Sunday, January 15, 2006


Depression is a morbid sadness or melancholy often symptomatic of a psychiatric disorder, neurosis, or psychosis. It is distinguished from grief, which is a realistic and normal reaction to personal loss or tragedy.
Depression in the elderly is usually thought to be exogenous, or reactive, as opposed to endogenous in younger people. Exogenous depression arises in response to events that occur outside the individual such as loss of a spouse, retirement, poor health, or a change in lifestyle. (Endogenous depressions are thought to be related to intrapsychic, or internal, characteristics of the individual.)
Depression is probably related to the very high SUICIDE rate of older men. Thus, this disturbance is to be taken seriously when it occurs in an aged person and treated actively, with special emphasis on dealing with the environmental factors precipitating it. Symptoms of depression may begin with physical signs such as weight loss, loss of appetite, severe fatigue, and sleep difficulties, especially early awakening or insomnia. The psychological indications of depression include sadness, low activity and interest levels, severe pessimism, and difficulty making decisions. Sometimes the person cries a great deal or experiences severe guilt or anxiety.
In diagnosing depression in the elderly, two additional possibilities should be evaluated as contributing factors. The first is whether medications the patient is taking may be causing a drug-induced depression. The second is whether the depression is associated with an illness.
A number of drugs may produce depression including Reserpine, Indomethacin, clonidine, propranolol, phenmetrazine, and amphetamines. Often, a drug-induced depression will require treatment with a tricyclic antidepressant.
The physical illnesses that appear to generate depression include hyperthyroidism, Addison's disease, Cushing's disease, Parkinson's disease, and cerebral arteriosclerosis. In treating a secondary depression, proper attention to the primary illness is essential. Rehabilitation may be necessary if disability results from the effects of the illness. Treatment for primary depression includes psychotherapy or counseling to determine the source of the depression. Antidepressant drugs may be needed. Involving the person in group activities or regular exercise programs may be helpful. The families of the older person need to be drawn into the treatment programs to lend their encouragement and support.
Rossman, I. Clinical Geriatrics, 3rd ed. Philadelphia: J. B. Lippincott, 1986.
Steinberg, F. U. Care of the Geriatric Patient. 6th ed. St. Louis: C. V. Mosby Co., 1983.


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