Older Adults: Depression and Suicide Facts
from National Institute of Mental Health
Major depression, a significant predictor of suicide in older adults, is a widely underrecognized and undertreated medical condition. In fact, several studies have found that many older adults who commit suicide have visited a primary care physician very close to the time of the suicide: 20 percent on the same day, 40 percent within one week, and 70 percent within one month of the suicide. These findings point to the urgency of enhancing both the detection and the adequate treatment of depression as a means of reducing the risk of suicide among the elderly.
In contrast to the normal emotional experiences of sadness, grief, loss, or passing mood states, depressive disorders can be extreme and persistent and can interfere significantly with an individual's ability to function. Dysthymic disorder* as well as depressive symptoms that do not meet full diagnostic criteria for a disorder are common among the elderly and are associated with an increased risk of developing major depression. In any of its forms, however,
depression is not a normal part of aging.
Older Americans are disproportionately likely to commit suicide, despite the statistics cited above. Comprising only 13 percent of the U.S. population, individuals ages 65 and older accounted for 19 percent of all suicide deaths in 1997. The highest rate is for white men ages 85 and older: 64.9 deaths per 100,000 persons in 1997, about 6 times the national U.S. rate of 10.6 per 100,000.
An estimated 6 percent of Americans ages 65 and older in a given year, or approximately 2 million of the 34 million adults in this age group in 1998, have a diagnosable depressive illness (major depressive disorder, bipolar disorder, or dysthymic disorder).
Depression often co-occurs with other medical illnesses such as cardiovascular disease, stroke, diabetes and cancer. Because many older adults face such physical illnesses as well as various social and economic difficulties, individual health care professionals often mistakenly conclude that depression is a normal consequence of these problems-an attitude often shared by patients themselves. These factors conspire to make the illness underdiagnosed and undertreated.
Research and Treatment
Modern brain imaging technologies are revealing that in depression, neural circuits responsible for the regulation of moods, thinking, sleep, appetite, and behavior fail to function properly, and that critical neurotransmitters-chemicals used by nerve cells to communicate-are out of balance.
Genetics research indicates that vulnerability to depression results from the influence of multiple genes acting together with environmental factors. Studies of brain chemistry and of mechanisms of action of antidepressant medications continue to inform the development of new and better treatments.
Anti-depressants
Anti-depressant medications are widely used effective treatments for depression. Existing anti-depressant drugs are known to influence the functioning of certain neurotransmitters in the brain, primarily serotonin and norepinephrine, known as monoamines.
Older medications-tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs)-affect the activity of both of these neurotransmitters simultaneously. Their disadvantage is that they can be difficult to tolerate due to side effects or, in the case of MAOIs, dietary and medication restrictions.
Newer medications, such as the selective serotonin reuptake inhibitors (SSRIs), have fewer side effects than the older drugs, making it easier for patients including older adults to adhere to treatment. Both generations of medications are effective in relieving depression, although some people will respond to one type of drug, but not another.
Therapy
Certain types of psychotherapy also are effective treatments for depression. Cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) are particularly useful. Approximately 80 percent of older adults with depression improve when they receive appropriate treatment with medication, psychotherapy, or the combination.
In fact, recent research has shown that a combination of psychotherapy and antidepressant medication is extremely effective for reducing recurrence of depression among older adults. Those who received both interpersonal therapy and the antidepressant drug nortriptyline (a TCA) were much less likely to experience recurrence over a three-year period than those who received medication only or therapy only.
*Dysthymic disorder: A chronic, mild form of depression that has been present for at least two years. It occurs twice as frequently in women as in men.
