About this leaflet
This leaflet is written for people over 65 who have depression.
We hope it will also be helpful for relatives, friends and carers.
It covers
- the symptoms of depression
- how it can be helped
- some suggestions for further reading.
Introduction
Everyone feels sad sometimes. But later life can give you more
reasons to feel down. You may have to deal with:
- stopping work
- having less money
- arthritis or other health problems
- the death of a partner or friends.
In spite of these difficulties, older people don't feel
depressed all the time - less than 1 older person in 6 feels so
depressed that they or others notice. Less than 1 in 30 older
people become ill with depression. But if you do, the help
available will work for you just as it does for younger people.
What is it like to have depression?
Feeling low or sad is not the only sign of depression. You
may:
- Lose interest in life - you can't enjoy the things you usually
do.
- Feel tired for no reason. You just don't feel like doing
anything. Simple things take a big effort.
- Lose your appetite - and weight.
- Feel restless - and find it hard to relax.
- Worry more than is usual for you.
- Want to avoid people.
- Feel snappy or irritable with people.
- Sleep badly.You may wake an hour or two earlier than usual and
find that you can't get back to sleep.
- Lose confidence in yourself.
- Feel useless or a burden to others.
- Notice that you can't concentrate properly.
- Feel panicky.
- Lose your sexual feelings.
- Feel bad or guilty. You dwell on things from the past and may
get things out of proportion.
- Think about suicide - at some point most people with severe
depression will feel like ending it all.
Particular problems for older people
Physical symptoms and depression
Some physical illnesses can give you symptoms that are similar
to those in depression. For example, loss of appetite
or poor sleep can be caused by thyroid problems,
heart disease or arthritis.
Long-term
illness
If you become depressed, you may start to get more upset by your
health, even though it hasn't really changed for the worse.
Treating the depression can't take away physical
health problems, but it can make them much more
bearable.
Confusion and memory problems
Depression, worry and anxiety can affect your memory and make
you feel confused. You may worry that you are suffering from
dementia (a permanent loss of memory) when it is actually just
depression.
A new sense of loneliness
Living alone does not automatically make you depressed. But
feeling more lonely for no obvious reason may be a sign of
depression.
Getting help
If you have strong feelings of depression, do take them
seriously. They are not a sign of weakness, but you may need to get
some help.
How do you know when it's time to get
help?
If your feelings:
- are worse than you would expect
- have gone on for several weeks
- interfere with your life
- mean that you can't face being with other people.
- make you feel that life is not worth living
- worry you are causing concern to friends or family
- include thoughts of harming or killing yourself.
What should you do?
Talk to your GP. They are quite used to helping people
with depression and will know what to do. You
are not wasting your GP's time by asking for
help. If you can't get out, ask your GP to see you at
home. You may find it helpful to take a friend or
relative with you when you see your GP.
I don't want to bother the
doctor - depression isn't a real illness
Older people tend to think more about physical problems than about
feeling depressed. You may have been brought up not to bother the
doctor unless you have a physical complaint. Sometimes the
first sign of depression can be a constant worry about having a
physical illness, even when your doctor can't find anything wrong
with you. If he or she tells you that you are depressed, it may
feel as though you are not being taken seriously. This isn't the
case. Depression can be treated just like any
illness.
Why do people get depressed?
When we are depressed, we tend to blame ourselves; this is
because depression makes us see things in a very negative way. We
may start to blame ourselves for things that we are not responsible
for.
Painful events. Depression
can come out of the blue. More often it is triggered by something,
like the death of a partner or close friend. Some of us are just
more likely to get depressed when faced by a difficult or painful
situation - it's our temperament. Women seem to be more likely to
get depressed than men, but men may just find it harder to talk
about.
Past depression. You are
more likely to get depression if you have had it
before.
Physical illness can make you feel
depressed, such as a problem with the thyroid gland. Your
doctor can check this.
Any physical illness can trigger depression.
This can be sudden, like a stroke, or long and disabling, like
Parkinson's disease. It may be several illnesses which have taken
their toll over the years. Although this may make the depression
more 'understandable', it doesn't mean that it can't be helped.
This type of depression often responds very well to
treatment.
Medicines. Depression can be caused by some
medications. You can ask your doctor or pharmacist about
this.
Helping yourself
It's the same at any age, you don't have to put up with
being depressed. Tell your GP how you feel.
It can be hard to get our regularly because of physical
problems, but it's worth doing. We know that if you keep up some
regular physical exercise (even just walks), you tend to feel
better. And if you are alone at home, you are more
likely to brood on things, which can make you feel even
worse.
It helps to keep your mood up by:
- keeping up with hobbies and interests
- staying in touch with friends and family
- visiting your local library or local lunch clubs and day
centres.
If you lose your appetite, it's easy to lose weight and run
short of important vitamins and minerals. Older bodies cannot
adjust as well as younger ones - so this can really affect your
health. Beware of stocking up on chocolate and biscuits -
these are quick and easy to eat, but they don't have the vitamins
and minerals to keep you feeling well.
