Depression

We all feel a little sad or down from time to time but feeling down is not the same as being depressed. Here we look particularly at how depression can affect older people and draw attention to the events and situations that can make it more likely. Recognising symptoms and seeking help early on and then being offered appropriate treatment and support can increase your chances of improving how you feel and promote a lasting recovery.

What is depression?

If you are depressed, the feelings of sadness and general lack of motivation that we can all experience from time to time are more intense and can persist for weeks or months. The feelings become so bad that they interfere with the way you think and behave and affect your daily life. 

• feeling tired most of the time
• sleeping badly - difficulty getting to sleep or waking up early and being unable to go back to sleep
• loss of appetite or eating more than usual
• weight change over a relatively short time – loss or gain
• experiencing physical aches and pains and unfounded fears of serious illness
• feeling apathetic and unable to enjoy things you normally enjoy
• distancing yourself from people, particularly those close to you 
• being reluctant to engage in usual activities or leave your house
• losing confidence in yourself and feeling life is pointless
• being self-critical and feeling guilty
• being unable to concentrate
• feeling anxious
• having suicidal thoughts.

Symptoms that also suggest a physical illness – such as tiredness, weight loss, problems sleeping and aches and pains - tend to be more typical in older people who are depressed and can disguise an underlying depression.

Could you be at risk?

Depression can just happen. But in many cases it can be ‘triggered’ by significant life events, especially events connected with loss. We tend to think of loss in terms of the distress we feel on losing a partner or close friend. But other types of loss are more common as we grow older too and can affect our self-esteem or how we see our place in the world. They include:

• loss of your job and daily routine when you retire – you may have been looking forward to retirement but when it comes, find it hard to adjust to the loss of a structure to your day, contact with colleagues and the purpose that working gave to your life.
• loss of good health – this could be a chronic condition like arthritis or hearing and sight problems that can get gradually worse; or a sudden change in your health that affects your previous sense of ‘invincibility’ such as having a heart attack. Poor health, particularly having a chronic health condition, is one of the most common factors contributing to depression in later life.
• loss of independence – this may come if you have an illness that means you need to depend more on other people or can no longer drive or if you take on a caring role that affects your own social life.
• loss of a much loved home – if you need to down-size to a more manageable property or move into sheltered housing or a care home.
• loss of your social network – this can happen if you move home, if close friends or family move away or die or if poor health or mobility mean you can no longer take part in activities you’ve enjoyed for many years.
  These situations might make anyone feel sad or a bit down and not everyone who experiences them goes on to develop depression. The important thing is to be aware of how these situations can be triggers for depression.
  

Can risk of depression be reduced?

If you are going through difficult times, you should seek support and help early on. This can prevent the normal reaction to sadness or a change circumstances turning into depression. Do not to brush how you feel under the carpet and hope it will sort itself out. Symptoms are likely to get worse if you do.

If you suspect a relative is in danger of, or could be, suffering from depression, then try and talk to them about it. The risk of developing depression increases when people feel alone and unsupported. Consider the following:

• be watchful and offer emotional and practical support particularly if the person does not live nearby
• look for signs that they are neglecting themselves or perhaps drinking more alcohol than usual
• express your concerns and let them know what you’ve observed
• encourage them to make an appointment with their GP or another professional at the practice they feel comfortable with and offer to go with them.

Men can find it particularly difficult to talk about or admit to how they feel and so are much less likely to seek help from family, friends or their GP. 

Some of the barriers to seeking or receiving help

Depression is a normal part of ageing – this is a widespread belief among some professionals and young and old people alike. But depression is not a normal part of ageing.
There is a range of effective treatments that can be tried and are effective, regardless of your age. Do not let yourself or your relative accept depression as an inevitable part of life.

I should be able to snap out of it myself or feeling like you this is a sign of weakness – commonly held beliefs that prevent many people seeking the much needed support and help they deserve.

I should only bother my family and friends or the doctor with a physical illness – when physical symptoms dominate, a diagnosis of depression is more likely to be overlooked. So it is important to talk about what is happening in your life and how you feel in yourself as well as any physical aches and pains.

A mental health problem is not as deserving of help as a physical health problem – a common thought but remember doctors are trained to diagnose and treat both mental and physical illness.

Depression and mental illness can have stigma attached to it and so you are reluctant to admit to a problem that you feel could reflect badly on you or your family – this is a common reason for not seeking help. Depression is a real illness that deserves treatment and can be successfully treated.

Diagnosis

If your symptoms persist, make an appointment with your GP or if you feel more comfortable, arrange to see one of the practice nurses. Take someone with you for support who you trust or as a second pair of ears to take note of what is discussed and agreed during the consultation.

