Treating depression: a necessity

That blue-eyed demon we call depression isn't pretty at any age. But trust me, it gets uglier as the years pile up.

OK, don't trust me. Reread last week's Healthspan where a case was made for depression's deadly impact on aging heart health.

Still not buying? I'll get your attention with this one: Alzheimer's -- that ultimate "boogeyman in the closet" -- has a cozy relationship with depression.

According to the September 2003 Harvard University Mental Health Letter: "Late-life depression is more common in people with a family history of (Alzheimer's), which suggests either that the disorders are genetically related or that depression is often an early sign of dementia."

And here is the real attention grabber: "Older people with even a few depressive symptoms are at much higher than average risk for cognitive decline."

Time to find those happy shoes and start dancing.

But for anyone who has struggled with depression, this is not always such a glib proposition. And as the years pass, it gets even harder.

The reason for this is that the risk factors multiply with age. Besides the usual burdens at any age, you can add the following: Empty nest, caretaking of a family member with illness, loss of loved ones, financial pressures of retirement and health care, greater incidence of illness and disability.

Here's an interesting fact about the impact of depression as we age. According to that same Harvard Mental Health Letter, depression, which is more typically found in women, becomes more egalitarian later in life. Of the AARP-eligible depressives, it shakes out as half and half on a gender basis.

There are treatments available. Those newer anti-depressant drugs called SSRIs -- you know them as Prozac and its younger cousins, Zoloft, Celexa, etc. -- can work equally well for older adults. It is a big improvement over the older version of anti-depression medication -- tricyclics -- that were known to cause abnormal heart rates that could prove to be fatal in some people. There are studies that show that people taking SSRI medication are three times less likely to suffer a heart attack. However, this doesn't prove that one prevents the other, and other studies have been mixed.

Hopelessness, low self-esteem, loneliness and hostility -- these are the depressive symptoms that research has established to have the most deleterious impact on our health. Psychotherapy is an effective way to deal with these human but potentially destructive foibles.

There have been many studies that support the American Psychological Association's claim that therapy (either cognitive-behavioral, psychodynamic or interpersonal) is as effective on the older crowd as the younger one. A large study of depressed people over 60 found that those who combined psychological therapy with drug therapy benefited the most. This reflects the most consistent findings about the most effective way of treating depression in general.

When prevention medicine guru Dr. Dean Ornish addressed the 2002 APA annual convention, he made a strong case for helping older people maintain vital social connections. "Depression, isolation and loneliness cause the most suffering in our culture because the spur behaviors that trigger our most deadly diseases," he claimed. He contended that those suffering from depression can and must be helped to move from the "I" of illness to the "we" of wellness.

Dr. Michael O.L. Seabaugh, a Cape Girardeau native, is a clinical psychologist who lives and works in Santa Barbara, Calif. Contact him at mseabaugh@semissourian.com.