- Remind yourself
that depression is an illness - not a sign of
weakness. You are not being lazy or letting other people
down.
- Tell
someone if you feel so low that you have
thoughts of taking your own life.
- Don't keep your feelings to yourself. Talking
to somebody does help.
- Watch your drinking. Alcohol can make
depression worse. It can also react with any tablets you are
taking.
- Try not to panic about
not sleeping properly. It will get better when the
depression lifts.
- Try not to
change the tablets you are on without discussing it with
your doctor. If your tablets have side-effects, tell
your doctor or nurse.
- Be kind to yourself - you may need to change
your routine while you are unwell.
- Try not to think that
depression causes dementia. It doesn't.
Treatments for depression
Talking treatments
It can help to talk to a good listener. This could be a friend,
a relative, a volunteer or a professional. If this is not enough,
professionals can offer special ways of talking which include:
Psychotherapy which helps
you to see how your depression may be connected with what
has happened to you in the past.
Cognitive Behavioural
Therapy which helps you to see how some of
your ways of thinking may be making you depressed. It then
helps you to think in more realistic ways that make you feel
better.
Are there problems with talking
treatments?
They are very safe. But, sometimes psychotherapy can bring up
unhappy memories from the past. A good therapist will know how to
deal with this. If you have concerns, you should discuss them with
your GP or therapist.
Your GP or another professional can arrange treatments
like these, although there may be a waiting list. Local
organisations and charities may provide counselling or talking
therapies free of charge. Ask your GP what is available
locally.
If your depression has been triggered by bereavement or
problems in a relationship, then bereavement counselling or
marriage therapy can help.
Antidepressant medications
If you are depressed and have poor sleep, poor appetite and loss of
weight (or over-eating and weight gain), or the depression has gone
on for a long time, your doctor will often suggest an
antidepressant. About 50-60% of people who take these tablets will
find they help. There are several types of antidepressant now
available, so it should be possible to find one to suit
you.
Do antidepressants have side-effects?
You may feel sick or more anxious over the first few
days, but these effects usually wear off. Some may make you
sleepy or give you a dry mouth. They can sometimes interfere with
other medicines, but your doctor will be aware of this.
In older people, antidepressants can lower the amount of salt
(sodium) in the blood - this can make you feel weak and
unsteady.
About 1 in 3 people can get withdrawal symptoms if
they stop these medicines suddenly. So it's best to come off them
slowly. To find out more, read our leaflet on
antidepressants.
Antidepressants take 1 or 2 weeks to start working. You
may find that it takes 6 to 8 weeks for them to really make a
difference. Don't drive if they make you sleepy or if they slow
down your reactions - if this happens, mention it to your
GP.
Many older people are already taking medication. If you add an
antidepressant, you may find it hard to keep track of which tablet
you should take, and when you should take it. To help with this,
your doctor or chemist can give you a special box, or blister pack.
This has all the tablets set out in separate compartments for each
time and day of the week.
St John's Wort
This is a
herbal
antidepressant that you can buy from a chemist
without a prescription. It has fewer side-effects than prescribed
antidepressants, but is not effective in more severe depression. It
can be harmful if taken with some other medications - so, if you
are taking other medication, ask your GP about this.
Practical help
You may become depressed because you are living in poor
housing, can't keep your home as you would like it or you don't
feel happy where you live. If so, a social worker can help you to
get advice on financial or practical support - or even moving
house. But do be careful, it is easy to make a bad decision about
moving when you are depressed. It is usually best
to put off big decisions like this until you are feeling
better.
Professionals can also help you find ways to spend
time with other people. This can be important because it's easy to
lose touch with people when you are depressed. There are lunch
clubs, day centres and support groups where you can go. It's really
important to talk with or just to meet other people. It
will help.
Which treatment is best?
Everyone can try the simple steps in this leaflet. Talking
treatments and antidepressants work equally well. Your GP is more
likely to recommend antidepressants if your depression is severe,
or has gone on for a long time.
Antidepressants work a bit faster than talking
treatments. Some people prefer talking treatments, whilst others
prefer tablets. You can have both at the same time. Your GP will be
able to give you advice. It may also help to talk over the options
with your family or a close friend.
What if depression is not treated?
Most people will get better, after weeks, months or even a year or
two, but the shorter the depression lasts, the better. The simple
steps outlined in this leaflet may be enough to help you feel well
again. If the depression is so bad that you are not eating or
drinking enough, you can become dangerously ill. It may give you
thoughts of suicide.
Seeing a specialist
Although most people get better at home with these treatments,
some people do not. If this happens, your GP may ask
a specialist to see you for some expert advice. That does not
mean that people think you are 'mad'. Your GP may need a
second opinion or advice about the best treatment for you.
In Britain most places have psychiatrists who specialise
in helping older people with depression. They usually work as part
of a specialist mental health team, so you will usually see a
nurse or a social worker first.