To help make the most of the consultation and provide a clear view of what is happening to you:

• make a list of all your symptoms, whether they are worse at certain times of the day or on particular occasions, how long you’ve had them and their effect on your day-to-day life and relationship with others
• explain any circumstances that could be contributing to these symptoms and the way you feel
• take a list of all medications you currently take, including any supplements or non-prescription medication
• Be as open and honest as you can; remember anything you say is confidential.

You should be asked how you’ve been feeling, for how long and how it is affecting you on a day-to-day basis.

Any physical symptoms you describe may need further investigation but if no reason for them is found, don’t be put off if the GP seems unhelpful or feels nothing more can be done to help you.

If your symptoms have lasted more than a month, depression is a diagnosis that should be considered. Your age on its own should not be seen as the cause of your problems and should not decide the type of treatment you are offered.

Treatment

There are several treatments available for depression depending on the severity of your symptoms:

• advice from your GP or nurse at the practice on managing or coping with symptoms, with the offer of a review within 2 weeks to see if they are helping and how you are
• joining a physical activity programme that takes account of any health problems you have. Regular exercise is known to improve mood and sense of wellbeing as well as improving physical health
• joining a peer support group - an opportunity for you to meet with others who have the same condition so you can share your experiences and solutions
• psychological therapies (talking therapies) such as counselling or cognitive behaviour therapy
• anti-depressant medication
• assessment and support from a member of the community mental health team or local older persons mental health team.

You may find there is awaiting list for talking therapies in some parts of the country.

In your discussion with your GP ask him to explain:

• which treatments may be appropriate in your case. If your GP favours a particular treatment, ask why?
• how the different treatments work and their benefits and risks
• how soon you can expect to start to feel better
• how long are you likely to need to continue with treatment 
• how often you need to come back for a review
• what you can do to help yourself and whether there are any local groups you may find it helpful to contact

You can then discuss your preferences and agree which treatment(s) you should try.

If you are considering talking therapy, be sure to mention any cultural, language or religious needs you have or any hearing or sight problems, so they can be addressed when arranging therapy for you.

If you have a health problem or hearing or sight difficulties that could be contributing to how you feel, make sure you are getting the best possible treatment for those too.

Support from family and friends

It may be helpful, if you agree, for a family member coming along with you to the GP so they can ask any questions about how best to help and support you. It can be weeks before the treatment makes you feel better and so support from family and friends to keep appointments or take medication can be vital to a successful outcome.  Their reassurance that things will get better with time, along with regular phone calls or visits and offers of practical help can all contribute to your recovery.

Keeping well in the future

It is important to do all you can to stay well. Be sure to continue with any prescribed medication. If you are now taking regular exercise, have learned some relaxation techniques, are getting out more and have developed new friendships and interests, keeping them up is important to your long term health and wellbeing.

Should your symptoms seem to be returning, let friends and family know and make an appointment to see your GP so any problems can be nipped in the bud. 

Help and Support

If you want to learn more about depression and the treatments available you may wish to contact Action on Depression. They offer information and support to people with depression and their families through their website, information materials and infoline.

You can also find information about NHS Inform in the Health A-Z section.

Your local Age UK may offer a range of services to help you meet new people and learn new skills such as computing. They may also run lunch clubs, arrange social outings and classes to help you keep fit and have volunteers who can visit you at home if you find it difficult to get out.

If you are offering support to a family member with depression it can be both rewarding and stressful. Information is out there which can support carers and enable them to discuss any difficulties they are experiencing.  Local carer support groups offer a handy support network.

Carers Direct, Carers UK and the Princess Royal Trust for Carers provide information and advice and details of local support groups for carers.

Further information

Carers Direct
Website: www.nhs.uk/carersdirect Carer Direct helpline: 0808 802 0202
An online and telephone service providing information, advice and support for carers

Carers UK
Website: www.nhs.uk/carersdirect
Careline: 0808 808 7777 (freephone)
Carers UK is a membership led national organisation set up by carers for carers.

Mind
Website: www.nhs.uk/carersdirect  
Mind infoline 0845 766 0163
Mind is the leading mental health charity for England and Wales.

NHS Choices website Health A-Z
Depression information can be found in the Health A-Z section
Website: www.nhs.uk/carersdirect

NICE guidance CG90 explains Treating depression in adults
Website: www.nhs.uk/carersdirect
Orderline: 0845 003 7783
The patient version of this guidance can be found under the heading Understanding NICE guidance.

NICE Guidance CG91 explains Treating depression in adults with a long-term physical health problem.
Website: www.nhs.uk/carersdirect
Orderline: 0845 003 7783
The patient version of this guidance can be found under the heading Understanding NICE guidance.

Princess Royal Trust for Carers
www.nhs.uk/carersdirect  
Telephone: 0844 800 4361(England office)
Princess Royal Trust for Carers provides information, advice and support services for carers across the UK.