Jan 12, 2018 in Medicine

Depression in the Elderly

The numerous studies showed that only 10% of the elderly receive depression treatment. The depression affects people aged 65+. Most of them consider the depression as a stigma. Moreover, they are not ready to admit the depression to themselves, usually considering the symptoms of the depression as normal reactions to looses, stresses, and other emotion-involved processes. Nevertheless, often, it is hard to talk about the depression in the elderly as it can be confused with the symptoms of other illnesses.

The factors of depression have different nature. They can be both psychological, environmental, and biological as well as genetic. E.R. Kandel describes the effect of depression in the book In Search of Memory. The author mainly concentrates on the nerve cells, short and long-term memory and how all this is affected by the depression. In addition, Kandel describes the signaling function of the nerve cells. The neurologist observes the function of the cells using magnetic resonance imaging (MRI). MRI helps to identify the depression. In the brain, there are parts for regulating the mood. In depression, they are functioning abnormally. Scientists are studying genes to understand why some types of depression have tendency to trace through families. Scientists are looking to the ways out from this situation. However, trauma, loss of a loved one or a difficult relationship may cause the depression no matter is there a gene or not.

The brain can loose volume because of existing cells shrinking or its decrease. Moreover, to maintain connections, brain cells need to stay active. The connection between cells is called synapses, which can disappear. Researchers provided by YaleUniversity have shown that that depression causes physical changes in the cells. The nerve cells in the brain are connected. When the cells are shrinking, their disconnection causes depression (Richards). Professor Robert Sapolsky considers that long-term exposure to hormones also influence the brain. According to the results of the studies, provided by him and others, glucocorticoids can make brain cells to shrivel. Therefore, the connections between the neurons wither away. Under such circumstances, prolonged exposure causes the destruction of the neurons. During the stress, the bloodstream remains on the high level. This can cause stroke or brain injury. Moreover, if glucocorticoids are damaging the brain, this causes difficulties in treatment of autoimmune or inflammatory disorders. Though, people prefer keep their condition under total control.

In MRI, the activity of the neurons is observed in the region of hippocampus. The Washington University scientists on the head with Yvette Sheline came to the result that people with long-term depression have smaller hippocampus averaging as mach as 15 percent. This phenomenon is known as hippocampal atrophy. The frontal lobe also can shrink. However, the connections of the neurons renew as the level of hormones returns to normal.

As it was mentioned before, stress can also provoke depression. Different types of stress cause unlike reaction of the brain. Therefore, the feeling of a rush of adrenalin is the marker of a sudden stress. Usually it is brief. Another kind of the stress is slow and unresolving. This type of the stress is caused by a long-term situation, mostly personal issues. In the process of creating, the stress is involved epinephrine (in other words adrenalin), which is produced by kidneys. Another hormone is cortisol. If adrenalin is a signal of a sudden stress, cortisol accompanies a prolonged stress.

Mostly cortisol is involves in creation of the depression. Corticotrophin releasing factor (CRF) is a compound, that control the amount of the cortisol. Adrenal glands are controlled by two other hormones and release cortisol. All these hormones are stress hormone and  are centered in the brain, not in the adrenal gland (kidneys). Hypothalamus signals to the pituitary what to do via CRF. After this, pituitary responds via adrenocorticotropic hormone (ACTH) to the adrenal gland. If everything is working right, the brain regulates the level of the cortisol using the whole body as a system. Though, if the signal is not effective, the system will not work correctly. In this way cortisol and CRF are leading to the cellular atrophy. These are the objects to claim that depression has a chemical ground. Interesting fact is that prozac increases the serotonin level. In this way, the brain starts to feed themselves again making protein. This helps to create new connections to the neighbor cells. Between is a gap or synapse. Serotonin is working as a neurotransmitter helping the cells to connect with each other. The principal is similar to the work of the key and the lock. Each key is unique. Usually cells are affected by the neurotransmitter so the activity of the cell is increasing. To add, there are about 100 of the neurotransmitter.

According to the researches provided by NIMH, depression was named as a major public health problem among the people aged 65+. Despite the numbers provided by the NIMH, depression is not the part of aging Often, depression is accompanied by post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, panic disorder, social phobia, and generalized anxiety disorder. In the older people, it usually occurs and accompanies other medical long lasting illnesses. Elderly with depression can experience symptoms of both depression and the illness. Such co-existing depression causes difficulties to medical control. Moreover, the depression rate increases when person is aware of the fact that he/she can die from the illnesses, is this case, cancer, diabetes or Parkinson disease. It also increases chances of cardiac diseases, e.g. heart attack. Another fact is that depression can be the cause of the suicide among people aged from 80 and more.

Depression is more common among women, than among men. Mostly, it is because of the life cycle, psychological and hormonal factors. If men are likely to be tired, irritable, and have insomnia, women tend to have feelings like sadness or worthlessness. Elderly can attend psychotherapy or counseling and take medicine or electroconvulsive therapy.

Most doctors prescribe antidepressants. They are believed to be effective in the treatment of depression. Nevertheless, there is a risk of side effects. One of them can be a drop in blood pressure. For example, tricyclics is antidepressant for elderly. Sometimes, it causes dizziness, the feeling of the “dry mouth”, weight gain, and drowsiness. Therefore, before the antidepressants start to work days or even weeks can pass. Psychotherapy is very useful for depression treatment. There are two types of it: cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT). The first type of psychotherapy helps the patients to reconstruct negative thoughts pattern, while the second helps to understand and work out the relationships that may be the ground for depression now or in the future. The doctors recommend combining medicines with psychotherapy. However, elderly mostly try to find support and understanding in the family or among friends. They need to feel that their presence is important. Often, elderly are visiting thematic clubs, dances or play poker.

Apart from traditional ways of the treatment of the depression, there is electroconvulsive therapy (ECT), in other words “shock therapy”.  In recent years, it was improved and despite the bad reputation, people are choosing this type of treatment. This type of therapy is prescribed for those patients who are not feeling improvement in their treatment. People feel relief after the procedure. Before the start, the patient receives anesthesia shot. Muscles are relaxed. This helps to provide electric impulses, which the patient feels unconsciously while sleeping. Though, it decreases the number of receptors on the postsynaptic cell. The patient has ECT few times per week. Despite this, patients did not show the adverse cognitive effects.

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