Depression and its Treatment in Older Adults. Gregory A. Hinrichsen, Ph.D. Geropsychologist New York City

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1 Depression and its Treatment in Older Adults Gregory A. Hinrichsen, Ph.D. Geropsychologist New York City

2 What is Depression? Everyday use of the word Clinically significant depressive symptoms : more severe, more longstanding than daily mood fluctuations Diagnosable disorder Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V)

3 Definition of Depression Major Depressive Disorder Feeling depressed and/or loss of interest in usual activities Reduced ability to function Additional symptoms: Weight change Sleep change Physical agitation or retardation Loss of energy Feelings of worthlessness or guilt Problems with concentration or decision making Thoughts of death, suicide; attempt at suicide

4 Definition of Depression Persistent Depressive Disorder ( Dysthymia ) Depressed most days for at least 2 years Additional symptoms: Changes in appetite Sleep changes Fatigue Poor concentration or problems in decision making Hopelessness

5 Definition of Depression Adjustment Disorder Response to life stressor Symptoms may include: Upset more than what is usually expected Affects ability to function Depression and/or anxiety

6 Causes of Depression Medical Issues Genetic predisposition Life Stresses Research links life stresses with increased risk for depression Research links problems in relationships with increased risk for depression Depression can impair relationships that can help a person recover from depression; and can increase the risk of depression in the non depressed partner/spouse

7 Facts about Depression Lifetime prevalence of major depressive disorder (MDD) is: 1 in 6 women; 1 in 4 men MDD impairs ability to function and has negative outcomes on physical health Suicide rate is 20 time higher among persons with MDD Tends to be recurrent: 1 episode = 50% recurrence; 2 episodes = 80%

8 Facts about Depression Prevalence of Depression in Older Adults (65+) Living in the community: 3 4% (vs. 7% younger adults)* Outpatient medical: 5% Inpatient medical: 10% Long term care settings: 20% *Note: Older adults have about half the rates of mental disorders than younger adults

9 Facts about Depression Rates of suicide are much higher in older compared with younger adults (chiefly: older, white men vs. older women or minorities) The vast majority of people who commit suicide are depressed Most older adults who commit suicide have recently seen their primary care physician

10 Treatments for Depression Antidepressant medications (generic/trade names) Electroconvulsive therapy (ECT) Psychotherapy Medication + psychotherapy Evidence based psychotherapies: proven treatments for depression, anxiety, behavioral problems associated with dementia, sleep problems, caregiver distress

11 Evidence Based Psychotherapies for Depression Cognitive Behavioral Therapy (CBT) Problem Solving Therapy (PST) Interpersonal Psychotherapy (IPT) Brief Psychodynamic Psychotherapy How studies are conducted: randomized, controlled, clinical trials ; review of evidence through meta analyses and professional groups

12 Problems that Bring Depressed Older Adults to Psychotherapy Life Transitions: Retirement, residential move, moving to long term care setting, onset of chronic health problem, onset of cognitive problems, becoming a caregiver to an older relative, becoming a parent to a grandchild Relationship Problems: Conflict with a spouse/partner, adult child, in law, sibling Coping with Death of an Important Person: spouse/partner, adult child, sibling

13 Problems that Bring Depressed Older Adults to Psychotherapy Social Isolation: wants connections with others, but finds it difficult to make, keep relationships Acute vs. long standing mental health problems The role of family members in treatment of late life mental health problems The importance of coordination of care

14 Considerations in Conducting Psychotherapy with Older Adults Resilience in older adults and the benefit of accumulated experience Negative stereotypical attitudes about older adults: doddering but dear Learned low expectations by older adults about their own aging: the enemy within Age cohort specific values, norms and expectations: the Greatest Generation, The Babyboomers

15 Considerations in Psychotherapy Common problems linked to later life Knowledge of mental health and preferences for mental health services The aging service network

16 Some Clinical Examples May: Providing care to her infirm husband Betty: Coping with medical illness Robert: Struggling with career disappointment

17 Questions & Comments?

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