Causes of Depression - Substance Abuse

    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.

    Alcohol is the most commonly abused substance in the elderly population, affecting over 13 percent of the American population over a lifetime. According to the US Department of Mental Health and Human Services Consensus, alcoholics do become depressed over time, as a matter of fact, it is as high as 10 to 30 percent. On the other hand it is found that alcoholism was rarely a consequence of depression, less than 5 percent. Ten percent of patients who have a major depressive disorder and a concurrent psychiatric disorder abuse alcohol. It is also important to know that even though depression and alcoholism often coexist, they are separate and distinct clinical disorders.

    Alcohol is easily available and accepted in our society to be used as a form of relaxation and is used readily in social contexts. Some elderly people begin to drink to cope with grief or loss, sleep disturbance, poor appetite, social and physical stresses, and some have continued to drink for a lifetime only finding it now effecting them in adverse ways, effecting their physical and emotional stability. The elderly absorb, distribute, metabolize and excrete substances differently than their younger cohorts resulting often in a buildup of toxins or drug in the blood. The fact that elderly are more sensitive to some medications, for example central nervous system depressants, is a contributing factor of change in mental status or mood.

    It is important to note that many prescription medication can be addictive and people can build up a tolerance. Some medications take longer to completely leave the body (refereed to as the half-life of a medication) and can produce adverse effects because of the build up of metabolites in the blood. Pain medication (hypnotic) those which help with sleep (hypnotic) or anti-anxiety medication can all be addictive and one can build a tolerance, needing more of the medication to get the same effect. Please talk with your doctor about your medication and the potential for tolerance or if it has addictive qualities. There may be other medications which are more suitable to the elderly population.

    If you or someone you know is feeling depressed, and substance abuse or dependence is a concern, there is help available. Hospitalization may be necessary to safely detoxify from alcohol or be tapered off a medication. The depressive symptoms can then be truly assessed and treatment may begin. It is very difficult to assess and evaluate for depression because the medication could be causing depressive symptoms. Doctors will most likely treat for depression if the person is still significantly depressed after the detoxification process has been complete for sometimes up to six months. Do not try to stop "cold turkey" because withdrawal symptoms can be sometimes very dangerous to the system. Detoxification or to be tapered off addictive medication needs to be done under a doctor’s supervision.

    Along with a physical dependence comes a psychological dependence as well. It is important to find a supportive network or system when going through the detoxifying process. Your doctor can suggest which one will be the most appropriate for you. A 12 step program like Alcoholics Anonymous is helpful because its foundation is grounded in helping people resocialize in an environment which is supportive of sober living. The 12 steps assist people to maintain their sobriety ‘one day at a time’. Many elderly have initiated sobriety in their "Golden Years". It is never too late to make a change for improved health.

    Remember, alcoholism is a family disease and does affect your loved ones. Involve them in your recovery, there is help for them too.

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