The first interview with someone from the team takes
about an hour. If you are depressed, you may find it difficult to
remember some of the details of how it all began. If so you can ask
a friend, neighbour or relative to be present with you. It
can also help to write down your ideas before the interview.
Going into hospital
If you are very unwell - perhaps unable to eat or drink, or have
tried to kill yourself - you may need the safety of a hospital.
Only a small number of people with depression become this
unwell.
Staying well
Nobody wants their depression to come back again. To stay
well, it is best not to stop the antidepressants until
your doctor advises you to - even if you have
been feeling well for a while. There's a chance of the
depression returning if you stop taking your tablets too
soon.
If your general health is good and this is your first
depression, you will probably need to stay on the tablets for 6 to
12 months. If you have already had depression several times, your
doctor may recommend that you stay on an antidepressant for
longer.
Do go through the section on 'self-help' above. These things
will all help you to stay well - and to feel that you have some
control over what is happening.
For relatives and friends - how can you help?
- You may be the first person to notice the depression. Encourage
them to get help. Tell them that depression is quite common, it can
be treated and that they will get better. They may need to be
reassured that they are not "going mad". You can suggest that they
see their GP - and offer to go with them.
- People with depression get tired easily. Try to offer some
practical help, like shopping or cleaning for them. They may need
reminding to eat properly.
- Don't force them to talk. Just being with someone is often
helpful.
- Don't push them into doing things. It can help to get out
and do some gentle exercise - but it may not help if you have
to nag them to do it. In fact, people will often dig their heels in
if they feel they are being put under too much pressure. It may be
more acceptable for you to offer to go with them to something they
want to do - a lunch club, a day centre, library or interest
group.
- Be patient. Depression can make someone constantly ask for
reassurance or become convinced that they've got something
physically wrong with them. It's often because they are frightened
or don't understand what is happening to them. Reassure them as
much as you can and try to spend time listening.You may need to
reassure them that they are not "losing their mind".
- Don't be embarrassed to ask if they have felt suicidal. Most
people who feel like this are just relieved when someone asks about
it. Talking about it will help.
- You can become exhausted while caring for someone with
depression - and then it is important to ask for help
yourself. The specialist mental health team can give you a
break by arranging for them to go to a day centre or
day hospital. They are also there for you to talk to.
- Finally, try not to make decisions about housing or
accommodation when someone is depressed. They may put pressure
on you and say that how they feel is all to do with where they
live. But things are not usually that simple. People who move when
they are depressed may regret it once they are better. Remember
that social services may be able to help with self-care, meals and
finances.
- Don't judge and do be supportive - depression is an illness
which can be helped.
References
Wilson K, Mottram P, Sivanranthan A, Nightingale A.
Antidepressants versus placebo for the depressed elderly
(Cochrane Review). In: The Cochrane Library, Issue 4, 2001.
Effects of exercise on depressive symptoms in older adults with
poorly responsive depressive disorder. Mather AS et al.
(2002) British Journal of Psychiatry, 180,411-415.
Cross-cultural comparison of depressive symptoms in Europe does
not support stereotypes of ageing. Copeland JR et al.
(1999) British Journal of Psychiatry, 174,322-329.
Organisations that can help
Age
UK
Tel: 0800 169 6565. Lines are
open between 8.00 am and 7.00 pm.
An excellent site, providing information and advice to older people
and their carers, including over 40 in depth, full text factsheets
and a similar number of reading lists from abuse to transport, and
an extensive list of links to related web sites.
Gives support to families by linking them through membership
and provides information on Alzheimer's Disease and dementia.
Aware: help to
defeat depression
Tel: 00 353 1890 303 302
Assists and supports those suffering from depression and their
families in Ireland. A helpline is available as well as support
groups, lectures, and current research on depression.
Tel: 0870 477 9400
Offers a service of counselling, advice and opportunities for
social contact to all bereaved people. Information on the grieving
process, and how to help children grieve are included.
Tel: 0845 123 23 20
email:
information@depressionalliance.org
Information, support and understanding for
people who suffer with depression, and for relatives who want to
help. Self-help groups, information, and raising awareness for
depression.
A national mutual support group for people suffering from
depression.
Recommended Reading
Depression and how to survive it, by S.
Milligan and A. Clare
The depression workbook: A guide to living with depression
and manic depression, by Copeland, M.A.
Malignant sadness: the anatomy of depression, by L.
Wolpert
Managing depression by Davis Westbrook
This leaflet had been produced by the Royal College of
Psychiatrists' Public Education Editorial Board.
Series editor: Dr Philip Timms
Expert review: Dr Martin Briscoe
Service user and carer input: members of Depression
Alliance
© Illustration by Lo Cole/eastwing.co.uk
Th
is leaflet is made available through the generosity of the
Charitable Monies Allocation Committee of the mental health charity
St Andrew's, Northampton.
© Updated June 2010. Due for review: June
2012 Royal College of Psychiatrists. This factsheet may be
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