Late Life Onset Depression
How does late life depression differ from depression experienced in earlier stages of the human life cycle?
Clinical depression is different to the occasional sadness that is inevitable throughout life as a result of disappointment, hurt or loss which causes minimal disruption of the capacity to cope with everyday life, passes with no intervention other than support from others, nurturance of self, positive distraction and time.
Clinical depression is more persistent, lasting at least two weeks and accompanied by several significant physiological changes in sleeping, appetite, energy, and psychological symptoms such as decreased capacity to problem solve, or concentrate, initiate activity or conduct personal or professional relationships, and perhaps thoughts of death or suicide.
There are a range of psychological and pharmacotherapeutic treatments for clinical depression. As an APS Psychologist, I am trained and registered to provide research-based solutions to depression, under Better Access to Mental Health Services and can offer Medicare rebates.
Late life onset depression is an episode of clinical depression after the age of 60 in persons who have no history of clinical depression. The experience, changes and development over time, the causes and treatment are different to clinical depression first experienced in earlier life stages. Late life onset depression is not a normal part of the aging process.
In comparison to clinical depression, symptoms of late life onset depression include increased risk of thought and memory problems as opposed to the experience of sadness; increased comorbidity with physical ailments; increased likelihood of changed brain structure; a decreased familial history of clinical depression or anxiety; greater experience of agitation and fatigue.
These symptoms may be of greater duration than clinical depression with earlier onset and recurrences may be more frequent. Recovery is maximised for female extroverts with a family history of depression with high levels of social support who have never had substance addictions and who have never been hospitalised for depression. However researchers find that positive recovery outcomes are most influenced by positive social support regardless of gender, age, or depressive symptoms.
Whilst biological and psychological factors play a part in any depression, in late onset depression causes may include physical illness and disability, such as may result from heart attacks or stroke, grief and social isolation. Older carers are at heightened risk of late onset depression because of the stress of caring.
Many psychological, physiological and financial changes which occur during later life may trigger depression in people with no prior history, but the symptoms of depression are not “normal” and should not go untreated. Depressed older persons are more likely to die by suicide or exacerbation of pre-existing conditions. Frighteningly, research suggests that older people are at heightened risk for suicide and that many may have visited a primary health practitioner within a week of successfully suiciding. It is imperative that we rethink the myth that it is inevitable that old people be depressed and therefore no intervention is required; no questions asked about mood, future orientation and degree of pessimism/optimism.
Late life depression, like all depression, is treatable with standard interventions Psychological interventions. As a psychologist my interventions include coaching people to depart their depressive thinking patterns, increase problem solving, redefine activities/recreational patterns; and rework existing/build new relationships to increase soical support. I use researched-based psychotherapies which have been found to be as effective as pharmacotherapy and often takes effect sooner with effects lasting as long as the behaviour changes.
Pharmacotherapy is effective in reducing the symptoms of depression but may take a few weeks to effect mood and in this period people often stop taking the medication; there are often side-effects which result in non-compliance with treatment prescribed by the primary health-care worker. These issues should be discussed with the prescribing physician so that the longer term effect/benefit can be achieved. Another issue can be that the symptoms may return when medication is discontinued.
Whether and when to use pharmacotherapy or psychotherapy is often a very individual choice. Like all health care decisions, it is better that the treatment plan be the result of informed choice. People should discuss all options with appropriately trained and qualified primary health-care workers and psychologists/psychotherapists. decide day to make tomorrow better. I can help you make the choice to make the change.
