Category Archives: Senior Depression

Treatment for Depression: Psychotherapy and Psychological Treatments

Treatment for Depression: An Introduction

Treatments for depression have come a long way in the last couple of decades with many advancements in psychotherapy and psychological treatments that have been empirically supported by research. Research into cognitive behavioral therapy, behavior therapy and interpersonal therapy have now been conclusively found to be effective. Evidence has also been found to support the use of cognitive therapy and reminiscence therapy among senior adults. A review of each of the main specific therapeutic modalities follows below.

Treatment for Depression: Cognitive Behavioral Therapy

Cognitive behavioral therapy was originally developed by Aaron Beck M.D. in the late 1960’s. It has easily become the most popular treatment modality for depression, anxiety disorders and a multitude of other mental health conditions. Cognitive behavioral therapy focuses on the connection between thoughts, moods and behaviors and utilizes primarily the thoughts as the main intervention point to modify moods and ultimately behaviors. It recognizes the negative bias that many people develop that results in biased information processing and dysfunctional beliefs that lead to and maintain depression. The main goal is to identify and change the dysfunctional or maladaptive thinking which is believed to then consequently change the individual’s affect and behaviors.

Cognitive behavioral therapy is traditionally provided within a structured format that facilitates learning experiences, monitoring thoughts, development of more adaptive coping skills and Socratic questioning of maladaptive thinking. A full course of cognitive behavioral therapy may involve 14 to 16 sessions along with booster sessions whenever necessary. There has been significant evidence over the last several decades recognizing the effectiveness of cognitive behavioral therapy in treating depression. Various outcome studies have found it to be at least as effective as pharmacotherapy and may be more effective than depression medications alone in assisting with preventing relapse of depressive symptoms. A more recent field of cognitive behavioral therapy has also had an increased interest and attention in that it has integrated the concept of mindfulness as well into the traditional cognitive behavioral model, in an attempt to reduce the incidence of relapse.

Behavior Therapy Treatment of Depression:

Behavior therapy focuses on the use of reinforcement and extinction of behaviors that are found to be either positive or negative. Behavior therapies focus on increasing the quality as well as the frequency of pleasant experiences which are then expected to result in improvements in an individual’s mood. A structured treatment program that was developed utilizing this theoretical perspective is the Coping With Depression course. This course uses the format of a psychoeducational group which usually consists of 12 sessions over approximately eight weeks, and then uses skills training to improve social skills. The objective is then to increase activities that are pleasant as well as to teach individuals how to relax. Some recent evidence has found that the use of this Coping With Depression course is at least as effective as antidepressant medications in treating depression in the short-term and possibly even over the long-term.

Interpersonal Therapy for Depression:

An interpersonal therapy model for depression was developed by Klarman, Wiseman and Associates in the 1980’s. The basis for Interpersonal therapy is the Interpersonal model of depression which considers depression to be the result of or to be exacerbated by interpersonal difficulties between people. As a result, interpersonal therapy focuses on remediating these interpersonal problems. Interventions may focus on role transitions, or disputes, interpersonal deficits and skills and even grief issues which have been denied, delayed or may be inadequately completed.

Interpersonal therapy is also provided within a structured format and utilizes a progression through three phases: (1) the diagnosis and identification of specific areas of interpersonal difficulties as well as an explanation of the course of therapy; (2) focus on resolution of the specific problematic areas or difficulties and (3) termination of therapy. This type of therapy has been utilized in a modified format among several specific populations such as adolescents and the elderly and has been used for other mental health disorders as well. Interpersonal therapy has been demonstrated to be effective for both the acute and maintenance phases of depression.

Learned Helplessness Treatment Model for Depression:

Significant research has also recognized the importance of the learned helplessness model for the development and maintenance of depression. Learned helplessness is based upon a model by Martin Seligman Ph.D. in the early 1960’s in which he recognized that there was a connection between an individual’s sense of control over their environment and depression. He found that an individual’s inability to have a sense of control over adverse circumstances in their environment resulted in a sense of helplessness and ultimately depression. He believed this perspective and consequent depressed mood was basically a learned experience. This model recognizes the need for increasing an individual’s sense of control over their environment, reducing feelings of helplessness, hopelessness and depression.

