According to an article published in the Journal of the American Medical Association (JAMA), “Depression is one of the most common, disabling, and costly conditions encountered in older primary care patients.”[1] The risk of developing depression increases as older adults move into long-term care facilities.[2] This makes screening for it important.

The simple question, “Do you often feel sad or depressed?” may seem like a good place to start. However, many seniors don’t “feel sad.” Instead, they don’t feel motivated to do anything. They complain that they just don’t have any energy. Pain intensity increases. They lose appetite.

When a senior loses his or her zest for living, depression may be as much a cause as a symptom. At Highgate Senior Living, we recognize that depression reduces the quality of life for everyone in our community, not just of those who are blue. Here’s our approach to ensuring despondency is treated appropriately.

Listening for Signs of Depression

There are many conversational cues we listen for. As a family member, if you hear these comments, please share your concerns with us.

• “I’m such a burden to …”
• “I’m worthless …”
• “I wish I could just die …”
• “I wish I could sleep.”
• “Just let me sleep.”
• “I feel so helpless.”
• “I’m in too much pain to …”

Watching for Signs of Depression

We’ve already mentioned a lack of motivation, a drop in activity levels, and loss of appetite as signs of depression. There are additional cues we watch for.

• Withdrawing from social situations
• Dropping hobbies
• Losing significant amounts of weight
• Speaking and moving slower
• Increasing use of alcohol
• Requesting more medication
• Escalating memory problems
• Neglecting personal care
• Experiencing pain that cannot be diagnosed

Looking at Health Issues and Medications

There are many medical conditions which have long been associated with depression in seniors—dementia and Alzheimer’s for example. As if these conditions weren’t concerning enough, the actual changes in the brain’s nerves—as blood flow is reduced by vascular disease—can cause depression. [3]

Parkinson’s disease is another condition known to trigger depression. One of the reasons may be the medications prescribed to treat it. They raise brain dopamine levels, which may cause depression because dopamine exposure remains high.[4] The other reason is the development in about 30% of Parkinson’s sufferers of microscopic deposits known as Lewy bodies. These concentrate in the brain stem and then spread into the rest of the brain’s nerve cells. This may been seen as outbursts of anger[5] or as depression.

In addition, many of the health events experienced by older adults may trigger depression—strokes and heart disease, cancer and diabetes. The following medications prescribed for these conditions have raised concerns for being mood-altering drugs. They may cause depression or aggravate existing tendencies toward depression.

• Clonidine, a common blood pressure medication
• Lopressor and Inderal, beta-blockers prescribed to manage cardiac arrhythmia and prevent recurrence after an initial heart attack
• Valium, Xanax and Halcion, tranquilizers sometimes prescribed as sleep aids
• Calcium channel blockers, prescribed for high blood pressure and angina
• Zantac and Tagamet, ulcer medications
• Reserpine containing heart medications
• Lipitor, Mevacor and Zocor, cholesterol lowering drugs
• Premarin and Prempro, estrogen replacements
• Prednisone, triamcinolone, methylprednisolone and other corticosteroids, prescribed to treat inflammation, lupus, rheumatoid arthritis and gout

Age-related reductions in stomach acid may lead to vitamin B-12 deficiency, which has been linked to depression. Poor folate uptake, which is essential for serotonin production (the brain’s mood elevator)[6] is often overlooked as a cause of depression. And iron deficiency from poor digestion complicates matters by lowering energy levels.

Considering Treatment Options

While prescribing antidepressants is one option, there remains the risk of complications from incompatible drug combinations. There are a number of natural strategies we encourage our residents to pursue before they consider pharma-solutions or electroconvulsive therapy (ECT), the most dramatic of depression treatment options. In studies, these non-drug treatment options have demonstrated equally promising outcomes, when compared with anti-depressant meds. They offer few risks and also cost less.

Explore Cognitive Behavioral Therapy.

CBT is a proven therapy, “which is as effective as antidepressants in the short term (even for serious depression), and is more effective in the long term.”[7] It works by focusing on thinking patterns and behaviors that aggravate depression. As these causative factors are identified, the depressed individual learns to think in a manner and behave in ways that change their feelings.[8]

Get Out and Exercise.

The side effects of exercise are “improved physiological and mental health.”[9] One study showed that depression went into remission for 42% of the participants when they exercised the amount recommended by public health officials—150 minutes of moderate-intensity aerobic activity per week plus some type of muscle-strengthening activity two days a week.[10]

Unfortunately, when medications are added to the mix, the benefits of the exercise goes down. At least one study suggests that even those who respond to the combination tend to relapse.[11]

Turn Up the Light.

Too little sunlight has been associated with depression for years. Now studies prove that exposure to 10,000 lux units of light at the beginning of the day offers benefits to many people, not just those who have been diagnosed with seasonal affective disorder.[12]

Clinical studies prove that ‘sunlight spectrum’ lights lift mood as well as the antidepressant medications currently available. The initial investment may seem a bit steep until you consider the cost of ongoing medication. For most people, just 30 minutes a day transforms their outlook on life.

Because light therapy has been associated with common migraine symptoms—headaches, eye strain, nausea and agitation, it may not be for everyone. However, for many people it revitalizes their outlook on life.

Depression may be far more common among seniors than previously realized. However, in the Highgate Senior Living community, we are committed to making sure our residents get the support they need to prevent the ‘blues’ from robbing them of a high quality of life. Learn more about our holistic healthcare philosophy in our ebook, Guide to Holistic Healthcare for Older Adults. 

[1]  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4136434/

[2]  Ibid.

[3]  https://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=139

[4]  http://www.aarp.org/health/drugs-supplements/info-02-2012/medications-that-can-cause-depression.html

[5]  Ibid.

[6]  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1810582/

[7]  https://chriskresser.com/treating-depression-without-drugs-part-i/

[8]  http://psychcentral.com/lib/in-depth-cognitive-behavioral-therapy/

[9]   https://chriskresser.com/treating-depression-without-drugs-part-i/

[10]  http://www.ncbi.nlm.nih.gov/pubmed/15626549

[11]   https://chriskresser.com/treating-depression-without-drugs-part-i/

[12]  http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.162.4.656