The Toll of Untreated Depression


It's normal to feel low occasionally, but bouts of prolonged depression can be a serious threat to both your physical and mental health. Unfortunately, many older adults with depression go untreated, which can have devastating consequences.


Depression's effects on the heart


It's well established that depression can be triggered by illnesses such as cardio­vascular disease, diabetes, hypertension and arthritis. But depression alone may increase the risk of developing certain con­ditions, according to a growing body of research. A new study, in the January 2014 issue of Psychosomatic Medicine, reports that early treatment of depression can slash the risk of heart attacks and strokes.


Researchers looked at 235 clinically depressed patients, ages 60 and older. Of those patients, 67 had pre-existing car­diovascular disease. A collaborative care team that included primary care physi­cians and depression specialists treated the participants for depression using anti­depressants and psychotherapy. The researchers then followed the participants for an average of eight years. After that period, patients who had no pre-existing cardiovascular disease had halved their risk of a heart attack or stroke. The risk reduction is comparable to major cardio­vascular disease prevention strategies like quitting smoking and exercising, accord­ing to researchers, making the case for early depression intervention.


The reason depression is a risk factor for heart disease isn't entirely clear, although it may be that stress associated with depression leads to coping strategies such as smoking, excessive drinking or unhealthy eating. Another possible expla­nation is that depression may cause bio­chemical reactions in the body that initiate plaque buildup or clot formation in the arteries.


Depression's link to other illnesses


Heart disease isn't the only consequence of untreated depression. Depression clearly has a harmful effect on other aspects of physical health Past studies have linked depression with:


Dementia


A 2010 study published in Neurology analyzed data on 949 partici­pants with an average age of 79 and found that those who were depressed faced a 70 percent increased risk of dementia and Alzheimer's disease,: compared with those who weren't depressed. The study didn't prove cause and effect, but researchers hypothesized that certain proteins in the brain that increase with depression may also make developing dementia likelier. Other factors, such as: poor diet, exercise and socialization habits, may also play a part in the link.


An increased risk of dying of another disease.


A 2007 Norwegian study found that people with significant depression had a higher risk of dying of most major causes of death, even after adjusting for age, med­ical conditions and physical complaints.


 A heightened risk of fails and bone fractures


Older white women with depressive symptoms are more likely to fall and suffer a bone fracture. According to a 1999 study, depression is associated with a greater frequency of falls, which partly explains the higher fracture risk Further­more, some antidepressants can lead to low bone mass or osteoporosis.


Diabetes.


Because depression can lead to making unhealthy eating choices, smoking and not exercising, the condition can boost diabetes risk. The stress hormone cortisol plays a role in blood glucose metabolism and insulin sensitivity. People who are depressed have high blood levels of the hormone, which is linked to increased abdominal fat deposits —a risk factor for type 2 diabetes.


Suicide.


Depression is a leading risk factor for suicide. White males 65 and older are at highest risk for suicide.


What's behind undertreatrnent?


An estimated 63 million adults ages 65 and older suffer from major depression. Its prevalence doubles after age 80. Yet an analysis of 13,320 U.S. adults, published online in December by General Hospital Psychiatry, found that about 70 percent of people with symptoms of depression don’t receive treatment—especially individuals 80 years and older, men and minorities.


A 2012 survey of more than 1,300 people ages 65 and older, conducted by the John A. Hartford Foundation, found that of the respondents who were at the time being treated for depression, anxiety or other mental health disorders, many weren't being treated according to current evidence-based standards of care. For example, about half of the respondents being treated for depression received no follow-up care weeks after beginning treat­ment. Yet follow-up and treatment adjust­ments are critical, according to the survey, as healthcare providers and patients work together to find the right regimen to com­bat depression The first treatment used fails as much as 70 percent of the time. Moreover, few respondents knew the seri­ous health consequences of depression.


Why is depression so often undiag­nosed or misdiagnosed, especially in older adults? One reason could be that many people mistakenly think of depression as an inevitable part of the aging process—a belief held by almost one in three people surveyed by the Hartford Foundation. Many major life milestones occur later in life—the loss of a loved one, retirement, financial concerns, fears of death or loss of independence social isolation and medical problems—which may help explain the perceived correlation between aging and depression. In addition, many older people with depression suffer from medical ill­nesses to which depressive symptoms are incorrectly attributed.


Fear of stigma may be another reason for undertreatment. People now under­stand that depression is an illness with a biological cause, but in the past, depression was thought to be the result of psychological or moral weakness.


Getting help


If you have symptoms of depression (see below “warning signs”), don't be afraid to talk with your doctor about them. Depression can be treated successfully. In fact, according to the U.S. Department of Health and Human Services, 60 to 80 percent of older adults who receive appropriate treatment achieve a reduction in their depression symptoms.


Psychotherapy (also known as talk therapy or counseling) can help relieve depression and its symptoms and prevent depression from recurring or mild depres­sion from worsening.


Drug therapy is another treatment for depression. Doctors can choose from, a wide range of antidepressant medica­tions, such as selective serotonin reup­take inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), dopamine reuptake inhibitors, tricyclics and tetracyclics. For people experiencing a first-time episode of moderate to severe depression, drug of choice is usually based on avoidance of side effects. For older adults, this may mean avoiding drugs that lower blood pressure and cause drowsiness and con­fusion. Antidepressants can be effective against mild, moderate and severe forms of depression and, when used properly, are considered safe.


A combination of psychotherapy and drugs is often the best course of treatment for depression, especially if it's severe.


Warning signs of clinical depression


According to the Diagnostic and Statistical Manual of Mental Disorders, a reference guide used by mental health profes­sionals, a person is suffering from major depression If  he or she experiences either one or both of the first two symptoms from the list below, along with any four others, for more than two weeks:


1. Depressed mood most of the time


2. Apathy—loss of interest and pleasure in activities formerly enjoyed


3. Sleep problems—insomnia, early-morning waking or oversleeping nearly everyday


4. Decreased energy or fatigue


5. Noticeable changes in appetite and weight (significant weight loss or gain)


6. Inability to concentrate or think, or indecisiveness


7. Physical symptoms of restlessness or being physically slowed down


S. Feelings of guilt, worthlessness and helplessness


9. Recurrent thoughts of death or suicide, or suicide attempt


Minor depression is characterized as hav­ing two to four depressive symptoms, Including at least one of the first two symptoms, lasting at least two weeks but no longer than two years. Minor depres­sion is more difficult to detect and can lead to major depression within two years if not treated.