Treatment for Depression: Conclusion

Research and my (Paul Susic Ph.D. Licensed Psychologist) clinical experience has found over the last several decades that optimal treatment for depression may include both psychotherapy and/or psychological treatments along with medications for the most effective treatment of major depressive disorder. Although medications frequently are prescribed as a front-line treatment for depression, this physiological focus is often not ideal. Medications alone have been found to have higher relapse risks of additional episodes than psychotherapy alone. In most cases it seems that the most effective approach may be to attempt to remediate the depression with psychotherapy and then add medication as necessary rather than trying medication and then adding psychotherapy as an adjunct treatment.

By Paul Susic Ph.D. Licensed Psychologist

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Depression Symptoms and Information You Must Know

Depression Symptoms and Information:

Depression is a mood disorder that most people have some awareness of, but may not know the various symptoms and what actually defines it as a disorder. Clinical depression is a serious disorder that presents in many ways resulting in various different levels of intensity and consequences. When people refer to the term “depression” they are frequently referring to a sad mood or experience of grief. Clinical depression however is actually a syndrome of at least five symptoms that have lasted for at least two weeks. When evaluating the symptoms of depression, a mental health clinician will analyze whether there has been a change from previous functioning, and must include at least one of the first two symptoms listed below:

1. Depressed or irritated mood
2. Diminished interest or pleasure in all or almost all activities
3. Significant weight loss or weight gain, or decrease or increase in appetite
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive or inappropriate guilt
8. Diminished ability to think or concentrate, or indecisiveness
9. Recurrent thoughts of death, suicidal impulses or actions

The depression symptoms described above may actually form a syndrome which is referred to as Major Depressive Episode when it occurs for the first time. If it then reoccurs it is referred to as a Major Depressive Disorder. An individual may have only five of the above symptoms for a relatively short period of time while other individuals may experience many or most of the above symptoms for many years. Obviously, when someone is diagnosed as having Major Depression it is very important. Also, part of the analysis needs to include an assessment of its severity and duration.

Comorbidity of Depression:

The comorbidity of depression refers to when depression presents itself in conjunction with other psychiatric and medical disorders. Older individuals may have significant comorbidity with medical concerns such as heart disease, diabetes, stroke and various other medical concerns. They may also have significant comorbidity with anxiety disorders and other psychiatric diagnoses. Some of the most common comorbid psychological conditions include dysthymia, cyclothymia, anxiety disorders, personality disorders, eating disorders and substance abuse disorders.

Major depression is easily one of the most common of all mental disorders. It is believed to annually affect about 12.9% of American women on the average and is about 1.7 times higher than the rate for males in the United States. Also, it is believed that at least 20% of adults in the United States population will experience clinical depression during their lives. Many researchers and mental health clinicians believe that the incidence of depression has increased in recent years and that could be as much as 50% higher by the year 2050 than it is presently.

Age of Onset:

The most typical pattern of the initial presentation of major depression is for it to occur for the first time in individuals in their mid to late adolescence. However, a first or recurrent episode can occur at any point in an individual’s life. It was previously believed that young children could not experience clinical depression, but this viewpoint has changed and it is now believed that it is indeed possible. In most cases however, the symptom patterns among children are somewhat different than for adults.


Major Depressive Disorder usually lasts between four months and one year if you do not seek treatment according to statistics by the American Psychiatric Association. Antidepressant medications and psychotherapy have been found to be helpful and effective in treating Major Depression, although it is commonly recognized to be chronic, recurrent and have high relapse rates. Obviously, recurrent and severe patterns of Major Depression are much more difficult to treat than an episodic and less intense depression.


As previously mentioned, American females have an incidence of depression at a rate of 1.7 times that of males. That pattern seems to begin in early to middle adolescence and continue throughout adulthood and even into the senior years. Many explanations have been proposed to account for these differences between the sexes including hormonal differences, gender roles, and various other issues related to socialization and differences in coping styles.

