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. So, occasionally, severe depression can look
just like dementia (a permanent loss of memory).
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
- are noticed by other people (sometimes friends or family
members spot the problem before you do)
- 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. It
may help to have 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 symptoms 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
Just because you are older, you don't have to put up with being
depressed.
It can be difficult when you get older because of physical
problems, like stiff joints or swollen ankles, but it's worth
doing. Staying at home all the time can make you brood on things,
which can make you feel even worse.
If you lose your appetite, you can 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.
- Keep reminding
yourself that you are ill. You are
not being lazy or letting other people down.
- Keep reminding
yourself that the vast majority of people
get better.
- Tell
someone if you feel so low that you feel
like ending it all.
- Try not to
keep your feelings to yourself. Talking to
somebody does help.
- Alcohol can make depression worse. It may 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.
- 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.
Psychotherapy helps you to understand
depression in terms of what has happened to you in the past.
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.
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 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.
How do antidepressants work?
They affect the action of two chemicals in the brain that affect
our mood. These chemicals are called serotonin (or 5HT), and
noradrenaline. But we don't know for certain how they work.
Do antidepressants have side-effects?
You may feel sick or more anxious over the first few
days, but these effects usually wear off. Others 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.
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. If
you are taking other medication, ask your GP about this.
Practical help
You may become depressed because you are living in poor
housing or not happy where you live. If so, a social worker may be
able to help you move but - it is important not to make a
decision about moving when you are still depressed. You may regret
it when you are feeling better.
Professionals can also help you find ways to spend
time with other people. This can be very important because you can
become isolated when you are depressed. There are lunch clubs, day
centres and support groups where you can go. It's really important
to talk to 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 very severe, it can make you physically
ill, through not eating or drinking enough, or even make you want
to kill yourself.
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 specialists (called
'psychogeriatricians' or 'old age psychiatrists') who are experts
at treating 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.
Going into hospital
A small number of people need to have their depression treated
in 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.
Staying well
It's important to stay well and try to make sure it doesn't
happen again. To do this, it is best not to stop the
antidepressants until your doctor advises you to - even if you
are feeling well. 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.
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". Suggest that they see
their GP.
- Older 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 bully 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.
- Be patient. Older depressed people may 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. Point out that
they are not developing dementia. People who have had depression
are no more likely to get dementia than anyone else.
- Don't be embarrassed to ask if they have felt suicidal. Talking
about it will help.
- Suicidal thoughts are a sign that help is needed. Most people
who feel like this are relieved when someone asks about it.
- Caring for someone with depression can be exhausting. If you
are becoming worn out, ask for help for yourself. The specialist
mental health team can arrange for the person to go to a
day centre or day hospital to give you a break. They are also there
for you to talk to.
- Finally, try not to make decisions about housing or
accommodation when someone is depressed. Your friend or relative
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. Many
older people who move when they are depressed may regret it once
they are better.
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
Concern
Tel: 020 8765
7200
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.
Tel: 020 7278 1114
Provides practical support and help for older people to live
independent lives, particularly those who are frail, isolated or
poor.
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
© Updated August 2009.
Royal College of Psychiatrists. This factsheet may be downloaded,
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