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"The older we get,
the more reasons there seem to be for feeling sad. Most of us
have retired, losing the day-to-day routine of work that has filled
our days for years. Our children are grown, and some of them have
moved far away. Many of us have lost our parents, and now, we
are beginning to face the reality that we are going to lose siblings,
friends and even spouses as the years go by."
Have you ever felt that
way? No one can deny that loss creates sadness. It is totally
appropriate to react with deep sadness to the major losses in
one's life. But where is the line drawn between the sadness of
loss or grief and depression that needs the attention of a doctor?
There are people who think
that depression is something that happens to you as you age, just
as your skin begins to wrinkle or you tire more easily. This is
not true. Some may think that depression is the response to physical
illness. But there is a difference between feeling sad or upset
and being clinically depressed. It is important to understand
this difference. Even family physicians are not always aware that
a patient may be exhibiting symptoms of depression. The older
person himself may not admit feeling depressed.
A depressed person experiences
overpowering sadness that lasts for more than a few weeks. He
feels hopeless and is overwhelmed by great anxiety and irritability.
He may lose interest in the activities that he normally enjoys,
have trouble sleeping or sleep too much, have no appetite or eat
all the time. He may feel all sorts of aches and pains. He feels
generally sluggish and has trouble concentrating. He may also
talk about wanting to die or having nothing to live for.
Because older people are
expected to slow down, the sluggishness of depression is often
not noticed. Since they are more likely than younger people to
have other physical problems or illnesses their doctors may focus
on these and not notice the depression. But treating depression
is as important as treating other illnesses. A depressed person
can feel better. There are medications and other types of treatments
that work. If you think you are depressed, please talk to your
doctor. It is important to get a full physical examination and
explain exactly how you have been feeling. Your doctor will want
to know about all of your symptoms so that he can better determine
how to help you. He may also send you for tests or refer you to
other doctors to decide on the best treatment.
Sarah is an 82-year-old
woman who lives alone in her own apartment. She remained active
and involved with community activities since her retirement at
65 from her career as a schoolteacher. However, since the death
of her husband Philip two years ago, she has been having dizzy
spells and aches in her legs. She doesn't eat much and is losing
weight. When her daughter Maggie visits, she complains that she
cannot sleep at night. Every little noise frightens her. She has
discontinued her community activities, hardly sees her friends
or neighbors and spends much of her time staring out the window.
When Maggie or her brother Bob come to visit, they often find
her sitting at the dining room table and crying. Maggie is beginning
to wonder if her mother should still be living alone. Should she
invite Sarah to live with her or maybe consider finding a nursing
home for her?
Theodore is a seventy-four
year old man. He is married to Maxine, who is ten years younger
than him and truly the love of his life. In addition, his life
had been devoted to music. He retired at sixty-nine from an illustrious
career as a violinist with the Philadelphia Symphony Orchestra.
He would still be performing if he hadn't developed arthritis
in his hands. He can no longer play. The first few years after
he retired, he pushed himself to walk and swim to stay in shape,
but he didn't keep it up. His wife, Maxine, pampered him with
fancy lunches and brought him books to read and CDs to listen
to, but she was often busy with her own life. She taught art part
time, went to yoga, her book club, had coffee with her friends.
He was bored, felt more and more alone, and as time passed he
became depressed. Instead of relaxing when he listened to classical
music, he felt anxious and angry. He even snapped at Maxine for
being too young and active. When she suggested he talk to their
doctor about his moods, he blew up. Talk to the doctor? It was
enough to have to talk about his arthritis with him. Anyway, their
doctor was young and handsome. What would he know of getting old?
Both Sarah and Theodore
have experienced loss. Sarah is grieving for Philip, but she is
also grieving for her own life with Philip, her marriage and life
the way she knew it for almost sixty years. Theodore has a loving
wife and is younger than Sarah. He became depressed after a different
type of loss, the loss of his ability to play the violin. Theodore
is grieving the loss of his art, his creativity. Life has become
a meaningless abyss.
Maggie discussed her mother's
situation with her own doctor who encouraged Maggie to bring Sarah
to a specialist in geriatric medicine to be evaluated. In Theodore's
case, his wife Maxine finally convinced him to see their family
doctor.
A geriatric specialist
or a family physician should be the one able to determine what
is the best way to treat the depressed person. If for any reason,
you feel that your doctor is not helping you, there is no reason
why you cannot go to another one. It's important to feel comfortable
with your doctor and to trust him as being the right doctor for
you.
There are different ways
to help people like Sarah and Theodore. Sarah's geriatric specialist
put her on a low dose of antidepressant medication and counseled
her children to take her out to dinner, to visit family members.
He encouraged Sarah to join a golden age club at the community
center or participate in church activities, where she would spend
time with people. He requested that she make an appointment to
see him in two weeks, when he would determine whether she also
needed to see a psychiatrist.
Maxine finally convinced
Theodore to see their family doctor. Their doctor felt that Theodore
might be helped without medication and he worked with him to plan
an exercise program, which included daily walks and swimming in
the community pool in the mornings. The exercise would be good
for his arthritis as well as his mood. He also gave Theodore the
phone number of a social worker in the area that specializes in
helping older people and made him promise to make an appointment.
His doctor felt that discussing his feelings and frustrations
on a regular basis would be helpful to Theodore. He also requested
that Theodore return in two weeks.
The depressed person not
only perceives the world "through a glass darkly." He
experiences physical as well as emotional symptoms. But there
are ways to fight depression. It shouldn't be assumed that depression
is the fate of the aged. Both old and young deserve the best possible
quality of life.
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