Recognizing Depression

It is important to recognize the signs and symptoms of depression in the elderly because it can be easily masked by other illnesses, psychiatric conditions, or use of certain medications or alcohol. The symptoms of depression can be different in the elderly population versus the adult population.

Depression can lead to many consequences that are debilitating (Muller-Spahn/Hock, 1994).

		Decreased quality of life
		Isolation
		Increased mortality
		Increased dependence on others for care
		Vulnerability to physical illness
		Can be a financial burden

According to Small (1991) 40 percent of depression in the elderly is undiagnosed. Even if your primary health physician recognizes the depression, he/she may not have current knowledge about the most effective or current treatments for depression. There is no lab test that can be done to identify "depression" at this time. Certain tests, like thyroid function tests, complete blood panels, and EEGs are being used to rule out medical conditions that can cause depression. Some research is being done with EEGs and imaging studies to determine certain psychiatric conditions, but only a combination of these procedures, laboratory results, a physical and psychiatric evaluation and a clinical interview by a trained doctor can make the diagnosis. If you suspect yourself or someone you love to be depressed, please consult your physician so you can be referred to the appropriate health care provider i.e. geriatric psychiatrist.

Five or more of the following symptoms present for a 2 week period, represent a change in previous functioning and are either a subjective report by the person feeling depressed or an objective report by another.

		Pervasive, depressed mood
		Anhedonia (a decrease in interest or pleasure in usually pleasing activities)
		Appetite disturbance with weight gain of loss
		Sleep disturbance with either insomnia or too much sleep
		Feeling agitated, restless, or slowed down (slow moving, constipation)
		Lack of energy
		Feeling not worth while or experiencing excessive guilt sometimes to delusional proportions
		Ambivalence, decreased concentration or attention that may affect memory
		Lack of energy or fatigue
		Focus on death, life not worth living, suicidal ideation with or without plan

		Anxiety
		Preoccupation with physical ailments
		Cognitive deficit (memory, difficulty concentrating or making decisions)
		Restlessness, inability to settle, sleep disturbance (psychomotor agitation)
		False beliefs (delusions) or hypochondriacal syndromes (i.e. disbelief in the ability to swallow)

		Stressful life events (loss of loved one, financial difficulties)
		Lack of support or lack of perceived support from family, friends, professionals
		Physical illness
		Being unmarried or recently widowed

A note about suicide. If you or someone you know is having thoughts of suicide or feeling like life is not worth living, seek medical attention. It is important to take those thoughts seriously! Do not be alone and if you are with a person who feels suicidal stay with them until they have sought medical attention.

		Age
		Male gender
		Previous suicide attempts
		A plan for committing suicide (feasible and lethal)
		Psychiatric disorder (depression)
		Severe chronic illness (pain, poor prognosis)
		Death of spouse and loss of relationships (lack of support system