Impairment and Other Concerns:

Individuals actually diagnosed with clinical depression may experience significant levels of emotional, physiological, behavioral and cognitive impairment that may affect many aspects of their daily functioning. For instance, many individuals with depression experience a negative impact upon their ability to work, function well in school or cause difficulties in interpersonal relationships with friends, spouses and children.

Making a diagnosis of depression:

In order to make a formal diagnosis of depression, a mental health clinician will first assess whether an individual has a specific constellation of depressive symptoms. Then they will determine whether they are of a high enough level of severity to impair their functioning and are not attributable to the effects of substance abuse or a medical disorder. The diagnosis should not be made unless the symptoms last longer than two months following an incidence of bereavement or grief. As stated previously, some other psychological disorders also include some of the features of clinical depression such as bipolar disorder and schizoaffective disorder. These other mental health syndromes need to be ruled out and the symptoms need to be differentiated from these other disorders in order to have a diagnosis of depression.

Major Depressive Disorder in the Older Adult:

Depression and Major Depressive Disorder frequently occur among the elderly as well as among younger individuals. However, there are unique concerns related to the elderly in that older individuals with depression frequently experience impairment in their thinking or cognitive skills as part of the clinical syndrome. Depression among seniors may actually simulate dementia as individuals experience concentration difficulties, memory loss and distractibility. It is very common for dementia and Major Depressive Disorder to co-occur. Comorbidity is common. It is not very often however that findings of dementia are fully explained on the basis of depression or what is referred to as a pseudodementia.

Some studies have found that the prevalence of Major Depressive Disorder among older individuals in nursing homes may be as high as 30%. It has a tendency to frequently occur in the presence of medical conditions such as heart disease and stroke which also then complicates the treatment for both the depression and the primary medical conditions. Careful evaluation of medications is imperative which may also help explain some of these associated symptoms. When older adults have their first occurrence of depression, they must be carefully evaluated for the comorbid medical conditions such as undiagnosed cancer, cerebral ischemic events, or complications of metabolic conditions such as adult onset diabetes mellitus and thyroid dysfunction.

By Paul Susic PhD Licensed Psychologist

Major Depressive Disorder: Important Information and Treatment

Major Depressive Disorder Overview:

Major Depressive Disorder is the most commonly diagnosed mental health disorder among adults in the United States. Some studies have found lifetime prevalence rates for men at 9% – 12% and about 20% to 25% for women. According to the American Psychiatric Association, point prevalence rates (the amount of the general population who may have this diagnosis at any given point in time) are 3% for men and 6% for women. These rates have been found to be relatively consistent throughout the lives of both women and men.

The effects of Major Depressive Disorder:

Depression is known to have severe individual and societal effects. Individual suffering includes the emotional aspects of sadness, fatigue, and impaired physical and psychological functioning which may undermine every aspect of an individual’s personal and professional life. Societal burdens are also imposed as individuals have increased utilization of social and medical services and may incur enormous financial expenses for treatment and have a severe impact upon an individual’s productivity at work, school and social responsibilities.

How do I know if I have Major Depressive Disorder?

In order to receive a diagnosis of Major Depressive Disorder you must experience a significant feeling of personal distress and have a reduction in functioning in your normal activities of daily living. Also, the two weeks prior to an assessment by a mental health clinician, you must experience on a relatively daily basis a feeling of low mood (tearful, empty, sad) and/or a significant reduced interest in your normal activities and interests.
The diagnostic manual used by psychologists, psychiatrists and other treatment professionals is the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) published by the American Psychiatric Association in 2013. According to the DSM-5 Major Depressive Disorder “represents the classic condition in this group of disorders. It is characterized by discrete episodes of at least two weeks duration (although most episodes last considerably longer) involving clear-cut changes in affect, cognition, and neurogenerative functions and an inter-episode remissions”. This depressive disorder can be diagnosed after only one episode but is usually recurrent in nature. An important consideration is to separate normal reactions to life experiences such as sadness after loss from a Major Depressive episode. Grief after loss may entail significant suffering but doesn’t necessarily indicate Major Depressive Disorder. When both are experienced simultaneously, the depressive episode seems to be more severe than if it were not occurring at the same time. Grief related depression usually seems to occur in individuals with some vulnerability to depression and treatment may include psychotherapy or antidepressant medication or a combination of both. For more specific criteria to determine whether you have major depressive disorder please see the specific criteria on this website.

