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The holidays: A time of celebration, or of loss?
For many, holidays are a time for happiness and celebration. It is also the time of the year when more people become depressed. Many seniors are affected by losses. These losses can take on greater significance during the holidays. People are reminded that loved ones are no longer there to share the holidays with them. Grown children are busy with their own social obligations, and may not realize that their parents or grandparents look forward to a visit or a phone call.
What are the signs of depression?
In the senior population, signs of depression can be quite subtle. Loss of appetite and increasing isolation may be the only signs. The signs of depression may or may not be recognized by friends or family.
Other possible signs of depression include:
- Weight loss or gain
- Difficulty sleeping, or increased sleeping
- Behavior that is more nervous or agitated than normal, or more slowed and unresponsive than normal
- Complaints of being tired all the time and having low energy
- Sad or irritated mood
- Loss of pleasure and interest in usual activities
- Complaints of feeling worthless
- Difficulty with thinking or concentration
- Thoughts of suicide
If you or a loved one are showing these signs, it's important to deal with the situation by contacting your physician, because it can be treated and made better.
Depression may be caused by medical factors
When friends or family notice something wrong, it's critical that these signs are not just dismissed as part of aging. Older people may be on medications for their heart, blood pressure or arthritis. Some of these medications can cause depression or lethargy. On the other hand, depression can be a symptom of a variety of medical problems. Problems with the thyroid gland can cause apathy. Sometimes a simple urinary tract infection can have fatigue as its only symptom. Fatigue may be the only complaint in someone who is anemic.
What can I do about depression?
If you or someone you know shows evidence of depression, it is important that you see your primary care physician or encourage the person you know to do so. A good physician will not just assume that an older person is naturally depressed. Instead, the doctor will evaluate the older person for the medical conditions described above.
There are tests that can evaluate whether someone is depressed. In the senior population, one of the simplest and most accurate tests is called the Brink-Yesavage Geriatric Depression Scale. It only takes a few minutes to take and can be a very accurate indicator of depression.
How is depression treated?
Once a diagnosis of depression is made, there are a variety of approaches for treatment. If the depression is due to medical causes, these should be treated and resolved. But what if the depression is due to emotional factors?
Psychotherapy is always the first approach to consider. As an initial step, this could simply mean counseling with a social worker or a member of the clergy. There might be situational problems causing the depression that can be recognized and effectively addressed in this manner.
If this approach does not work, it might be necessary to try medications. A variety of different medications can be prescribed by your physician or by a psychiatrist. If you do start medication, make sure that the potential side effects are explained to you and that you are started on a low dose with gradual increases. It may take up to four weeks to see the effect of many antidepressant medications.
A psychiatrist will usually recommend psychotherapy in combination with medication. It is also possible to seek counseling from a psychologist or licensed social worker who consults with your physician with respect to your prescription medication (only a medical doctor can prescribe drug therapy for depression).
There is nothing wrong with seeing a psychiatrist or psychologist. However, if you're not happy with your therapist, don't assume that you have to continue seeing him or her. You may need to "shop around" to find the therapist who best suits you. The doctor-patient relationship is very important, and nowhere is this more critical than with a psychiatrist or psychologist. You deserve to see someone who you are entirely comfortable with.
Conclusion
Depression is treatable. First it must be recognized. Then your doctor must be sure that there is no medical reason for the depression. Only then can treatment be initiated. During this coming holiday season, give someone the biggest gift: Help them recognize depression and help make sure that it is evaluated and addressed.
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External Sources
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Depression: Awareness, Recognition and Treatment (NIH)
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The National Foundation for Depressive Illness
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The Depressive and Related Affective Disorders Association
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This article was reviewed and updated June 2007.
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