MGordon_MD
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Jun 22, 2007, 12:44 PM
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By Dr. Michael Gordon
We met walking out from the university hospital.
“Hi, I haven’t seen you in years. I’m CC, and you looked after my grandmother many years ago.”
I immediately recognized him; we were residents at about the same time almost 30 years previously and had continued to share some professional interactions. He had gone into surgery and worked at one of the university hospitals. We had not seen each other for at least five years.
“I learned a lot from my grandmother, and your diagnosis and treatment of her depression, to which she responded. She not only went back to her bridge games but lived another 10 years. Most interesting, my sister developed some depressive symptoms years later which we recognized because of grandma. She too got better with treatment.”
As we walked along I recalled; “She was one of my first patients who I recognized with late onset depression whose loss of interest in her life-long love of bridge was a diagnostic clue which I have often used as part of my teaching anecdotes. I remember just how dramatic her response to anti-depressants was and how wonderful I felt when she returned and told me, ‘I played bridge again last week, and won!’- which was an indication to me that the treatment was successful.”
Since that patient, almost thirty years ago, I have to dealt with many older people with depression. Over time, from a condition which was not readily understood by many physicians, late age depression is now known to be very common, often misdiagnosed or ignored, and therefore inadequately treated. The consequence may be a person who is not able to fulfill their potential in life, and in some more tragic cases, results disastrously in death, either from lack of eating or self care, or sometimes, in desperate situations, self-inflicted death.
Severely depressed older people who are intent on ending their lives are tragically often very successful in their attempts.
The good news is that with increased awareness of the condition and a wide array of treatments many older depressed individuals can be successfully treated and return to a level of function that meets their expectations and that of their loving families.
Late life depression can occur in many scenarios, with potentially different implications of the illness and the potential for response to treatment, either through drugs, psychosocial therapy, or as often happens, a combination of the two.
At one end of the spectrum are those who for the first time experience and demonstrate evidence of depression. The symptoms often include a sense of dread, rumination (going over again in their mind or in talk, terrible events or experiences from the past) or a sense of loss, hopelessness, and worthlessness.
Sometimes there are physical symptoms with almost every ailment being mimicked and quite often a loss of interest in enjoyable activities including food, entertainment, and family interactions. One test that I use I call the grandchild “kvel” test. When a grandparent has lost all interest in the wellbeing of their grandchildren, it is often a symptom of profound depression.
Sometimes depression has existed before and responded to treatment. When that occurs, it bodes well for treatment of another occurrence in later life. Depressive symptoms may be a premonitory sign of early or future cognitive impairment which may develop into dementia. This can only be recognized as the illness progresses and the response to treatments unfold. It is usually necessary to address the dementia as well, through various treatments including the newer medications that may provide some benefit.
Depression should not be discounted by family members and physicians. With proper recognition and treatment, beneficial outcomes can often occur, to the satisfaction of all.
Dr. Michael Gordon, is vice-president of medical services at Baycrest in Toronto, Canada, and co-author with Bart Mindszenthy of Parenting Your Parents.
Parenting Your Parents is available in bookstores and online at: Indigo-Chapters, Amazon and Barnes & Noble.
For bulk orders email info@dundurn.com. Call: 416-214-5544 or Fax: 416-214-5556
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(This post was edited by MGordon_MD on Sep 24, 2007, 1:37 PM)
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