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SENIORS AT RISK FOR DEPRESSION
By: Peter Philander, M.D., UMC CCSN Quick Care

Seasonal affective disorder (SAD) is the term used for the onset of depression during the winter months. Depression is very common: one out of every six Americans will suffer from this illness during their lifetime.

It is not known exactly what causes depression and why some people get depressed and others do not. The start can sometimes be traced to a stressful event, but it may also happen for no apparent reason. Brain chemicals seem to play a role. Recently, research has helped us isolate brain transmitters such as serotonin and dopamine and the thinking is that inadequate amounts of these chemicals trigger depression. Genetics and inheritance also play a role. Individuals with family members who have had depression are more likely to develop the disease.

The good news is that depression can generally be treated very effectively with medications that have few side effects and are well tolerated. The essential first step is to realize that there is a problem and to help the person get to a doctor. Once medication is started, it must be continued long enough to ensure recovery.

Depression is not always obvious, even to the trained observer. All people experience moods that fluctuate from elation to sadness, from feeling relaxed to being worried. These moods are part of the human condition. Depression is worse than feeling blue. Depression causes persistent sadness that lasts day after day. A person loses interest in the activities of life and withdraws. Hobbies such as reading, listening to music, visiting with friends or going for a drive, lose their appeal and no longer provide any pleasure.

When a depressed person can be persuaded to talk about feelings, one hears of sadness, tiredness and lack of energy. Sleep patterns may change and the individual will describe nights spent staring at the ceiling, unable to fall asleep or otherwise going to sleep easily enough but waking up after only a few hours. The person feels worthless and guilty about the most unlikely and minor actions. The illness interferes with work, and the person goes to work late, leaves early, or on some days does not go to work at all. They cannot concentrate on work or play. Grooming standards fall and clothes may be stained, creased and unmatched. Some people become agitated and anxious when they are depressed. They go from task to task without getting anything done.

Who should we worry about? People who have had recent losses such as new widows, recent divorcees, people with serious financial problems or addictions to gambling, alcohol or drugs. In addition, post-traumatic stress disorder is now widely recognized among Vietnam veterans, but many men who fought in the Second World War or Korea carry around distressing memories as well. When they came home from the war, however, our society expected them to cope and to adapt as well as they could. Many years later, the emotions and feelings that they had buried, come back to haunt them. Talking helps and medical treatment may also be necessary.

The treatment of depression has greatly improved over the last few years. Prozac, Zoloft, Paxil, Celexa, Wellbutrin and similar medications are well tolerated and have few side effects. As a rule, these medicines do not work overnight but after about two weeks there is a great improvement in mood and performance. Patients often express concern about becoming dependent on medication. It is important to understand the way in which these medicines work because then it is clear that this worry is unnecessary. When treated, patients increase their brain level of serotonin and dopamine, and this leads to improvement. Once the brain is capable of creating adequate levels of the transmitters, the medication can be stopped.

The occasional patient will attempt to self medicate with St. John's Wort or similar substances. There are some reports that these products are effective but unlike the medicines listed above, St. John's Wort has not been studied over a long period in a large group of patients. For this reason, we really do not know if it works or if it is safe. With an illness such as depression, one should not take a chance on an untested medication.

It is clear that it is difficult to confront depression. One reason is that the person with the illness often does not have the energy, drive or ability to seek help. It is up to family, friends and co-workers to assist these people in obtaining care.

Peter Philander, M.D., UMC CCSN Quick Care
Dr. Peter Philander is a family practice physician at the UMC CCSN Quick Care, 3150 N. Tenaya Way, Suite 370, Las Vegas 89128. Phone: (702) 360-2088
http://www.umc-cares.org/temp/quickcares/quick_ccsn.asp