Depression and Aging

“Alone we can do so little, together we can do so much.”

~ Helen Keller

Welcome and Thank You

Lynn Northrop, PhD

National Depression Screening Day

¨  1991 – 20 years next year! ¨  Initiated by Douglas Jacobs, MD, a Harvard

psychiatrist ¨  Now run by SMH, Inc., a non-profit based outside of

Boston which Jacobs heads ¨  Raises awareness about depression and depression

treatment ¨  Screenings occur in every state in the US ¨  Screens more than a half million people per year

Lynn Northrop, PhD

What is Depression? Major Depressive Episode* = symptoms for 2 weeks or more

Depressed or irritable mood AND at least 4 below:

¨  Loss of interest or pleasure ¨  Change in weight or appetite ¨  Change in sleep ¨  Change in psychomotor activity ¨  Fatigue or low energy ¨  Worthlessness or guilt ¨  Cognitive dysfunction ¨  Recurrent thoughts of death -  self or others (suicidal ideation) ¨  Interferes with functioning

Older adults

More likely to report physical symptoms

Less likely to report mood symptoms

More likely to report problems with memory

Apathy and withdrawal more common

Diminished self-worth is more prominent

Lynn Northrop, PhD

• Major Depressive Disorder • Dysthymia • Minor Depression • Bipolar Disorders (I&II) • Hypomania

Mood Disorders

Lynn Northrop, PhD

How common is major depression?

¨  21million people in US with Major Depressive Disorder

¨  Lifetime prevalence: 1 to 2 out of 10 people ¨  Older and younger adults have same risk ¨  More common in medically ill of any age ¨  Very common among caregivers (more than half)

Lynn Northrop, PhD

Estimated number of depressed older adults

Area Number of people age 65+

11% clinical depression

California 3,866,140 42,5275

SD County 325,615 35,818

La Mesa 11,605

1,277

City of San Diego 128,008 14,080

Lynn Northrop, PhD

How does depression impact health?

¨  Depression is predictive of hip fracture (Mussolino, 2005), a second heart attack (Carney and Freedland, 2007), stroke

¨  Treating depression reduces arthritic pain (Lin, 2003)

¨  OA treated for their depression are 45% less likely to die in next 5 years (Univ. of Penn, 2007)

¨  Correlation with adherence and health behavior ¨  30,000 deaths by suicide in the US

  more than alzheimers, homicide, liver disease, arteriosclerosis, or HTN   Suicide 50% higher in older adults

Lynn Northrop, PhD

Additional Impact of depression

¨  Reduced Quality of Life ¨  Lost Productivity - $44 billion cost to employers

 Leading cause of disability in US (NIMH)

¨  Lost, damaged relationships ¨  Less likely to take meds as prescribed, follow

medical advice, etc. ¨  When all else is equal, depressed elders more

likely to be placed in nursing home.

Lynn Northrop, PhD

Who gets depressed?

¨  Anyone ¨  You, me, everyday people and famous people ¨  Rich, poor ¨  Male, female ¨  Young, old ¨  People of all races, religions, ethnicities,

occupations, IQ’s ¨  People across history

Lynn Northrop, PhD

Edwin "Buzz" Aldrin, astronaut Alexander the Great, king Hans Christian Anderson, author Drew Barrymore, actress Ludwig von Beethoven, composer Marlon Brando, actor Dick Cavett, broadcaster Ray Charles, R&B performer Winston Churchill, British prime minister Dick Clark, entertainer (American Bandstand) Calvin Coolidge, U.S. president Francis Ford Coppola, director Charles Darwin, explorer and scientist Kitty Dukakis, former First Lady, Mass. Thomas Edison, inventor Ralph Waldo Emerson, writer Sigmund Freud, psychiatrist Dwight Gooden, baseball player Tipper Gore, wife of U.S. Vice-President Phil Graham, owner, Washington Post Stephen Hawking, physicist Andrew Jackson, U.S. President Thomas Jefferson, U.S. President Larry King, talkshow host Robert E. Lee, U.S. general John Lennon, musician

