It's Not a Failing, It's an Illness
August 20, 2004
Daily Herald; Arlington Heights, Ill.

The human brain just wasn't built to operate at peak performance levels for 100 years.

The breakdown in the brain that signals some form of depression already is estimated, conservatively, to be present in as many as 7 million Americans aged 65 or over. That means nearly 1 in every 5 senior citizens could be experiencing depressive symptoms. As many as 2 million senior citizens are believed to be experiencing major depression, experts say.

It doesn't have to be this way. Those who work in the mental health field and with elderly patients, in particular, say so many of our senior citizens do not have to suffer through dark days of depression at life's end.

Psychotherapy, anti-depressant medications and electroconvulsive therapy, or some combination of the three, work well.

"It's important to get the message out: It's an illness, it kills and treatment works," said Barry Lebowitz, chief of geriatric treatment at the National Institute of Mental Health.

Electroconvulsive, or shock therapy, might sound like the most daunting of the treatment options for depression. But some psychiatrists, including Dr. Maria Caserta, a geriatric psychiatrist with the University of Chicago, believe it can be an effective option for older patients because it's fast, has few side effects and avoids the complications that often occur when anti- depressant medication interacts with other prescription medicines.

Counseling is a key line of treatment, though making some senior citizens comfortable with it remains a challenge.

"There is that stigma, and getting them to put that foot over the threshold of an office that says 'psychiatrist' is difficult," Caserta said.

Anti-depressant medications are more prevalent and accepted as necessary now than they used to be, but caregivers must watch for multiple drug interactions, especially with senior citizens who often take maintenance medicines for physical illnesses. Doctors also must give the anti-depressants enough time to work, said Dr. Anil Godbole, chair of Advocate Illinois Masonic Medical Center's psychiatric department in Chicago.

Most such medications take two to six weeks to start to work to change the brain's chemistry. Doctors and their patients need to understand that going into treatment, said Godbole, who is a member of a 15-person presidential panel that developed a plan for overhauling the country's mental health treatment system.

Often dosages will need altering or different types of medications might need to be tried. Patients need to continue taking them regularly for six months to a year because the depression relapse rate is high in the first year, Godbole said. Recent studies, he said, have shown family doctors are under- diagnosing mental health problems; those who are diagnosed often are under- treated.

Experts say getting depressed elderly patients and those closest to them to recognize their illness and seek proper treatment remains the biggest obstacle to lowering the numbers of those suffering.

"The tragedy is we're not getting to the people of the highest need," Lebowitz said. "We've got to do a better job of recognition and getting treatment where people live."

A significant gap exists between what experts know works and what is practiced in communities, Godbole said he and his fellow presidential panel members found.

Godbole and Lebowitz said they believe the treatment system must be revamped to focus on better detection of mental illness away from hospital and institutional settings and in the primary care doctors' offices, clinics and other community centers where senior citizens spend their time.

A "collaborative care model" that puts mental health workers in offices alongside primary care physicians works, Godbole said, but it's not being used much, partly because such care is not reimbursed or co-payments are too high.

"What we need is to create an understanding that our resources need to be appropriately distributed to family care," Godbole added.

"It's a win-win situation, really. It's just that a lot of people don't know it, don't know how to do it, and the reimbursement system isn't set up to support it."

Godbole and others said they are hopeful depression among the elderly soon will get more time, attention and resources.

The number of seniors experiencing depression likely will more than double as the baby boomer generation ages.

At nearly 36 million now, the elderly population is projected to more than double to 86.7 million by 2050, according to the U.S. Census Bureau. Experts predict the number of depressed elderly Americans, therefore, will jump to 15 million.

"These are the people who are going to make noise and demand more," Godbole said. "We are hoping the baby boomer generation may be a catalyst in helping us in transforming the system."

In the meantime, experts don't hesitate when asked what needs to be done now to help depressed senior citizens as their brains wear down.

"Don't assume depression is a natural part of aging," said Mark Bornstein, a Buffalo Grove-based psychologist who focuses on geriatric patients. "Stay close to mom and dad because you're going to be old as well. It's good for your soul."