Depression in Older Adults - Part One

by Emily Carton, MA LISW

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In his book Identity and the Life Cycle, Erik Erikson points to human development as a sequence of stages and milestones. Each stage of development from infancy through old age is described as a journey of discovering who we are in relation to ourselves, our peers, and the larger world.

For example, Erikson identifies the first issue of life as that of trust versus mistrust. If an infant has a consistent and trustworthy caregiver, a sense of trust and hope is established. Without this consistent bond, the infant will have difficulty learning to trust that his needs can be met. Rather than seeing development as a straight progression up a flight of stairs, Erikson saw that each step may need to be revisited and reassessed throughout our lives.

For adults in their later years Erikson viewed this as a period in which to come to terms with who we are, of recognizing and accepting our accomplishments, and of integrating all that we have learned. He defined the opposing forces as that of integrity versus despair. He believed that to come to terms and to accept our lives will lead not to hopeless or despair but to a sense of integrity. Integrity is to know and to stand on the solid ground of our lives and to live our remaining years with a sense of completeness.

Opposing issues in later life: The later years bring many joys and possibilities. It may be the enjoyment of one's family, the participation in new activities, or the deepening pursuit of a life long interest. It can offer a period of reflection and contemplation. Yet, these years also carry a multitude of changes, and such great change at any age tips life toward increased stress. For some retirement might be a dream come true, but for others it is a time of dread. Many will be living in a body that no longer performs as it once did; some may find that they can not participate in activities they used to. There are inevitable losses of family and friends. Then too, is the knowledge that we are much closer to the end of our lives than the beginning.

Defining Depression as Opposed to Sadness: From time to time everyone feels blue or melancholy. These feelings occur in response to specific events in one's life, or a cold, dark, winter day can bring a sense of lethargy. Sadness and grief over one's losses, feeling "low," on a lonely day, are normal responses to real events. These feelings vary in intensity and duration. The feelings of sadness, grief and despair that we feel when we lose something or someone that we love is part of the dance of life. Yet, in between these moments of sadness the pain lessens and the joy of living returns. One can still move forward, retreat back into sadness, and return once more to joy.

When one is depressed, these feelings continue for a prolonged period of time and obliterate all other responses to life. The dance of life becomes the dance of hopelessness. The sadness is like a veil placed over the world. One can no longer really see the beauty of the first flowers of spring or dream of things ahead. The opening buds of a dogwood tree, the sounds of the first young birds of spring, go unnoticed. The obstacles in one's life seem insurmountable and life does not seem worth living.

Defining Depression

The American Psychiatric Association defines depression as having at least five of the symptoms listed below that last for a prolong length of time:

Depressed mood most of the day, nearly everyday
Loss of pleasure in daily activities
Significant weight loss or gain
Change in mobility either by slowing down or exhibiting nervous gestures
Feelings of worthlessness, self reproach, excessive guilt
Diminished ability to concentrate
Suicidal thoughts

There can be many causes of depression:

Physical Illness: Researcher have found a clear link between brain chemistry and depression. There are medical illnesses that can cause such changes and increase the likelihood of Depression. Known causes can be Parkinson's Disease, Thyroid Changes, Strokes, Diabetes, and certain forms of Cancer. Hormonal Changes in the body can also change brain chemistry and produce the onset of depression.

M edications: It is also known that certain medications that are used in treating many of the disorders that increase with age can have a depressing effect. Certain blood pressure medications are known to increase the risk of depression. Interactions of medication can also cause unwanted side effects.

Lack of physical and emotional reserve: The changes that occur and issues that present themselves in later life would be overwhelming for anyone at any age. Increased depression in later life might be the result of decreased physical reserves and outlets that we once had to alleviate stress. Anyone who has suffered from a major depression in life is more likely to suffer with a another episode during his or her lifetime. With the added stress that aging can bring the possibility of a recurrence increases.

Facing Depression:


Don't accept that depression is a normal part of growing older.
Don't accept age as an explanation for what you are feeling.

Ask yourself honestly: Are your satisfied with your life? Are you happy when you get up in the morning? Are there things you are looking forward to? If the answer is no, then consider that depression may be a cause.

Talk to your physician. Ask about possible side effects of your medications. Share how you are feeling and inquire about a referral to a mental health professional who understands the physical and emotional changes that accompany growing older. Prolonged depression can and should be treated. Whether we have a day, a decade or a lifetime ahead of us, we have the opportunity to seize life with all it's pain and pleasure. Without the veil of despair and hopelessness consuming our energy we all can continue to live full lives in our later years.

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For more information about the signs and symptoms of depression and resources in your area you can contact:

National Alliance for the Mentally Ill
Wilson Blvd., Suite 302
Arlington Va 22201
800-950-6264

Recommended additional reading:
Billig, Nathan. To Be Old And Sad: Understanding Depression in the Elderly.
Lexington MA Lexington Books
(Macmillan) 1987

Continued in Part Two

5/29/98

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Emily Carton MA, LISW, is a licensed social worker who works with Elder Options, a private care social service firm in the DC Metropolitan Area. She is also an is an intern in Bibliotherapy at St. Elizabeth's Hospital in Washington D.C.

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