Depression is hell. I know. I’ve been there. Depression may hide behind decreased activity, sleeplessness, loss of appetite, weight loss, constipation, decreased enjoyment, and lack of interest. Some people call it “normal aging”. Depression may come on suddenly or so slowly it is not recognized. It runs in some families and may be a biochemical disease of the brain. It tends to be recurrent. Depression can ruin a person’s life.

Untreated depression may land you in a nursing home unnecessarily or may make you unloved and lonely. One-third of widows and widowers say they are depressed and half of these are still in the same state a year later.

You can die unnecessarily from a depression. Suicide rates in the general population are 12.4 per 100,000 people and in the 80 to 84 year olds, the rate is 26.5. Don’t wait and see. It won’t be brief, an untreated, depression will last at least six months.

Family physicians see depression in five percent of their office practice and twenty percent of their nursing home patients. The first year in the nursing home is a time of high incidence of depression. Many older people may not report depression because they think it is “normal” or they have no hope for any form of treatment. Only about ten percent of the elderly who need treatment for mental disorders get it.

The chances in a lifetime of having a depression are about fifteen percent and only a quarter get properly treated. Society has stigmatized mental illness for so long that people with depression, and sometimes their families, feel ashamed.

Depression often requires treatment. You don’t will yourself, “mind over matter”, out of a depression. Control studies show that modern anti-depressive medicines work. A depressed person has an all pervasive feeling of sadness. There are feelings of worthlessness, inadequacy, and incompetence which hound the patient daily. They can’t think normally and they don’t calculate correctly. Depressed persons isolate themselves by withdrawing from friends and families. There is no laboratory test to make this diagnosis. There are, however, score sheets which reliably differentiate reactions to sad news and grief from depression. Simple grief should only last about three months. After that, consultation is recommended.

Treatment given by capsules, such as Desipramine or Nortriptyline, works extremely well. There are other drugs, but these are most satisfactory in the elderly. Sixty or seventy percent of people will improve on one of these medicines, but it takes up to six weeks to show full improvement. The physician must explain the mild side effects of the dry mouth, constipation, slight giddiness, and other happenings so that the patient remains compliant and continues to take the medicine until the good effects begin. Most of these can be avoided by taking the medicine at bedtime. A course over six months of medication will cost about $100, which is miniscule compared to the damage caused by an untreated depression.

In a small number of patients where these medicines are not effective, electroconvulsive therapy is worthwhile. It is nowhere near as repulsive as the movies would have us believe, and a course of this treatment may cut short an otherwise intractable, life-threatening depression. The length of time to give capsules to a depressed elderly patient is somewhat indefinite, but it will be at least for six months, and it may be for more than a year if there is a history of recurrent depression.

The biggest problem is to reach people in need of help. In Sweden, mail carriers are instructed to cautiously inquire about the health of people who have not picked up their mail. There has been some trial training of mail carriers and other public employees in Iowa to detect mental illness in the elderly. This type of outreach is very necessary.

If you have this problem, please let your doctor know. No one will think the less of you, but they will certainly congratulate you on your improvement with treatment.