Older Adults and Depression (Part 2)

What are my treatment options?

The primary treatment options for depression include medication and psychotherapy. It is important to remember that as doctors and therapists develop a personalized treatment plan for each individual, different treatments or treatment combinations sometimes might be tried until you find one that works for you.

Medication

Medications called antidepressants can work well to treat depression. While some symptoms usually begin to improve within a week or two, antidepressants can take several weeks to work fully. As with most medications, many people experience some side effects, which in most cases can be managed or minimized. The most common side effects of antidepressants include:

• Nausea and vomiting.
• Weight gain.
• Diarrhea.
• Sleepiness.
• Sexual problems.

Antidepressants may cause other side effects that are not included in this list. Most side effects lessen over time. If you are taking antidepressants, talk to your doctor about any side effects that you are experiencing, especially if they are new, worsen over time or worry you. Often, temporarily lowering the dose or switching to a different medication will help when side effects are problematic. If you have thoughts of suicide or experience any unusual changes in mood and behavior, call your doctor right away.

People over 65 have to be careful when taking medications, especially when they're taking medications for different conditions. Older adults have a higher risk for experiencing bad drug interactions, missing doses or overdosing. Be sure to tell every doctor you see about all of the medications you are being prescribed. It is also a good idea to get all of your medications from the same pharmacy; pharmacists are excellent sources of information about medications and will alert you and your doctors if there are concerns about a possible interaction between medications — which can happen inadvertently when a doctor is not familiar with a medication being prescribed for a different condition by a different health care provider.

Older adults also tend to be more sensitive to medications. Therefore, lower or less frequent doses may be needed. Before starting a medication, older adults and their family members should talk with a doctor about whether a medication can affect alertness, memory or coordination, and how to help ensure that prescribed medications do not increase the risk of falls. If you have trouble remembering to take multiple doses of medicines throughout the day, your doctor may want to prescribe one of the antidepressants that require just one dose daily; either way, antidepressants must be taken every single day, not just "as needed."

If you are taking antidepressants, it is important to not stop taking them without the help of a doctor.

Even after you are feeling back to yourself, antidepressants should be continued for a number of months to prevent depression symptoms from returning. When it is time to stop the medication, the doctor will help you slowly and safely decrease the dose. It's important to give the body time to adjust to the change. People don't get addicted to (or "hooked on") these medications, but stopping them abruptly may cause withdrawal symptoms.

Psychotherapy

Psychotherapy (or "talk therapy") can also be an effective treatment for depression. It helps by teaching new ways of thinking and behaving, and changing habits that may contribute to the depression. Psychotherapy can help you understand and work through difficult relationships or situations that may be causing your depression or making it worse. Research shows that cognitive behavioral therapy (CBT), including a version called problem-solving therapy, may be an especially useful type of psychotherapy for treating older adults and improving their quality of life.

Research also suggests that for older adults, psychotherapy is just as likely to be an effective first treatment for depression as taking an antidepressant. Some older adults prefer to get counseling or psychotherapy for depression rather than add more medications to those they are already taking for other conditions. However, if your depression is severe or if you are coping with other serious illnesses, medication or a combination of medications with psychotherapy may be a more effective approach.

Complementary Therapies

Examples of complementary therapies for depression include yoga, exercise and certain dietary supplements. These therapies may offer some benefits for people with depression; however, they should not replace talking to your health care professional or continuing with the treatment plan determined with that doctor. Tell your health care professional about any complementary health approaches you use or plan to use. This will help ensure your safety. Physical activity is a helpful part of any treatment plan for depression, and may become easier to add as a person starts to feel better as antidepressant medication and/or psychotherapy begin to work. Talk to your health care professional about your options, and visit the National Center for Complementary and Integrative Health to learn more about these types of therapies: https://nccih.nih.gov/.

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy (ECT) is sometimes used for severe depression that is very difficult to treat and does not respond to medication or psychotherapy. ECT is a type of brain stimulation therapy, a class of treatments that involve activating the brain directly with electricity, magnets or implants. Some of these treatments are still at the experimental stage. If your depression persists despite adequate trials of medication, or if your depression is so severe that you are unable to eat or you develop false, fixed beliefs (delusions) about your illness, your doctor may recommend ECT as the best option. Although it has been in use for almost 80 years, ECT remains the strongest and fastest-acting treatment for severe depression.

Despite ECT's efficacy and safety record in older adults, many misconceptions still persist among both patients and health care professionals. ECT can be safe and highly effective for severe, treatment-resistant depression, as well as a variety of other serious mental disorders. ECT may cause side effects, such as confusion and memory loss. Although these side effects are usually short-term, they can sometimes linger.

Beyond Treatment: What You Can Do

As you continue treatment, you may gradually start to feel better. Remember that if you are taking medication, it may take several weeks for it to start working. If the first medication does not work, be open to trying another. You may need to try a few different medications before finding one that works for you. Sometimes, if an antidepressant medication is only partially effective, adding a second medication of a different type can be helpful.

Try to do things that you used to enjoy before you had depression. Studies have shown that doing these things, even when you don't expect to enjoy them, can help lift your spirits. Go easy on yourself. Here are other things that may help:

• Break up large tasks into small ones, and do what you can as you can. Don't try to do too many things at once.
• Spend time with other people, and talk to a friend or relative about your feelings.
• Stick to your treatment plan. It will take time for treatment to work.
• Discuss decisions with others who know you well. Do not make important life decisions until you feel better.

If You Are Having Suicidal Thoughts

Older adults with depression are at risk for suicide. If you are thinking about harming yourself or attempting suicide, tell someone who can help immediately:

• Call your doctor.
• Call 911 for emergency services.
• Go to the nearest hospital emergency room.
• Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to be connected to a trained counselor at a suicide crisis center nearest you.

How do I help someone with depression?

If you know someone who has depression, first help him or her see a doctor or mental health professional. Several ways you can help an older adult with depression follow:

• Offer support, understanding, patience and encouragement.
• Help keep track of his or her appointments and weekly "pillbox" if possible, because many older adults with depression may not be thinking clearly.
• Try to make sure he or she has a way of getting to doctor visits.
• Talk to him or her, and listen carefully.
• Never ignore comments about suicide, and report them to your loved one's therapist or doctor.
• Invite him or her out for walks or outings, or to engage in indoor activities with you.
• Remind him or her that, with time and treatment, the depression will lift.