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What is Depression?

Published Online: Saturday, September 1, 2001   [ Request Print ]

What Is Depression?
Depression is typically characterized by one or more depressive episodes. An episode is at least 2 weeks of depressed or low mood, or loss of interest in activities that were previously pleasurable (such as gardening, going to the movies, etc), accompanied by at least four additional symptoms such as decreased energy or appetite, problems sleeping, difficulty in concentrating, or problems with memory. Depression can interfere with a person?s ability to function independently. For example, a depressed person may not be able to take care of common household chores such as grocery shopping, preparing meals, or taking their medications. One of the most important things to remember is that depression is NOT a part of normal aging, and that it can be effectively treated in more than 80% of cases.

How Common Is Depression and Who Is More Likely to Become Depressed?
Overall, about 13% to 20% of people age 65 years or older are affected by depression. Among those living in nursing homes, about 25% to 50% are affected. On a national level, depression affects more than 6 million of the more than 40 million Americans age 65 years or older.

Women, unmarried or widowed people, people who have suffered stressful life events, and those without supportive social networks are also more likely to become depressed. Additionally, older people who have certain chronic diseases, such as heart disease, stroke, Alzheimer?s disease, Parkinson?s disease, arthritis, cancer, and lung disease, are more likely to develop depression.

What Causes Depression?
Although we do not know exactly what causes depression, it appears that an imbalance of certain chemicals in our brains is responsible for the symptoms and signs of depression.

What Are the Symptoms and Signs of Depression?
Symptoms of depression in older people can be quite varied and include any of the following:

  • depressed mood (feeling sad or unhappy)
  • lack of appetite and loss of weight n sleeplessness (early morning awakening)
  • decreased or no energy or feeling slowed down
  • problems with concentration or memory
  • feeling nervous or pacing/being fidgety
  • numerous vague bodily complaints such as aches or pains. 
  • Additional symptoms include excessive worrying, preoccupation with guilt, feelings of worthlessness or hopelessness, thoughts of suicide, and frequent tearfulness.

Why Is Treating Depression So Important?
Treating depression is important because if left untreated it can greatly affect a person?s overall health, worsen other existing diseases (such as heart disease, lung disease, arthritis, or any other illness), and lead to high rates of health care use, which can be costly to the affected individual as well as to the health care system. Treating depression is especially important in the elderly because older depressed people have higher rates of completed suicide than the general population. For example, in the general population the suicide rate is 12.4 per 100,000 people compared with 26.5 per 100,000 in people 80 to 84 years of age, with the highest rates being noted in older males.

Diagnosis and Treatment
If you have any of the symptoms noted above, or worry that you may be depressed, you should see your physician because depression can be effectively treated with antidepressant medications. Although there are several agents available for the treatment of depression, older patients may respond better to and have better compliance with the following agents over other antidepressants: mirtazapine (Remeron Tablets and RemeronSolTab), venlafaxine (Effexor), nefa-zodone (Serzone), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa). These drugs are not likely to cause significant confusion, drowsiness, tiredness, and constipation, which tend to be a problem with the older antidepressants. The above agents also tend to be easier to use. For example, patients often only have their drug dose increased once or twice before reaching an effective dose.

The new formulation of mirtazapine (RemeronSolTab), an orally disintegrating tablet, is unique because it does not have to be swallowed whole with fluid like other tablets. It may be placed on the tongue, where it will dissolve in 30 seconds, and can be swallowed with or without water. In addition to RemeronSolTab?s efficacy in treating depression, it can also relieve the associated symptoms, such as anxiety and sleep disturbances, as early as week one.


Practical Tips for Patients Being Treated for Depression
It is very important to realize that the full benefits of antidepressant drugs in older patients may take up to 6 to 12 weeks to manifest. The various symptoms of depression resolve at different times for different people.

If this is the first episode of depression, treatment needs to continue for at least 6 months from the time that you feel well. For those with more than one episode, it is generally recommended that treatment be continued indefinitely.

You must take your medicine as prescribed by your physician. Taking too little medication will not effectively treat the depression, while taking too much medication can be dangerous, and will NOT make the symptoms go away faster.
Before you begin taking any drug, ask your physician and/or pharmacist about the possible side effects. 

Antidepressant medication is not addictive or habit forming.
If you are experiencing side effects that are intolerable or are persistent, or if you are having thoughts of hurting yourself or others, you should seek your physician?s help at once.

If you have any questions about your medication, including when to take it, what you can take your medicine with, what over-the-counter drugs and herbs you should not take, and anything at all relating to your medicines, talk to your pharmacist.





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