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4 Treatment Options for Geriatric Depression 

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Depression is a real illness, a mental illness, and a serious mood disorder, that can be treated successfully. It is not just a normal part of the aging process.

Physiological changes that can bring on depression are more common in older adults, especially those who are socially isolated or have chronic illnesses or disabilities such as chronic pain, heart disease, diabetes, or cancerThe good news is that only about one to five percent of older adults are depressed, but this can rise to about 11 to 13.5% of seniors on home health care or who are hospitalized.

However, geriatric depression should not be shrugged off or overlooked. The sooner depression is treated, the better the outcome. Feeling sad or “blue” is a common and normal part of life however, it’s usually a response to sad or upsetting news or life events. 

Prolonged sadness (over two weeks) can trigger depression and lead to major depression or depressive disorder and more risky circumstances such as suicide. If the sadness persists and worsens, or is accompanied by the symptoms listed here, it’s time to take action.

Symptoms of Depression to Watch for

  • Fatigue and decreased energy when walking or talking 
  • Irritability and restlessness - unable to sit still
  • Loss of Interest in activities or hobbies that were once a source of pleasure (reading, watching TV, sewing, puzzles, card games, etc.)
  • Insomnia or excessive sleeping and waking too early in the morning
  • Persistent sad, anxious, or apathetic mood
  • Difficulty concentrating, remembering details, or making decisions
  • Change in eating habits such as overeating or loss of appetite with associated unintentional weight loss or gain
  • Feelings of worthlessness, hopelessness, helplessness, or guilt
  • Increasing aches, pains, headaches, cramps, or digestive problems which respond poorly to treatment
  • Suicidal thoughts or suicide attempts

These signs and symptoms can come on slowly or quickly. It is possible for them to have an entirely different look from one person to another. They may also differ dramatically from the signs and symptoms of depression in younger people. 

The manifestation of these can be influenced by your senior’s age, culture, background, environment, and attitudes. 

Some people are very good at expressing their emotions and feelings and others internalize them and present with physical symptoms such as worsening pain or digestive issues. Others may feel numbness, disinterest, and a need to withdraw.

It is essential to understand that depression is a mental illness meaning it’s an actual medical condition that requires treatment. Treatment options can include taking prescribed antidepressant medications, psychotherapy, or a combination of both. 

It is not something that will go away if friends and loved ones cheer them up. It’s not something anyone can “just snap out of” or “get over.” Encouragement and support from friends and family is a necessary adjuncts, but medical treatment is also required.

 

 Are There Risk Factors for Depression?

  • There are some strong indications that a family history of a depressive disorder can increase a senior’s risk of developing clinical depression.
  • Outside influences can also increase the risk of depression such as major life events including a new diagnosis of a medical condition such as cancer, the death of a loved one, or a sudden change in living arrangements.
  • Changes in the brain which are associated with conditions such as Alzheimer’s Disease or other dementia, Parkinson’s Disease, or the result of a stroke can increase the risk for depression.
  • Stress is a major risk factor as are sleep issues.
  • Addiction to drugs or alcohol can also increase the risk for a substance-induced depressive disorder.
  • Low levels of key chemicals in the brain and body such as norepinephrine and serotonin can contribute to the onset of depression.
  • Dementia often causes some of the same symptoms and signs of depression. Depression can also be an early indication of dementia. This should be brought to the attention of the primary care practitioner for further analysis.
  • Complications of aging such as chronic illness, chronic pain, limited mobility, social isolation, financial hardships, transition to retirement, death of friends and loved ones, and marital changes of divorce or widowhood can all contribute to deep sadness and geriatric depression.

How to Help a Depressed Senior Loved One

Encourage your loved one to seek and follow medical treatment. Be aware that this will be a long-term process as there is no cure for mental illness. 

Many people have no idea that their symptoms can be treated and their quality of life improved, consequently, they don’t seek out treatment. Left untreated, depression can become a major depressive disorder for older adults.

It can be quite common for healthcare providers to misdiagnose depression as sadness. Point out that the sadness and other symptoms have persisted for two weeks or more. It’s important to advocate with their primary care provider and request further investigation including a mental health evaluation.

Offer to help make the appointments, accompany them, and participate if they so desire. It may take some time and experimentation to find the right combination of medications and therapy for your loved one. 

Encourage them to examine how they feel, be honest with themselves, evaluate what is helping or not, and to be open with their healthcare providers so that adjustments can be made. 

Antidepressant therapy can take several weeks to provide optimum results. 

Psychotherapy can take a while to work as well. Sometimes it might require a change of therapist if it’s just not a good fit. It is important to not discontinue treatment once your loved one feels better. Consult with the health professional before changing or discontinuing any treatment options.

