One reason their effectiveness may not be captured in studies, he explains, is that a medication that works for one patient may not work for another. “We often find that we have to try several different medications before we find the one that works for a particular patient.” Unfortunately, doctors have no way to know in advance which antidepressant is likely to help.
The pills also require time to take effect—up to six weeks in some patients. “So one problem we often see is that people start taking antidepressants. Then, when they don’t feel better right away, they stop, thinking the pills aren’t working,” he says.
In fact, antidepressants can be effective, many doctors contend, and most prescribe them as the first-line treatment. For older patients, who are often on other medications that may interact with the antidepressants, doctors typically begin with small doses and increase as needed.
Depression linked to physical ills in older people
“Serious depression can ruin people’s lives and destroy families,” says Small.
But a reliable definition of depression is difficult in part because it takes many forms. “Depression is often associated with persistent sadness and melancholy, but sadness isn’t always part of it,” says Susan W. Lehmann, M.D., assistant professor in the department of psychiatry and behavioral sciences at the Johns Hopkins School of Medicine. “The symptoms of depression can also be a loss of pleasure and enjoyment in the things people used to enjoy, or a change in one’s sense of oneself, a feeling of worthlessness and uselessness, a kind of blankness.”
In older people, depression frequently shows up not as sadness but as a constellation of physical complaints—one of several reasons it is frequently overlooked.
“Older patients come in saying, ‘I can’t sleep, nothing tastes good, my back hurts,’ ” says Small. “The physical complaints may be real, but the underlying problem is depression. When we treat the depression, the physical complaints improve.”
Thoughts of suicide, one of the hallmarks of severe depression, also take a different, more passive form in older people, says Small. “Instead of someone saying, ‘Yes, I’ve thought of killing myself,’ they might say, ‘If God took me now, I wouldn’t mind.’ ”
Depression in older people may be accepted because younger family members tend to assume it’s an inevitable part of growing old, says Lehmann. “There’s a tendency to think, ‘No wonder Grandpa is depressed. I’d be depressed if I had to give up driving, or use a walker, or was losing my vision.’ ”
It’s not inevitable
In reality, the vast majority of older people go through life’s ups and downs without suffering depression. Depression isn’t a part of normal aging, experts insist.
Next: When to seek help. >>