Causes of Depression -
Co-existing Psychiatric Disorders
About 10-15 percent of depressive symptoms can be caused by medical conditions (US Department of Health and Human Services). This includes, but is not limited to, concurrent use of certain medications, substance abuse, chronic medical conditions and other psychiatric disorders or dementias.
Depression often coincides with other psychiatric disorders such as:
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Anxiety disorders (~ 30% with generalized anxiety disorder, 10-20% with panic disorder) | |
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Eating disorders (~50-75% lifetime history) | |
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Obsessive-Compulsive disorders (lifetime occurrence depressive symptoms with OCD is 80- 100%) | |
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Somatization Disorder | |
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Grief and Adjustment Reactions |
It is fairly common to find anxiety disorders along with depression among the elderly. The combination of depression along with panic attacks is a more severe disorder. The rate if suicide is twice as high for those who have panic and depression than with those who have only a panic disorder. The incidence of panic attacks along with depression is a more severe state due to a higher rate of suicide (Johnson, Weissman, and Klerman, 1990). Usually, both disorders are treated at the same time with medication that is effective for both panic and depression. Psychotherapy, biofeedback and other effective treatments for anxiety, will often be incorporated into the treatment.
Treatment for anorexia, bulemia and depression often coincide. Because depressive symptoms may resolve with weight gain, treatment is first aimed at the eating disorder. If the depression persists after the weight gain and malnourishment has been resolved, then treatment for depression as a primary disorder begins. Medication, a behavioral - cognitive approach along with psychotherapy treatments are utilized. Again, families are involved in treatment because often, young females are effected. Environmental and social aspects are also involved in the treatment of anorexia nervosa, bulimia and depression.
It is rare to see an elderly person with anorexia nervosa or bulimia. It is more common for the depressed elderly to not eat because they have a loss of appetite, they believe they cannot swallow, have passive suicidal ideation with refusal to eat or cannot get out to purchase or prepare food.
It is also less likely to see the elderly with true obsessive-compulsive disorder along with major depression (I have experienced two patients). What is more common, is the depressed elderly patient who experiences ruminations, but not the compulsions that go along with a true obsessive-compulsive disorder. The content of the ruminations are often very negative, nihilistic, and cause distress to the patient.
Even though many depressed patients have medically unexplained somatic complaints, most depressed patients do not meet the criteria for somatization disorder. A common complaint is of pain (joint, back, headaches, and abdominal). Because depressed people experience pain differently than non depressed people, effective treatment for the depressive disorder will usually decrease or result in relief of the pain complaint.
Many elderly experience multiple losses, especially the loss of one’s spouse. Usually their is a period of bereavement which is usually benign and resolves gradually without treatment. People do get confused over depression and bereavement and grief because people may experience the same symptoms. It is not common for one to experience suicidal ideation, psychosis or profound guilt while grieving. If you are experiencing depression for more than two months, suicidal ideation, delusions, hallucinations, or profound guilt, consult your doctor.
