to their suicide.

Successful treatments
Fortunately, depression is treatable with an 85% to 90% success rate. Treatment will depend on the degree of depression. "With situational and minor depression, I try to get people involved in a group," Dr. Kaplan said.

At Columbia, there is a geriatric outpatient group that comes together for both group activities and therapy, ending seniors’ isolation. "We had two of our outpatient group members meet. They’re getting married now," Dr. Kaplan said.

In addition to activities to help alleviate depression, there are the newer types of mood elevating drugs called SSRIs, which treat the chemical imbalances that cause depression with very few side effects. "These drugs have revolutionized outpatient psychiatry and they are much better tolerated by those who need them," Dr. Kaplan said.

When someone is suffering from severe depression and medications don’t work or can’t be prescribed, there is a new twist on an old psychiatric standby called electroconvulsive therapy, or ECT. This is a therapy performed while a patient is sedated. Patients are then placed on maintenance medication and the results are often remarkable.

"It is much more refined and painless than the old treatment and can be done as an outpatient procedure. It still carries a stigma but I explain to my patients that it can be a lifesaver," the doctor said.

Dr. Kaplan cited two examples from among his patients. One involved a man who had spent two months living in another psychiatric hospital. His wife consulted Dr. Kaplan who agreed to try ECT. "I told her if it didn’t work, the man would need to be transferred to a nursing home. But when the guy woke up from ECT, he put on a 3-piece suit and went home. He later attended his 50th wedding anniversary. His last few years were spent at home. If it wasn’t for ECT, I’m convinced he would have died in a nursing home.

"Another patient who became isolative and had stopped eating improved so much after ECT that I didn’t recognize her at her three-month follow-up. She was talkative and lively, wearing makeup and jewelry and had gained twenty pounds. I could hardly believe it was the same woman," Dr. Kaplan concluded.

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