Aging can be a time to find meaning in a life fully lived.  It also can be a time of despair – despair that goes far beyond the grief and loss we experience in life.  Nearly one in five seniors has a mental health problem that is more than “normal” difficulties in adjustment.  Many do not get help. 

BARRIERS TO GETTING HELP.

There are many different reasons seniors do not seek help when they struggle with depression, grief, or stress.   Some feel mental health problems are shameful, a sign of weakness or failure of character.  Others interpret signs of depression or stress as symptoms of a physical problem, and may not realize that they have underlying depression or anxiety.  Some may be afraid to speak up about confusion or lack of focus caused by depression because they fear they are signs of dementia.  Still others believe that feelings of emptiness, loss of energy, and sadness are to be expected as part of “normal” aging.  And depression often leaves people feeling hopeless or unmotivated.  Picking up the phone to ask for help may feel like lifting the weight of the world.

It’s important to break down these barriers to getting help.   Depression is a medical condition, not a character flaw.  It requires medical care just as surely as do diabetes or high blood pressure.

RISKS OF UNTREATED DEPRESSION.

Untreated mental health problems leach happiness from seniors’ lives and those of their families.  Depression among seniors puts them at higher risk of suicide.

Physical and mental health are profoundly interrelated. Untreated depression increases the likelihood of physical problems, and can prolong recovery from physical illness.   In turn, seniors with physical difficulties are more vulnerable to depression. 

An untreated mental health problem, such as depression, can cloud thinking and deplete energy.  It may leave seniors unable to meet the challenges of aging and making transitions, much less able to enjoy the pleasures of family, friends, and increased leisure time.  It can burden seniors and their families.

GETTING HELP MAKES A DIFFERENCE. 

Fear of stigma, as well as lack of knowledge about current treatment, causes many seniors to suffer with this treatable illness.  Depression is a disease.  People with depression cannot simply ignore it or will it away.  It’s important to get help.  With counseling, medicine, or a combination of the two, seniors can feel vibrant and alive, able to engage with the world around them.  There is no reason to let depression rob them of life’s pleasures. 

WHEN IS IT “JUST AGING” AND WHEN IS IT A MENTAL HEALTH ISSUE? 

People are at risk of depression throughout the life cycle.  But depression often looks different depending on where you are in that cycle.  In adolescents, depression often comes out as anger.  In new mothers, depression may express itself as guilt about being a poor mother, feeling disconnected from the baby, or feeling acute anxiety. 

Depression among seniors often includes irritability, sleep problems, feeling empty, helpless, low-energy, or bored.  Seniors with depression often withdraw from their regular activities and isolate themselves.  Seniors may be less likely to identify these symptoms as depression because they view them as physical problems or part of the normal aging process.  To see the Geriatric Depression Scale …

WHAT TO DO WHEN YOU’RE WORRIED THAT YOU, A FRIEND, OR A FAMILY MEMBER MAY BE DEPRESSED. 

People who suffer from depression often feel blamed and defensive.  Frequently, a depressed person will be very irritable, sad or withdrawn.  It’s important to approach a family member or friend with great respect, noting concern about present behaviors that show significant decline from past behavior patterns.  An example might be, “You used to enjoy going out and playing bridge on weekends.  I’m concerned because, for the last three months, you stayed in the house and watched TV most of the weekend.”  If you see that your friend or family member resists your approach, end the conversation with a genuine expression of your concern and a resolve to approach the issue at another time. The first step towards health is an evaluation by a primary care doctor.  It’s essential to look at whether there are physical problems that create depressive symptoms, or whether depression creates symptoms that are masked as physical ones.  Especially as we age, the interrelationship of physical and emotional issues is a complicated dance.  Here are some issues to keep in mind:

• We tend to take more medications as we get older.  Sometimes the combination of different medications can result in feelings of sadness or worry. Certain medications used alone can have side effects that create feelings of anxiety or depression.  And sometimes patients do not report using herbal remedies, which can create bad side effects when combined with prescription drugs. Make sure a doctor knows all medications you are taking (including over-the-counter drugs).

