Depression and Sadness

General Information
Depression is a disorder of mood. Depression may vary from a mild, expected (normal) response to the stresses of daily living to a severe psychiatric disturbance that can interfere with daily living. Severe depression is often reversible and should be treated. The occurrence of depression is more frequent with aging. It is more likely to occur in people who have had a prior episode of depression or if there is a family history of depression. Physical illness, particularly chronic illness, also is a predisposing factor. Social factors such as isolation, financial losses, and bereavement can lead to depression as well. Losses, whether primarily physical, such as of income or a home, or primarily emotional, such as of a spouse, a friend, or even a pet, are part of the aging process. When symptoms of depression persist for 2 or more months, a severe depression often called a major depressive episode is diagnosed.

Many manifestations of depression in older individuals overlap changes related to aging or changes due to other diseases. One must be careful not to overinterpret these clues. In the older patient, it is also possible for depression to present with primarily physical symptoms rather than changes in mood. This is ‘‘masked depression’’ and may be difficult to appreciate and dif- ficult for the caregiver or the patient’s physician to identify. Common manifestations include nervousness, insomnia, memory loss, and dizziness, all problems easily ascribed to other aging-related problems. Careful evaluation by a physician is necessary to separate depression from other causes of confusion.

Important Points in Treatment
When the patient’s physician can identify a likely specific underlying cause for the depression, the therapy focuses on treating this underlying condition. Even in these cases, the patient’s physician may recommend supportive care by a counselor, social worker, psychologist, or psychiatrist. Supportive care of this sort can hasten recovery.

Medications
Major depression with impairment of function, as well as depression without an identifiable and treatable underlying cause, may respond to the use of drug treatment. Several drugs are effective, and the most commonly used are tricyclic antidepressants. These are potent medicines that have side effects. Selection of the most appropriate drug is often based on the ability to tolerate possible side effects. Careful control of the dose and the time of administration is essential to their proper and effective use and to the management of side effects. Special attention by the caregiver is important for successful treatment.

Side effects of these medications may include, but are not limited to, dry mouth, blurred vision, urinary retention, rapid heart rate, persistent heartburn, and glaucoma attacks. Some patients may experience dizziness when they stand up. Occasionally, these drugs produce confusion, sleepiness, or bizarre or inappropriate behavior. Any abrupt behavior changes in a patient receiving drug therapy for depression should be brought to the physician’s attention immediately.

Depression may also be related to substance abuse. Abuse of alcohol or illegal drugs may be a factor. Stopping the substance abuse is an important but difficult step in treatment. Seasonal depression is a feature associated with winter in northern climates. A variety of treatments with bright lights are helpful in alleviating this form of depression.

Notify Our Office If ...

• You note any clue or suggestion that the patient may have suicidal thoughts. This should be taken seriously and promptly reported to the patient’s physician. Suicide is an unfortunate and not uncommon accompaniment of severe depression. The patient is often indirectly asking for help.
• Side effects of drug treatment occur. Side effects often require prompt, even immediate, intervention to be reversed. These particularly include glaucoma attacks (sudden, acute pain in the eye), which may lead to blindness if not promptly treated; urinary retention, which may lead to bladder infection and damage to the kidneys; and abnormal heart rhythm, which often manifests as dizziness and, if untreated, may lead to sudden death.