mental health disorders
Depression
Introduction
Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to interfere with functioning. It may follow a recent loss or other sad event but is out of proportion to that event and lasts beyond an appropriate length of time. Heredity, side effects of medications, emotionally distressing events, changes in levels of hormones or other substances in the body, and other factors can contribute to depression. Depression can make people sad and sluggish and/or lose all interest and pleasure in activities they used to enjoy. Doctors base the diagnosis on symptoms. Antidepressants, psychotherapy, and sometimes electroconvulsive therapy can help. (See also Overview of Mood Disorders .) People often use the term depression to describe the sad or discouraged mood that results from emotionally distressing events, such as a natural disaster, a serious illness, or death of a loved one. People may also say they feel depressed at certain times, such as during the holidays (holiday blues) or on the anniversary of a loved one's death. However, such feelings do not usually represent a disorder. Usually, these feelings are temporary, lasting days rather than weeks or months, and occur in waves that tend to be tied to thoughts or reminders of the distressing event. Also, these feelings do not substantially interfere with functioning for any length of time. Depression is the second most common mental health disorder ( Overview of Anxiety Disorders is the most common). About 30% of people who visit a primary care practitioner have symptoms of depression, but fewer than 10% of these people have major depression. Depression typically develops during a person's mid teens, 20s, or 30s, although depression can begin at almost any age, including during childhood. An episode of depression, if untreated, typically lasts about 6 months but sometimes lasts for 2 years or more. Episodes tend to recur several times over a lifetime. Depression affects about 1 of every 6 older adults. Some older adults have had depression earlier in their life. Others develop it for the first time during old age. Causes of Depression in Older Adults Some causes of depression may be more common among older adults. For example, older adults may be more likely to experience emotionally distressing events that involve a loss, such as the death of a loved one or a loss of familiar surroundings, as when moving away from a familiar neighborhood. Other sources of stress, such as reduced income, a worsening chronic illness, a gradual loss of independence, or social isolation, may also contribute. Disorders that can lead to depression are common among older adults. Such disorders include Symptoms of Cancer , Depression Versus Dementia In older adults, depression can cause symptoms that resemble those of dementia: slower thinking, decreased concentration, confusion, and difficulty remembering, rather than the sadness people tend to associate with depression. However, doctors can distinguish depression from dementia because when depression is treated, people with depression regain their mental function. People with dementia do not. Also, people with depression may complain bitterly about their memory loss and rarely forget important current events or personal matters. In contrast, people with dementia often deny memory loss. Diagnosis of Depression in Older Adults Depression is often difficult to diagnose in older adults for several reasons: The symptoms may be less noticeable because older adults may not work or may have less social interaction. Some people believe that depression is a weakness and are reluctant to tell anyone that they are experiencing sadness or other symptoms. The absence of emotion may be interpreted as indifference rather than depression. Family members and friends may regard the symptoms of a person with depression simply as something that is expected as people get older. The symptoms may be attributed to another disorder, such as dementia. Because depression may be difficult to identify, many doctors routinely ask older adults questions about their mood. Family members should be alert for subtle changes in personality, especially lack of enthusiasm and spontaneity, loss of sense of humor, and new forgetfulness. Treatment of Depression in Older Adults Selective serotonin reuptake inhibitors (SSRIs) are the antidepressants used most often for older adults who are depressed because SSRIs are less likely to have side effects.Citalopramandescitalopramare particularly useful. 