In general, some of the main symptoms of major depressive disorder include significant weight loss, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive or inappropriate guilt, decreased concentration or indecisiveness, and/or suicidal ideation, plans, or attempts.

Major Depressive Disorder treatment:

There have been major improvements in treatment for depression over the last three or four decades. Some of the current treatments now include somatic interventions which include antidepressant medications and electroconvulsive shock treatment (ECT), as well as a number of psychological treatments such as cognitive behavioral therapy, behavioral therapy and interpersonal psychotherapy. The treatments discussed on this website will only include treatments that have had at least two comparative outcome trials with patients between the ages of 18 and 65 years old. Psychological treatments for Major Depressive Disorder have been studied extensively and have been found to have approximately the same level of effectiveness as antidepressants, although they are frequently combined at times for more efficacious treatment.

By Paul Susic Ph.D. Licensed Psychologist

See Related:

Depressive Disorders and Related DSM-5 Diagnostic Codes
What are the depression medications and how do they work?

Geriatric Depression: Don’t We All Feel Sad, Sometimes? By Paul Susic Ph.D. Licensed Psychologist

An overview of geriatric depression:

Geriatric depression appears in many forms. Although everyone feels sad sometimes, which is a natural response to negative circumstances and loss, ultimately, the feelings associated with bad experiences are qualitatively very different from geriatric depression. While it may be similar in that it can initially arise as a result of a sad event or circumstance, or specific medical condition that is not always the case. Sometimes geriatric depression has been known to occur for no apparent reason. Among the senior population, psychologists frequently see depression occurring as a result of physical illness, or merely at the same time, a term that we refer to as comorbidity.

An important factor to understand about geriatric depression as well as depression in general is that it appears very differently to different people. One person may have a sense of “feeling blue” as they try to conduct their normal everyday activities and another person may feel a very heavy feeling that makes it almost impossible for them to even get out of a chair. This heavy feeling of despair can become absolutely incapacitating. Unfortunately, it could even become much worse in that this overwhelming sense of despair and feeling of worthlessness could even lead your loved one to even turn to suicide for relief.

You should never underestimate the incapacitating feelings associated with geriatric depression. In my clinical work, I’ve heard many people over the years blame seniors for their conditions as if they did not have a strong enough will to relieve their suffering on their own. The blaming actually makes it much worse as people then start feeling responsible for their condition. I don’t believe that many people choose to feel bad. And certainly, it doesn’t make the situation better for people to feel like it is their fault.

The elderly are frailer and their bodies are more susceptible to a variety of circumstances and conditions which contribute to their geriatric depression. There are many physical conditions including strokes, Parkinson’s disease, and multiple sclerosis which seem to predispose seniors and others to depression. Also, medications are infamous for increasing the level of depression among the elderly. In addition to these comorbid medical conditions which seem to predispose or exacerbate the experience of depression among the elderly, geriatric depression is frequently precipitated by changing life circumstances as individuals proceed into their senior years.

The most prominent life circumstance that contributes to geriatric depression is the experience of loss. As seniors are no longer able to maintain their homes for example, they are frequently required to move into nursing facilities, move in with family members or otherwise unwillingly change their living circumstances. This is a tremendous loss for them to endure. Loss is also common in many other forms including loss of physical mobility, driving privileges and the loss of finances and the status of working or having a profession. When we do not choose circumstances but are forced into them as result of the aging process, this experience frequently leads to a feeling of loss..

While statistics very significantly it is believed that geriatric depression is experienced by approximately one out of every six older people. Some of these people have a recurrence of depression experienced earlier in their life. For others, their first clinically diagnosed emotional problem arises in the form of geriatric depression.