• The effects of alcohol and drugs are magnified as we age.  As at any age level, alcohol or drug use among seniors can contribute to mental health issues. And their impact on seniors can be more severe because for them “less is more.” 

• Depression can prompt physical complaints (such as stomach problems, fatigue and pain) that do not respond to treatment.  It’s important to ask whether these issues reflect an underlying physical disease or are symptoms of depression.

• On the other hand, physical problems can produce depressive symptoms that have their origin in physical illness.  A doctor should determine whether there are underlying physical issues (such as thyroid problems, hormonal imbalances, and Alzheimer’s) when someone you know seems depressed.

• Physical difficulties (such as diabetes, cancer, Parkinson’s disease, heart attacks, strokes, and bypass surgery) make seniors more vulnerable to depression. 

 

WHAT TO DO IF IT’S DEPRESSION.

 If a physical examination suggests that symptoms are the result of depression or another mental health issue, it’s important to know that depression is very treatable.  One recent study found that about 4 out of every 5 older adults with depression recovered with a combination of counseling and medication.  Indeed, research indicates that the combination of talk therapy and medication can be more effective than either one approach used alone.  Both Medicare and Medicaid cover mental health care. 

Mental health professionals such as psychiatrists, psychologists, and clinical social workers, and licensed professional counselors can provide counseling that helps people lift themselves out of depression.  Some mental health providers are also pastoral counselors who can provide therapy in a spiritual context.  Geriatric psychiatrists can prescribe medication.  In some cases, your primary care provider may feel comfortable doing so.

 

POSITIVE STEPS TOWARDS MENTAL HEALTH.
 
Here are some steps you can take on your own to maintain good mental health.  These are not substitutes for treatment of depression, but they can help you stay positive about aging. 

• Decrease social isolation.  We are social beings who thrive on connection.  As we age, it may become more difficult to maintain those connections.  But it helps to get out into the world, whether that is by involvement in a place of worship, a senior center, a social club, or volunteer activity.  Especially if you feel down or lonely, it may be hard to take the first step.  See if you can think of one small, manageable thing to do each day to involve yourself with the world outside your home or apartment.

• Share your feelings with a friend, family member, member of your spiritual community, or a mental health professional.  Talking can help whittle worries down to size.

• Stay physically active.  Research shows that regular physical activity may help reduce mild depression.

• Use alcohol in moderation.  If you are feeling depressed, ask yourself whether alcohol is contributing to your depression.

•  Have a good system for taking medication consistently – sometimes failing to do so can create side effects similar to anxiety or depression.

• Eat regularly and nutritiously.

• Feed your mind as well as your body.  Engage in some daily activity that challenges your mind, whether it’s reading, doing crossword puzzles, playing chess, or working on a hobby.

• Think positively.  If you find yourself consistently anticipating the worst, see if you can use positive “self-talk” to substitute a more optimistic point of view.  Ask yourself “what’s the likelihood that the worst thing will really happen?”  See if you can find another way of thinking about something you fear or feel bad about.  And if you find yourself feeling very negative about yourself or something you have done, ask yourself what you would tell a good friend who was having the same feelings about himself. 

• Use humor to defuse worry.

• Do what you can to reduce stress in your life.  Don’t suffer from “the perfects” -  ask yourself whether what you have done is “good enough.”  Pace yourself, and break big tasks down into manageable pieces. 

Aging can bring with it many losses: death of family and friends, loss of meaningful work or independence, and loss of the sense of physical invulnerability some of us felt when we were younger.  We need to grieve these losses. 

But if feelings of sadness, grief, or depression persist, then it’s time to get help.  Seniors have a right to live life fully, without the weight of depression.  And getting help truly makes that possible.