November 26, 2011

USA: Depression in old age - Fighting a malady spurred by grief, pain, disability

COLUMBUS, Indiana / The Republic / Living / November 25, 2011

By GARY ROTSTEIN - Pittsburgh Post-Gazette

For Nancy King, the start of depression was the death of her husband when she was in her mid-60s.

An on-the-job back injury for nursing aide Dee Miller caused her chronic pain in her late 60s, sinking her mood and erasing her desire to get out of the house.

The deep blues arrived for Richard Janecek later in life, as medical conditions weakened the workaholic and left him unable to perform his usual physical activity.

Grief. Pain. Disability. They're among the primary causes of depression at late age for adults. Retirement, social isolation and chronic insomnia are other factors that trigger lower feelings among some elderly than they experienced when younger.

Fortunately for King, Miller and Janecek, they have received help as participants in studies at the University of Pittsburgh's Center for Late Life Depression Prevention and Treatment Research. It is one of the few academic centers focused on late-life depression nationally, with the National Institute of Mental Health recently awarding it a five-year grant totaling nearly $9 million to bolster its efforts.

Charles Reynolds, a psychiatry professor and director of the center, said its focus has evolved from treatment in the early years to equal emphasis on prevention now. Different studies search for methods to identify symptoms early and figure the right therapy, medication and other means to keep them from overwhelming individuals who have become vulnerable to what can seem like an inexplicable but paralyzing inertia.

"There are peaks and valleys, but no one told me the valleys would be so deep," said King, 82, who credits the center with giving her the coping skills to get over her bereavement-related depression.

Victims experience low energy and mood, lack of pleasure in activities, sleep disturbances, loss of appetite and other problems.

"There are peaks and valleys, but no one told me the valleys would be so deep," said King, 82, who credits the center with giving her the coping skills to get over her bereavement-related depression.

For Miller, a 68-year-old former nursing aide, a back injury led to problems at work, constant pain and reduced motivation she didn't recognize as depression because she'd never experienced it before. She came to the center for help last year and was revived by a program of counseling, temporary drug therapy and exercise.

"My body still aches, but I deal with it," she says now, noting that lots of social interaction with other residents of her senior housing complex also helps.

Jordan Karp, an associate professor of psychiatry and anesthesiology who is heading one of Pitt's new prevention studies -- one specifically focused on people troubled by pain -- said about one-fourth of older adults with chronic pain have major depression. Chronic lower back pain is worst of all for them, he said.

When older adults are in pain, they don't sleep well. When they don't sleep well, they might not take their medication properly. With all of those out of sync, they're more likely to be depressed.

"We're trying to break this cycle," which ties the pain and depression together, Karp said. "You have to treat them as linked conditions."

Reynolds said depression is rarely an isolated condition among the elderly, but "amplifies the disabilities that exist otherwise in old age."

Thus, the rate of depression among people over age 60 is estimated to be between 20 and 30 percent in long-term care settings, where patients or residents would presumably have physical afflictions limiting them. In the general community, Reynolds said, no more than 3 percent of people in the same age range are presumed to have depression.

Janecek said finding the right drug was crucial in his case to recover from his low moods resulting from physical ailments. Cancer treatment, knee replacement and other maladies left the former sheet metal worker, now 78, unable to care for animals and do other physical labor in the way he had been accustomed.

"Richard was depressed because he couldn't accomplish as much at 78 as he had at 68 or 58," said his wife, Karen.

George Niederehe from NIMH called such tales "the story of late life. ... It's rare to find people age 75 and older (with depression) who don't have some other combination of illnesses that complicate the picture."

Gary Rotstein

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