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Symptoms of Depression and the Aging Process

While symptoms of depression are obviously impacted by physical illness the consequences of the aging process can also mimic some of these symptoms. These considerations have caused many to question whether somatic symptoms of depression such as insomnia, fatigue and appetite and weight loss are really valid indicators in the elderly. One recent survey looking at this issue determined that appetite loss was not a valid symptom of depression in the elderly, but concluded that sleep disturbance and fatigue were. With this study, fatigue was demonstrated by diminished levels of energy and by feeling that almost everything was very difficult to accomplish. Fatigue was particularly associated with symptoms of depression among the old-old long-term care subjects in this study.

This information was not meant to conclude that appetite and weight loss were never associated with symptoms of depression among long-term care residents. These studies reflect the fact that there are many causes for appetite loss in the elderly including physical illness, the aging process in general and symptoms of depression. These results indicate that lack of appetite loses the powerful association with symptoms of depression that are usually seen in younger adults. Nevertheless, there are many residents of long-term care facilities who lose their appetite and sometimes significant weight due to depression. As a result, long-term care residents who lose more than a couple of pounds should always be evaluated for depression symptoms when a clear physical cause is not easily identified.

A study by Morley and Kraenzle evaluating residents in long-term care facilities who lost five or more pounds over a period of three or more months, may underscore the importance of recognizing the multiple factors usually associated with weight loss for residents in long-term care facilities. They found that depression was the cause of weight loss for large minority (36%) of long-term care facilities in their study. For about half of the residents in their study, it was determined that physical causes such as medications, swallowing disorders or cancer may actually be the causative factor.

Some information from the Merck Manual of Health and Aging

Additional information and webpage by Paul Susic Ph.D. Licensed Psychologist (Health and Geriatric Psychologist)

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Seniors Mental Health & Depression

A majority of men and women from the ages of 55-74 report they are satisfied with their lives and are currently in good health. While periods of depression may occur among seniors, it is important to remember that it is not a normal part of aging.

Depression is the most common mental health concern for older adults, affecting between 15 to 20 percent of older adults living in the community. It is not a normal part of aging. Symptoms such as decreased energy, poor sleep and preoccupation with health problems should be viewed as possible symptoms of a treatable illness and are NOT a result of the aging process.

Treatment for depression works, yet too many people remain undiagnosed and untreated because they don’t recognize the signs and symptoms of depression.

Mental health specialists generally agree on the following definition of major depression:

1.Symptoms persist for two weeks or longer
2.People either have depressed moods or seem unable to enjoy life.
3.Major depression should be considered if four of the following seven criteria are present:
•A change in sleeping habits (more or less than usual)
•A change in eating habits or weigh
•Low energy or fatigue
•Trouble concentrating
•Feeling worthless or excessively guilty
•Marked restlessness or slowed-down movements
•Thoughts of death or suicide

Depression can be defined as an imbalance of brain chemicals triggered by stress and life events, including biological, psychological and social factors.

Depression is NOT a character or personality flaw.

Many of the signs of depression may also indicate other problems or medical conditions – It is important to consult with a doctor to determine if your symptoms indicate depression or another medical condition.

Depression is often difficult to recognize among the senior population and it tends to be under diagnosed. Living with depression not only prevents older adult from fully enjoying their lives but it puts a strain upon their health, which can lead to other medical concerns. It is also very difficult for their caregivers and places a strain on their health as well.

What we do know is that there is no one cause for depression- every individual is unique in what may cause their depression, and what may trigger a depressive episode. Some possible causes and risk factors include genetics and family history, brain chemistry, personality, major illness, medications & alcohol, and life events. Risk factors for serious depression, particularly in older adults, may include loss and bereavement, lack of social support, isolation, living in poverty, being a caregiver, and abuse.

Having depression could also increase the risk of suicide among older adults, particularly in older males. According to the CDC, seniors account for more than 16% of all suicide deaths. Older adults who are over the age of 60 are far more likely to have a higher risk rate of suicide than younger people. If you feel that a friend or a loved one is suicidal, encourage them to seek out help either from a doctor, friend, crisis centre or, mental health agency.

