Depression & Advancing Age

By Larkin, Marilynn | FDA Consumer, March 1993 | Go to article overview

Depression & Advancing Age


Larkin, Marilynn, FDA Consumer


Many people assume depression is an inevitable part of growing older--a natural response to advancing years, illness, or the death of a spouse, friend, or family member. They may think little can be done about the often overwhelming feelings of grief and sadness experienced by many elderly adults.

But these attitudes are changing--and with good reason. New research on depression reveals that this debilitating illness is not an inevitable part of the aging process, nor is it necessarily triggered solely by emotional factors. Chemical changes in the brain caused by illnesses such as stroke, side effects of medications such as those used to control high blood pressure, genetic and environmental influences, and other factors--many of which are not yet clearly understood--also play important roles in the onset of depression.

For example, researchers at Washington University School of Medicine in St. Louis, Mo., recently identified areas of the brain that appear to function abnormally in people suffering from major depression. Using a three-dimensional imaging technique regulated by the Food and Drug Administration, called positron emission tomography (PET), Wayne C. Drevets, M.D., assistant professor of psychiatry at the university, and colleagues found these abnormalities in the left prefrontal cortex, a large area of the brain above the left eye, and in the amygdala, an almond-shaped structure deep within the brain's temporal lobe. Researchers have long suspected that both areas are involved in emotion and mood regulation.

"PET is helping us to understand that major depression is a biological illness and not a case of people who are unable to keep their emotions in check because of some character weakness," says Drevets. "Telling them to cheer up is not enough."

Charles F. Reynolds, M.D., professor of psychiatry and neurology at the University of Pittsburgh School of Medicine's Western Psychiatric Institute and Clinic in Pittsburgh, Pa., agrees that biology plays an important role in depression at all stages of life. This means that medications and other therapies that affect the brain's physiology can help a depressed person feel better, regardless of age.

"Depression in older adults is very treatable, and available treatments are very effective in improving quality of life," says Reynolds. Appropriate ongoing treatment can decrease depressive symptoms, reduce the risk of relapse and recurrence, and improve an affected person's overall medical and emotional health.

Depression vs. 'The Blues'

The word "depression" has a murky meaning in everyday usage. On the one hand, it's not uncommon to say "she's depressed" to describe someone who is feeling down at the moment. On the other hand, a person who is truly clinically depressed may be dismissed as a negative personality or chronic complainer--and told simply to "smile" or "snap out of it."

In medical terms, "depression"--also known as "unipolar depression" or "depressive disorder" is a syndrome that has very specific physical, emotional and cognitive (thought and perception) symptoms. At this time, there is no specific biological diagnostic test for depression. However, a thorough clinical interview and assessment by a qualified health professional (such as a psychiatrist, clinical psychologist, or neurologist) can help in making a diagnosis.

According to the Amencan Psychiatric Association Diagnostic and Statistical Manual, criteria for the diagnosis of depression include:

* changes in appetite and weight

* disturbed sleep (for example, not being able to sleep through the night)

* motor agitation or retardation (for example, constantly fidgeting or moving slowly and lethargically)

* fatigue and loss of energy

* depressed or irritable mood

* loss of interest or pleasure in usual activities

* feelings of worthlessness, self-reproach, or excessive guilt

* suicidal thinking or attempts

* difficulty thinking or concentrating

If at least five of these nine criteria are present, a diagnosis of major depressive illness, or clinical depression, may be made. …

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