Older adults can easily suffer from social isolation when they no longer drive, live alone, or their physical abilities are diminished by illness, chronic pain, or aging. Spend time and participate with them in activities. Physical activity can be a great way to improve mood and diminish pain and discomfort.

Take a walk outside or do chair exercises by a window. Older people are often affected by low light which can bring on a type of depressive disorder known as SAD (seasonal affect disorder) as cooler seasons bring cloudy and shorter days. Play board games or create something together.

Utilize the time to share memories and make new ones. Encourage other family members to get involved as well; either in person or virtually via Facetime, telephone, or mail - either snail mail or emails. If your loved one cannot manage technology on their own, use this time to assist them. 

Keep in mind that everyone needs hugs and personal touch as well as social connections to survive and thrive with the best quality of life.

Seniors should have in-person contact and experiences with people they care about as often as possible.

What are the 4 Treatment Options for Geriatric Depression?

Depression is a treatable illness. Improvement in quality of life can be achieved and maintained. 

As there are signs and symptoms that can mimic other medical conditions, it’s important to start evaluation as soon as possible with a primary care provider to rule them out. Then a psychological evaluation can be made with a mental health professional to determine the course of treatment.

Common forms of treatment for geriatric depression include:

1. Psychotherapy

Counseling or “talk therapy” can help identify and work with any troubling or disturbing behavior, thoughts or emotions. This can be done with a professional such as a psychiatrist, psychologist, mental health nurse practitioner, licensed clinical social worker (LCSW), or other licensed mental health professional. 

These professionals typically use therapies specific to the treatment of depression such as cognitive-behavioral therapy (CBT) or interpersonal therapy (IPT). Sessions typically may be in-person, or via video chat or phone calls.

2. Medications to manage hormonal imbalances

There are many antipsychotic medications older adults can choose from.

Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for older adults. A mental health professional can prescribe and monitor their medications for effectiveness and any possible side effects.

3. ECT and rTMS 

Only if effective treatment is not possible with the medications and therapy choice, it may be necessary to consider alternative therapy such as Electroconvulsive therapy (ECT) or Repetitive transcranial magnetic stimulation (rTMS). According to the Yale School of Medicine, a study published in the American Journal of Psychiatry, ECT is considered safe for the elderly and has been shown to lower the mortality rate among older adults with suicidal thoughts. 

In ECT, electrodes are placed on the head to allow for safe, mild, electric current to pass through the brain. rTMS involves the use of a magnet to stimulate the brain.

Unlike ECT, no anesthesia is required, and rTMS therapy is able to target specific areas of the brain thus reducing side effects such as memory loss, nausea, and fatigue that can result from ECT.

TMS is considered safe for older adults, but because it uses a large magnet anyone with metal in their head or neck should not use this therapy. This includes things like aneurysm clips, metal plates, cochlear implants, shrapnel or bullet fragments, and any magnetic ink for tattoos.

4. Complementary health approaches

Incorporating yoga, meditation, and mindfulness practice into your daily routine can help improve overall well-being and reduce stress. These options can help treat depression, but should not be used to replace prescribed therapy from the mental health professional.

Support groups can also be helpful in managing depression.

The importance of treatment for depression has been emphasized in recent years with the advent of the COVID pandemic.

Don’t avoid treatment due to the fear of costs. Private insurance and Medicare usually cover treatment for depression.

In addition, many local mental health community centers offer sliding scale plans for the treatment of mental disorders based on financial ability to pay. More information can be found on the National Institute of Mental Health (NIMH) website.

Are There Ways to Prevent Depression?

Unfortunately, there is no real way to prevent depression or to significantly reduce the risks.

However, there are healthy lifestyle choices that can provide long-term benefits and well-being.

  • Reducing stress can help to reduce high blood pressure and improve mood and sleep habits.
  • A healthy balanced diet and being physically active can help to avoid chronic illnesses and prevent complications due to debility which can lead to depression.
  • Sleep is vital. Get 7 to 9 hours of sleep each night.
  • Participate in hobbies and activities which bring joy and a sense of peace.
  • Reduce social isolation by keeping in touch with loved ones and friends.
  • If you experience signs and symptoms of depression, tell your loved ones, friends, and healthcare providers so you can get help.

If you or someone you love is in crisis, please seek help immediately. Call 911 and ask for the crisis team if possible. If suicidal, call 988. Or you can go to the nearest hospital emergency department or your health care provider’s office.

Another option is to call the 24-hour hotline for the National Suicide Prevention Lifeline at 1-800-273-8255 to speak to a trained professional. Don’t wait; get help now.

Kathy Quan

A Registered Nurse with 40+ years of experience, focusing primarily on home health and hospice care in a variety of roles from Field Nurse to management. She has also written several books and blogs for healthcare professionals and caregivers. In addition, she teaches online courses for nurses and caregivers.

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