Some things to keep in mind:

•Keep a positive attitude. Remember that slowing down does not mean you have to come to a complete stop. Chances are you will still be able to do almost all the things you used to; you may just need to take a little more time and learn to pace yourself.
•See your family doctor regularly. He/she can, then, deal with any changes or symptoms that require medical attention.
•Be careful about your medications. As you get older, they may begin to interact differently with other drugs and to affect you differently than before. Make sure your doctor knows about all your medications, even those prescribed by another doctor.
•Take responsibility for your own health. Do not hesitate to ask your doctor questions; some do not offer explanations unless asked.

Depression is a serious disorder that is treatable. In addition, dealing with an individual who is suffering from depression or at risk of suicide can be absolutely overwhelming for a caregiver. Although the caregiver is providing care and assistance to their loved ones they must also look after their own emotional, mental, and physical well-being.

While all of us may feel sad from time to time, sadness is not depression and it is important to remember that depression is not a normal part of aging.


Elder Caring Inc. is a group of experts with backgrounds in Social Work, Occupational Therapy, Physiotherapy and Gerontology. As working professionals in the field, all of our team members have many years of experience in working with the disabled, the elderly, and their families. The company has team members and representatives across Canada.

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Webpage by Paul Susic Ph.D. Licensed Psychologist Clinical Director of Senior Care Psychological Consulting

Personality Study on Depression: Risk of First Episode in Late Life

A recent study by the University of Rochester Medical Center found that certain personality characteristics were associated with a higher risk of having a first incidence of depression in later life. As reported in an April 14, 2008 article at ScienceDaily, people over the age of 70 whose personality characteristics make them more vulnerable to having feelings of distress, insecurity, anxiety and worry, are far more likely to experience a first episode of clinical depression in their later years than those who do not exhibit these same characteristics.

Paul R. Duberstein Ph.D., professor of psychiatry, and the lead researcher stated “We assume that because depression has not developed for people with these personality traits by the age of 70 that it won’t develop.” He went on to state that: “But even in older adulthood, these traits confer risk. Presumably something about aging helps take down the facade or destroys the protective sheath that has kept them from significant depression.”

Additional results from this unique study are published in the May edition of the journal Psychological Medicine. The study found that women were at greater risk than men and that individuals having a working-class background were also at increased risk for depression particularly prior to the age of 80. The study will help to understand some of the personality characteristics associated with late life depression. Dr. Duberstein, who is director of the Laboratory of Personality and Development at the Medical Center stated: “The findings suggest that long-standing personality traits can predict onset of depression into older adulthood.”

Researchers in this study considered data from a multidisciplinary study of 70-year-old residents from Goteborg, Sweden which began in 1971 in order to have a better understanding of aging, and some of the age-related disorders that develop among this age group.

Because most individuals in Sweden receive public healthcare, the study had access to medical records going back several decades. Data collection also included physical, mental health and social assessment. Individuals were then examined periodically over a 15 year period of time, at the ages of 75, 79, 81, 83 and 85.

Individuals with dementia and some other psychiatric disorders were eliminated from the study. Overall, a total of 275 records were analyzed, finding 59 cases of first lifetime episodes of depression after the age of 70. Authors of the study stated: “Although we are aware of no research on how people who are highly distress prone managed to stave off clinically significant depression, protective factors might play a role.” They went on to conclude that: “Candidate protective factors include close personal relationships, rewarding occupations or meaningful hobbies, physical vigor and vitality, economic independence, and spiritual well-being. Processes related to aging might inexorably erode some of these protective factors.”

The researchers obviously recommend continuing the study between age, personality and first-time episodes of depression. They stated: “This is a particularly important issue for older men, given their high suicide rate in many Western countries, and the observation that they often take their lives in the midst of a first lifetime episode of depression.”

