Depression is not a normal part of the aging process, according to a clinical review article published in the May 1994 issue of Southern Medical Journal. With this recognition comes the responsibility to accurately diagnose and treat elderly patients suffering from symptoms of depression, said David A. Casey, MD, an author of the article. According to Casey, elders are subject to many stresses that may contribute to the development of depression. Events, such as loss of occupation, income, companionship, social status, vigor, and physical health, can contribute to the mental problems of an individual. Grief manifesting in sadness is a normal healthy experience; however, there is a difference in the sadness exhibited in the act of grief and a continuing clinical depression, Casey said.
Because depression often is overlooked in the elderly, it follows that depression is a major factor in the excessive suicide rates of elders in contrast to the general population. Studies of suicide among the elderly have shown that patients who are suffering from major depression, psychosis, alcoholism, severe medical illness, or social isolation are at higher risk.
When depression is diagnosed and medication prescribed, the following conditions particular to the elderly must be considered:
* Because the elderly respond slowly to medications, be patient and do not expect quick cures;
* Elders are more sensitive to psychiatric medications because of the aging process;
* Loss of total body water due to aging tends to reduce the volume of distribution of a drug and increases its concentration;
* An increase in percentage of body fat leads to accumulation of many lipophilic psychiatric drugs; and
* The gradual loss of renal function reduces the ability to eliminate drugs, causing a higher blood level per dose.