Treatment Targets Specific Causes of Age-Related Depression

Medical advances that help people live long lives may not be so great if those extra years are miserable ones. Depression is a growing problem among America’s elderly, and I learned from an expert there’s no mystery why — to put it bluntly, advancing age often brings more to be depressed about. Awareness of this important health problem is an important first step to greater understanding and better treatments so life not only lasts longer, but is also happier and more rewarding up until the very end.

I read recently that the National Institute of Mental Health (NIMH) had awarded New York City’s Weill Cornell Institute of Geriatric Psychiatry its largest grant ever — $10 million — to study treatments for geriatric depression. I checked in with the lead researcher on that project, George Alexopoulos, MD, founder and director of Weill Cornell’s Institute of Geriatric Psychiatry at New York-Presbyterian/Westchester, to learn about new directions for research and also to tap his wisdom on how elderly patients with depression can be helped now.

How Many Suffer?

You may or may not agree with their definition of “elderly” (65 years old or older), but this population is surging — and is predicted to grow by 73% in the next decade. Dr. Alexopoulos told me that experts estimate that about 15% will suffer clinical depression. It’s sad to think that many will struggle for years — even decades — with chronic diseases and the accompanying disabilities that exacerbate their depression. Depression, in turn, sours everything else — including their medical problems and even outcome. “Depression is like breathing bad air — it makes whatever you have worse,” he said.

In elderly people, depression can be triggered by Alzheimer’s disease, and the symptoms of dementia and depression are often confused, Dr. Alexopoulos explained. Also, elderly patients with depression are likely to have unique symptoms that lead the diagnosis astray, including agitation and difficulties with mental processing (including memory, speech, hearing and understanding). Their complaints of aches and pains that do not have another obvious cause may be dismissed, misdiagnosed or improperly treated. And all these other issues occur in addition to the typical symptoms of depression that younger people have, too — such as sadness, an inability to experience pleasure, excessive or inappropriate feelings of guilt, changes in appetite, negative mood, sleep difficulties and physical complaints, such as fatigue, headaches and heart palpitations. I suppose it’s no wonder that elderly depressed people have both a higher rate of thoughts of suicide and higher rates of suicide than younger people with the same condition.

Brighter Days Are Here

But let’s take a deep breath here — the news is not all bad. There is much to be gained from these depressing details in that they provide context for better treatment. And that, of course, is where the $10 million grant is aimed. Dr. Alexopoulos told me that doctors have already learned a great deal about effective treatment of depression in vulnerable elderly people. Many, he says, can be helped by psychotherapy, medication or a combination of both that incorporates the latest new findings. Among the new developments:

  • New approaches in psychotherapy can be tailored to provide what elderly patients need most. According to Dr. Alexopoulos, that means specifically helping them to address and find solutions for their new mental and/or physical limitations. For instance, effective therapy for an elderly patient may focus less on personal growth or relationship issues and more on achieving a better understanding of their nutritional needs so they’ll eat better, which will improve mood and energy level. They may need help figuring out how to solve mobility issues, including how to get around their homes as well as making arrangements for transportation for shopping, doctor visits and seeing friends and family. And they may need to explore other ways to adjust their living circumstances so that they can feel better emotionally and physically.
  • It’s now known that inadequate blood supply to the brain can cause chemical changes associated with depression — and doctors can use modern brain imaging techniques to identify specific regions where this is occurring. They can then utilize corrective treatment if blood flow is found to be blocked or insufficient among elderly patients when they first show signs of depression.
  • Doctors have gotten better at fine-tuning medications for their elderly patients — for example, it’s now known that elderly patients do better with certain antidepressants (such as sertralinecitalopram and esctitalopram) that aren’t as likely to interact dangerously with other medications.
According to Dr. Alexopoulos, the goal is to help elderly patients with depression to take an honest look at what they used to be able to do that they can no longer do… explore how they feel about these limitations… and then to learn better ways to work around them, with the ultimate goal of finding a way to accept them. If you or someone you love faces this problem and these new approaches aren’t being incorporated into treatment, bring this article along to your next appointment and ask to discuss whether they can be. These are heartening steps in the right direction toward a brighter future… the hope is that we can all, indeed, look forward to living long and happy lives.