Adapted from an article at ScienceDaily (April 14, 2008) Personality Study Shows Risk of First Depression Episode Late in Life

University of Rochester Medical Center (2008, April 14). Personality Study Shows Risk Of First Depression Episode Late In Life. ScienceDaily. Retrieved April 17, 2008, from­ /releases/2008/04/080411124607.htm

Additional Information and webpage by Paul Susic Ph.D. Licensed Psychologist

Elderly Report More Depression in Long-Term Care Than at Home

The elderly self-report more depression and are more likely to be prescribed antidepressants in long term care facilities according to a new study. This recent study reported at ScienceDaily (May 9, 2008), was conducted by social work students at Indian University.
The researchers studied 272 elders with an average age of 81, and compared how often they self-reported depression, and were prescribed antidepressants at home or at a long-term care facility. The study was conducted through a homecare agency in west central Indiana.

While 11% of the elders reported feeling depressed when they received care in their homes through medical and social services, 30% of the elders reported the same depressive feelings at a long-term care facility. Also, 62% of the elders in long-term care facilities were prescribed antidepressants at some point time after their admission, compared to only about 25% of the elders cared for at home.

Lindsay Egan and Jodi Shapuras, both undergraduate students in the social work program at Indiana State University, conducted their study at their internships as part of a senior-level field practicum class. Shapuras and Egan stated “We are both interested in working with the elderly population in our careers, so we conducted this research to get a better feel for the prevalence of depression and those who need some level of outside care.” Shapuras stated “As social workers, it is important to understand the mental health issues, such as depression, within the different care settings.”

Neither of the researchers seemed to be too surprised by their findings. “We actually hypothesized that the long-term care patients would utilize antidepressants more and would self-report depression more,” Egan said. “When an individual moves to a long-term care facility, they undergo a tremendous amount of changes. They’re no longer able to live independently and are relying on others for care, and this greatly affects how they feel about themselves and the world around them.” Shapuras concluded that in an individual’s home, they’re still residing in a familiar environment. “They’re still at home and independently able to complete some activities of daily living, such as bathing, cooking or feeding themselves, whereas a long-term care patient may not be able to do all of those tasks.” She concluded.

The researchers are hoping that their study will help to create a higher level of awareness of depression among the elderly, and the degree to which antidepressants are prescribed in long-term care settings. Egan stated “I would like to see more effective alternative treatments researched, as opposed to what seems to in many cases to be the automatic prescribing an antidepressant.” Shapuras also said she would like to see more research done in this area and concluded that “It seems as though medications are sometimes viewed as the “fix-all” when depression becomes apparent.” She went on to say, “I hope to work in the field of gerontology as a social worker and to make some positive changes somewhere along the line.”

By Paul Susic Ph.D. Licensed Psychologist

Information adapted from:

Indiana State University (2008, May 9). Elderly In Long-term Care Setting Suffer Depression More Than Those Cared For At Home. ScienceDaily. Retrieved May 13, 2008, from­ /releases/2008/05/080508181557.htm

Depression Among the Elderly or Just Normal Aging?

Isn’t depression a part of the normal aging process?

Depression is easily the most common and reversible “noncognitive” psychiatric disorder among the elderly in both the community and the nursing home setting. Depression frequently goes unrecognized and is even commonly dismissed as part of the normal aging process in long-term care settings. There is absolutely nothing normal about depression, which most often occurs in the context of multiple physical and psychosocial problems. The symptoms can frequently be vague and variable (as with somatic complaints and anxiety) and may even be manifested in symptoms that you would not commonly relate to depression, such as agitated behavior or withdrawal. Depression occurs in individuals with full memory functioning as well as those with dementia, and its incidence increases with age.

Prevalence of depression among the elderly:

The prevalence of major depression among the general population of noninstitutionalized elderly is relatively low (1.8% to 2.9%) and in nursing homes is approximately 6%. Late-life depression may cause multiple dysfunctions (decreased energy, decreased appetite with poor nutrition, anxiety, withdrawal) and excess disability for the medically ill patient. It also significantly increases the risk of premature death. Approximately 40% of elderly patients with depression become chronically depressed if they remain untreated, with about 30% to 40% showing a recurrence of symptoms within a year of recovery. The severity of associated medical illness is often the most powerful predictor of depressive symptoms. Many medical illnesses (See Table 1) and medications (See Table 2) have been associated with depression. Individuals who commit suicide after age 55 are likely to have suffered from major depression, substance abuse or other high risk factors.

