Depression is one of the most common mental health problems in primary care. All ages can be affected. Occasionally feeling down or "blue" is normal. Yet, a long-lasting depression feeling or a loss of interest in things that you are usually fond of could be the early signals of depression.
Depression is a multifactorial disorder that is involved personal, genetic, biological, societal, and environmental factors. Older adults with underlying health issues, such as Alzheimer’s disease, have a higher incidence rate of depression. Residents in long-term care facilities are more likely to experience depression than in institutional settings.
There is a relatively similar prevalence of geriatric depression between developed countries (5.5%) and developing countries (5.9%). But the projecting data tend to increase in the developing countries and decrease in the developed countries.
In the US, there are as many as 10% of elderly diagnosed clinically significant depression in a primary care setting. But only one in five depressed older adults receives proper treatment. Though the high under-diagnosis rate of primary care, depression visits are still increasing over the years.
Symptoms and signs of depression from DSM5 diagnostic criteria include depressed mood most of the day, loss of interest in all or most of the activities nearly every day, significant weight loss, slowing down of thought and a reduction of physical movement, fatigue, feeling of worthlessness or excessive or inappropriate guilt, diminished ability to think or concentrate, or indecisiveness, and recurrent thoughts of death.
One must differentiate depression from sadness. Sadness from the loss of a loved one could lead to depression, especially for older adults. The essential difference is sadness required triggers, while depression is not. Depressed people may cry without reason. Depressed people tend to have thoughts of self-harm and suicidal inclinations, while sadness is just an expression of emotion that could be recovered after several days. Thereby, major depressive disorder is associated with high mortality at all ages.
Comorbidity of depression, such as insomnia, substance abuse and obsessive-compulsive disorder, are harmful. Family and peer support positively impact recovery and prevention of relapse. Family members and friends need to recognize the early signs of depression and encourage treatments, especially at the early stage of the disease.
Depression can be well managed with medications, cognitive therapy and psychotherapy. We'll focus on treatment options for depression in our next article.
1. Mijung Park, Jürgen Unützer, Geriatric Depression in Primary Care. Psychiatr Clin North Am. 2011 Jun; 34(2): 469–x. doi: 10.1016/j.psc.2011.02.009
2. Kessler RC, Birnbaum H, Bromet E, Hwang I, Sampson N, Shahly V. Age differences in major depression: results from the National Comorbidity Survey Replication (NCS-R) Psychological Medicine. 2010;40(02):225–237.
3. Harman JS, Veazie PJ, Lyness JM. Primary Care Physician Office Visits for Depression by Older Americans. Journal of General Internal Medicine. 2006;21(9):926–930.
4. Lyness JM, Kim J, Tang W, et al. The Clinical Significance of Subsyndromal Depression in Older Primary Care Patients. American Journal of Geriatric Psych. 2007;15(3):214-223. 210.1097/1001.JGP.0000235763.0000250230.0000235783.