Many people find the reality of getting older depressing. And depression itself often comes with a stigma. So when we talk about depression and aging combined, what results is a very complicated — and often hard to treat — issue.
Gary S. Moak, former president of the American Association for Geriatric Psychiatry, has written a new book to help. Beat Depression to Stay Healthier and Live Longer: A Guide for Older Adults and Their Families combines Moak’s years of experience working with elderly populations with the latest research on depression.
Moak begins by defining depression and clarifying many of the myths that surround it. The first clarification he makes — and perhaps the most important — is that old age is not itself depressing. Instead, Moak writes, it is a serious illness of its own.
While we might assume that illness, disability, and loss of independence all constitute depression, this is not the case, writes Moak. Depression also is not purely psychological. Instead, Moak tells us, it is condition that increases the risk of almost every physical ailment older adults finds themselves facing: things like Alzheimers and diabetes, even the risk of falling.
To make his case, Moak cites some powerful studies. Depression increases the chance of having a stroke. After a heart attack, depression doubles the chance of dying. Depression increases the likelihood that patients with chronic kidney disease will go on dialysis. Depression weakens the immune system — and, more generally, depressed people die sooner.
The reason depression so potently affects our physical health is due largely to one sole factor: elevated stress hormones. Unlike anxiety, which causes short-term elevations in cortisol, epinephrine, and adrenaline, depression leads to long-term elevation of stress hormones. This leads to a theory called “inflamm-aging.” According to this theory, Moak writes, “the lifelong, cumulative damaging effects of chronic inflammation are responsible for the telltale signs of aging and the common diseases that go with it.”
Yet given the deleterious physical and psychological effects of depression, many seniors are hesitant to seek, or even accept, treatment. They might be in denial, feel too pressured by their family members, feel as if they are being made to be crazy or senile, or want to handle the problem themselves. Or they might be afraid of taking pills, becoming addicted to those pills, or being forced prematurely into a nursing home.
For each of these objections, Moak offers sound and easily applicable steps that family members can take. For example, he suggests that, to overcome the fear of being put away, a family can discuss the fear that the elder may have about being considered crazy and reassure them that depression has nothing to do with going senile or losing their mind.
Later in the book, Moak turns to treatments that work for depression — after first reminding us that no one is ever too old to get better. Among the treatments he covers are antidepressant medication, psychotherapy, phototherapy, electroconvulsive therapy, transcranial magnetic stimulation, and several alternative approaches such as nutritional supplements, exercise, and lifestyle modifications. For the major classes of antidepressant medication, Moak provides the latest research on each, along with efficacy, risk factors, side effects, and common misunderstandings.
Again, one common misunderstanding is that older people don’t get better, or that they can be made suicidal by antidepressant medication. The reality, Moak writes, is that one in ten Americans take antidepressant medication, and most of them get better.
But if medication is not the desirable route, or you wish to compliment it, Moak offers several suggestions for alternative practices. For example, in combatting the inflammatory effects of depression, curcumin (turmeric) and omega-3 fatty acids may both, according to studies, have anti-inflammatory and anti-oxidant properties. Exercise, which improves brain function and provides psychological benefits, tai chi, yoga, and acupuncture are also helpful complimentary treatments for depression, Moak writes.
Still, despite the many options available to help, effective alleviation of depression can take time. Much of the reason for this is that doctors face three challenges in making a correct depression diagnosis: many conditions mimic depression, diagnosing the correct type of depression can be difficult, and there are no tests to weed out depression. Here, Moak offers numerous case studies of seniors who, despite their initial hesitation and resistance, went on to overcome depression and reclaim their lives.
“Too many older adults don’t expect to get better,” Moak writes, “because they think depression is just part of aging and the elderly don’t respond well to treatment.” But, as Moak shows throughout the book, depression in older patients can indeed be treated, whether you are in your sixties or nineties.
Beat Depression to Stay Healthier and Live Longer: A Guide for Older Adults and Their Families
Rowman & Littlefield, February 2016
Hardcover, 280 pages