Depression and dementia:

Frequently, it is difficult to distinguish between depression and dementia, particularly in patients with mild dementia or moderate to severe depression. Research has found that approximately 25% to 40% of elderly patients with dementia also have mild to severe depressive symptoms that require treatment, with about 80% of them being treated effectively using combined medication and psychotherapy. Pseudodementia refers to the cognitive impairment associated with depression in the elderly and occurs in 10% to 15% of cases. Studies have found (and my own professional experience as a psychologist working with nursing home patients has confirmed) that cognitive deficits in the areas of information processing and executive skills have been shown to improve significantly with antidepressant treatment and frequently the use of psychotherapy (studies continue to demonstrate the effectiveness of psychotherapy for patients with mild-moderate dementia).

Depression and treatment effectiveness:

Depression is the most treatable of the psychiatric diagnoses for all age groups including the elderly. There is clear evidence that elderly patients respond to antidepressant medications in cases which include even severe medical comorbidities (concurrent medical problems) and even at very advanced ages. Positive outcome studies have demonstrated success rates as high as 75% to 80% of individuals with depression being treated successfully with adequate medication and psychotherapy. Improving the level of recognition and treatment of late-life depression in long-term care settings, could markedly reduce excess disability and significantly improve the quality life for elderly residents.

Some information from Professional Psychology in Long Term Care by Victor Molinari Ph.D.

Additional information by Paul Susic Ph.D Licensed Psychologist Clinical Director of Senior Care Psychological Consulting

Long Term Care Medical Problems Associated with Depression

In long-term care facilities, both medical problems and medications are frequently associated with depression. Medications that can sometimes contribute to depression include antihypertensives, beta-blockers, and benzodiazepines. Some of the medical problems associated with depression in long-term care facilities include:

•Endocrine disturbances: diabetes mellitus, hypothyroidism
•Viral infections: hepatitis, pneumonia, encephalitis, HIV
•Tumors: of the lung, pancreas, and central nervous system
•Neurological: Parkinson’s disease, stroke, epilepsy, cerebrovascular disease, Huntington’s disease
•Other: hypertension, electrolyte abnormalities, anemia, alcoholism

These disorders have been known to contribute to depressive symptoms in at least two ways, including the fact that depression may be a reaction to a medical problem. An example may be the losses associated with a head injury or stroke which has frequently been found to result in depression. Also, medical problems are sometimes believed to lead to or exacerbate depressive symptoms. Head injuries and strokes are known to cause structural changes in the brain, which are believed to trigger biochemical changes leading to depressive symptoms. It is sometimes difficult to figure out the specific causes of depression in a given long-term care resident. Some options include having nursing staff in long-term care facilities providing further assessment, changing medications or observing residents for longer period of time. In many cases, the depression may resolve if the underlying medical problem improves or the medications are changed for the resident.

When assessing a long-term care resident with these medical problems, it’s important to remember that these medical issues may also be the cause of some of the biological symptoms of depression including loss of energy, weight loss or appetite, and sleep disturbance. When medical problems are believed to be causing some of the depressive symptoms, you should probably focus next on some of the psychological symptoms of depression, such as guilt, helplessness, hopelessness lack of pleasure in normal activities and interests, feelings of worthlessness and suicidal ideation.

It’s very important to understand the reciprocal nature of physical problems and depression among long-term care residents. Physical problems are known to contribute to depression as well as depression having an adverse affect on an individual’s medical condition. It is a known fact for example that depressed long-term care residents complain of more intense pain at more pain locations then do residents who are not depressed with similar medical problems. Long-term residents who do feel like eating then become undernourished. Fatigue and lack of interest in activities make it less likely that residents will exercise, endangering their physical conditioning.

Some information from Psycholosocial Intervention in Long – Term Care by Gary W. Hartz Ph.D and D. Michael Splain LCSW

Additional information and webpage by Paul Susic Ph.D. Licensed Psychologist (Health and Geriatric Psychologist)