How Pharmacists Can Help Depressed Seniors

JUNE 19, 2015
More than 20 years ago, my mom died after many years of surgeries and extended hospital stays. Throughout that time, my dad was her primary caregiver.

Within a few months of Mom's death, Dad moved 350 miles to live near his children. Shortly thereafter, Dad needed and underwent cardiac bypass surgery to allow blood to continue to flow through his heart.
 
In the few years following, Dad carried with him a varying level of depression that he never completely overcame. Within a year, he experienced 3 of the most common scenarios that lead to depression: a serious medical illness, the death of a loved one, and a major move.
 
My dad was an incredibly stoic individual and didn't want to bother anyone. At one point, we visited his physician to discuss depression. Dad was prescribed an antidepressant that he took for 2 or 3 days. I remember him stating that he didn’t like how it made him feel, so he stopped taking it.
 
Depression has many contributing factors that may lead an individual to feel overwhelmed with sadness and loneliness. In my opinion, it is difficult for senior citizens to understand the concept that this sadness and loneliness is not a weakness, but a symptom of decreased levels of neurotransmitters.
 
It is not uncommon for senior citizens to be uprooted from their homes of 20 years and placed in assisted living facilities. This change may happen not long after they have lost a loved one or experienced some sort of major medical illness. At this point, caregivers may think it is normal for the senior citizen to feel sad and lonely. Family members may just assume that if they give them some time, they will come out of it.
 
Neurotransmitters are used to carry messages in the brain. When these message are decreased, an individual may receive mixed and varying signals about behavior, emotion, and other daily functions often taken for granted. These mixed messages may manifest as the overwhelming feeling of sadness and loneliness commonly diagnosed as depression.
 
Antidepressant medication therapy works to elevate these neurotransmitters so that thoughts may be processed more smoothly and completely. Senior citizens will most likely feel uncomfortable during the first 2 weeks of antidepressant therapy. As time passes and neurotransmitter function is improved, however, the uncomfortable feeling should dissipate.
 
As pharmacists move through their daily practice, they need to remember that senior citizens may be experiencing any number of contributing factors which could lead to a decrease in neurotransmitter function. Normally, this is not a situation where a patient will just come out of it and everything will be normal.
 
When prescribed an antidepressant, senior citizens may benefit from a complete explanation and understanding of why they are taking the medication. Above all, this explanation needs to include a description of how they may feel during the first 2 weeks of therapy, and what they can expect over the next 1 to 2 months. 
 
Taking the time to provide a simple understanding of brain chemistry and how a prescribed medication will affect it may go a long way towards helping a senior citizen work through the overwhelming feelings of sadness and loneliness.

Steve Leuck, PharmD
Steve Leuck, PharmD
Steve Leuck, PharmD, has been practicing both hospital and community pharmacy for over 30 years. He founded AudibleRx, in 2011, which provides Consumer Medication Information which is both Useful and Accessible. Content designed to meet health literacy guidelines. Format designed to "read along" with the audio presentation in a simple to use web application. More information at AudibleRx.org.
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