Anti aging guide

Depression and old people



Why depression often lead to physical illnesses through self-neglect and what are the treatments or drugs available?

Depression is the commonest psychiatric condition in elderly people. The prevalence of severe depression is about 3 per cent among people over the age of 65, but milder degrees probably affect 12-15 per cent of people in this age-group. These milder depressive states are difficult to distinguish from the melancholia which may attend the changes and losses of advancing age. The lowering of mood and loss of pleasure in true depression is however more pervasive and of a different quality to that encountered in normal experience. In severe forms, the sufferers are preoccupied with ruminations of guilt, dread, fear, hopelessness, lack of self-worth, and anxiety in what has been called a ‘ceaseless roundabout’. There is apparent apathy and loss of spontaneity, and frequently there are deluded thoughts relating, for instance, to real or imagined physical disease, so that physical symptoms are common. Restlessness and agitation are other common manifestations in old people, and another form of depression is characterized by an apparent lack of orientation that may lead to the suspicion of dementia.

Losses and physical illnesses may precipitate true depression, as can certain drugs. In most cases, the cause is not clearly known, although genetic factors may play a part. There is thought to be a neurochemical abnormality caused by the under activity of certain neurons which are dependent on amines such as noradrenaline and serotonin for transmission of impulses from one nerve cell to another. Antidepressant drugs achieve their effect by blocking the absorption of these substances into the nerve endings and thus increasing the quantity present in the clefts between the cells.

Depression often leads to ill-health through self-neglect, malnutrition, and dehydration. The most obvious complication, however, is suicide and men over the age of 80 are the highest risk group in the population. Apparent attempts at suicide are, more often than not, unsuccessful in the young: the reverse is true among the old because many live alone and are found too late, and because resuscitation is more difficult. In general, the older the sufferer, the greater the suicide risk, especially among men. Other risk pointers are a family history, a previous serious suicidal attempt, social isolation, bereavement or an anniversary thereof, physical ill health, and hypochondria sis.

The modern drug treatment of depression is often successful. If it is not effective in a particular case, electroconvulsive therapy (ECT) may be life-saving despite its generally bad press. Indeed,many people feel that ECT is a safer and quicker form of treatment than drugs for elderly people gravely afflicted by this dreadful state.

Anxiety states

Anxiety is a common feature of depression, dementia, and physical illness, and often affects persons of all ages, young as well as old, who have none of these things. Sometimes it is permissible to wonder whether it would be normal if the old and frail, the isolated, and the impoverished were not anxious, or, for that matter, frankly depressed. Anxiety states occurring in isolation are less common than depressive illness, but may lead to a degree of depression, and may commonly produce physical symptoms such as palpitations, breathlessness, giddiness, and abdominal discomfort. The condition may respond to the doctor’s reassurance, or, better still, to the relief of loneliness if this can be achieved. Otherwise, a three or four week course of a minor tranquillizer such as diazepam (Valium) may be useful but the dose should be a low one and never exceeded by the patient. A gentle hypnotic may be required at night, and drugs which can be recommended, with reservations, are chlormethiazole (Heminevrin), dichloralphenazone (Welldorm), and temazepam (Euhypnos).

Institutional neurosis

`Institutional neurosis’ is the term given to the state of apathy and passive acceptance found in those consigned by society-to long term care. Now that the days of prolonged residence of young people in mental hospitals are over, the condition has become very much the preserve of the very old, and even today those who visit extended-care geriatric wards may find the inmates sitting round the walls of the day room in silent inactivity—however great the efforts made by the staff and by voluntary workers. This is a powerful argument for delaying, or better still, avoiding custodial care.

Posted by Carol Hudgens - April 29, 2012 at 5:35 pm