Abraham Lincoln, U.S. President Greg Louganis, U.S. diver and Olympic gold medallist Robert McFarlane, former US Nat’l Security Adviser Marilyn Monroe, actor Sir Isaac Newton, physicist Florence Nightingale, British nurse Richard Nixon, U.S. president Deborah Norville, television journalist Dolly Parton, singer Jimmie Piersall, baseball player William Pitt, Prime Minister Sylvia Plath, poet Edgar Allen Poe, writer Jackson Pollock, artist Cole Porter, composer Yves Saint Laurent, fashion designer Charles Schulz, cartoonist (Peanuts) George Stephanopoulos, political advisor Darryl Strawberry, baseball player Spencer Tracy, actor Ted Turner, founder, CNN Network Mark Twain, author Vincent Van Gogh, artist Walt Whitman, poet Jonathan Winters, comedian Natalie Wood, actor

Lynn Northrop, PhD

Lots of older people get depressed…

Does that mean it’s a normal part of aging?

Lynn Northrop, PhD

No. Depression is a treatable medical illness.

No more common in older adults than younger adults.

It is not any more “normal” than diabetes or cancer.

Lynn Northrop, PhD

Depression is a physical illness. Lynn Northrop, PhD

How is depression treated

Antidepressant Medications

Therapy  Individual, group, IOP, inpatient

Medication + Therapy ECT, TMS

Lynn Northrop, PhD

At the cellular level

Depression affects chemicals that enable cells to talk to each other.

Lynn Northrop, PhD

Glucose metabolism

Depressed brains use glucose differently.

Change thoughts, change the brain.

Lynn Northrop, PhD

What puts people at risk for depression?

¨  Chronic medical problems ¨  Chronic pain ¨  Poverty ¨  Loss ¨  Chronic Stressors ¨  Isolation ¨  Limited social support ¨  Family history ¨  Previous episode ¨  Some medications

Are these CAUSES? (like heat causes burns or viruses cause flu?)

Lynn Northrop, PhD

Do situations cause depression?

Alice and Georgia lived in the same senior housing complex.

Both 85 y.o., retired, recently widowed, live alone, very limited income, diabetes and heart disease, chronic severe arthritic pain, one daughter -- lives nearby, family and personal history of depression,

And here’s the kicker…

Georgia was depressed. Alice was not.

Lynn Northrop, PhD

Cognitive-Behavioral Model of Depression

¨  Depressed people are more likely to think inaccurate thoughts and to believe them.

¨  Depressed people are more likely to behave in ways that maintain depression.

¨  Treatment targets thoughts and behaviors.

Lynn Northrop, PhD

Common Inaccurate Thoughts

¨  All-or-nothing ¨  Negative filter (on self and others) ¨  Catastrophic ¨  Mind-reading ¨  Taking it personal ¨  Should statements

Lynn Northrop, PhD

Common changes in behavior

¨  Dropping hobbies ¨  Spending more time alone ¨  Sit more ¨  More time in bed ¨  Complain/criticize more ¨  Dismiss compliments ¨  Procrastinate ¨  Less self-care

Lynn Northrop, PhD

Cognitive Behavioral Model of Depression

Thoughts

Behaviors Feelings

Focused on the here and now more than history

Lynn Northrop, PhD

Downward Spiral

Feel Bad

Do Less

Feel Worse

Do Even Less

Feel Even Better

Do More

Feel a Little Better

Do

Something

Lynn Northrop, PhD

Staying well…

¨  Stay active ¨  Keep connected ¨  Daily APES ¨  Strive for accurate

thinking (not always +) ¨  Look for the good ¨  Live in the moment ¨  Complain/criticize less ¨  Express gratitude

every day

At Gary and Mary West Senior Wellness Center:

• Feeling fit • Yoga • Tai chi • Travel class • Movies • Cooking class • Book club • Civic engagement/volunteerism • Games • Health education • Sing-along • Bingo • Stress and happiness management class • SCREENINGS • And more! Lynn Northrop, PhD

Take Home Messages

¨  Depression is fairly common, but not “normal” ¨  Depression is a medical illness, not weakness, not “crazy”

¨  Depression leads to many adverse consequences (social, medical, can be fatal)

¨  Depression is very treatable ¨  Help is available ¨  If you or a loved on is depressed, get help

Lynn Northrop, PhD