By Kayt Sukel
More than a year after her mother’s death, Cheryl noticed a big change in her 73-year-old father’s behavior. She noticed he wasn’t eating much—and that he was complaining more of sleep and memory problems. An avid golfer for most of his life, he hadn’t hit the greens in months, despite repeated invites by good friends. And, recently, when she and her two children came by for their weekly visit, her Dad, normally a very playful and hands-on grandpa, seemed disengaged and withdrawn. Was he just still grieving for Mom, Cheryl wondered? Or could he be depressed?
It’s a valid question—and with more than 6 million Americans aged 65 or older suffering with depression, it’s a question Cheryl needs to explore further. David Steffens, the Chairman of Psychiatry at UConn Health, and former President of the American Association for Geriatric Psychiatry, says depression in older adults often presents itself differently than what you see in younger patients.
“You don’t see as much of the sadness, the crying, the blues,” Steffens says. “Rather, it’s more of a decreased ability to experience enjoyment and pleasure. It also often comes with a big life change, like the loss of a loved one, retirement, or a serious illness. So it can be hard sometimes to recognize on its own.”
Furthermore, he adds, what people don’t understand is that depression can have profound impact on other medical conditions. “People with diabetes do worse if they are depressed. People with heart problems, chronic pain syndromes, they do worse, too. It’s a very disruptive medical illness that needs to be addressed. So if you suspect that your parent may be depressed, you need to talk to them about it and bring it to the attention of their doctor as soon as possible.”
The good news, says Steffens, is that most geriatric depressions are short-lived and can be treated in the primary care setting—either with psychotherapy or antidepressant medications. But in the case of the latter, it’s important that doctors are aware of all medications that a patient may be taking—as polypharmacy, or the use of multiple drugs, is more common in older adults.
“Fortunately, a lot of medications that boost serotonin are well-tolerated and can be given with other types of common medicines,” says Steffens. But he says many hospitals and medical institutions are now using pharmacogenomic testing, like Assurex Health’s GeneSight Psychotropic test, to help them select the right depression medication for seniors—and avoid problematic drug interactions and unpleasant side effects like headaches, joint pain or sleep disturbances. Steffens says this kind of testing is not the standard of care, yet—but he would not be surprised if genetic testing becomes part of the American Psychiatric Association’s official recommendations in the next five years.
Steffens says he would counsel someone like Cheryl to seek help for her dad sooner rather than later.
“Families, and ultimately patients, need to be aware of how debilitating depression is. They need to understand the physiological effects, how it can affect the family, and how it can affect medical conditions,” he says. “So the adult child who is worried about an elderly parent needs to raise the issue —and help make sure that the older adult is getting that assessment and care that they need.”