Depression and Aging
Welcome and Thank You Alone we can do so little,together we can do somuch.              ~ Helen Keller                   L...
National Depression Screening Day¨  1991 – 20 years next year!¨  Initiated by Douglas Jacobs, MD, a Harvard    psychiatr...
What is Depression?Major Depressive Episode* = symptoms for 2 weeks or more     Depressed or irritable mood AND           ...
Mood Disorders• Major Depressive Disorder• Dysthymia• Minor Depression• Bipolar Disorders (I&II)• Hypomania               ...
How common is major depression?¨  21million people in US with Major Depressive    Disorder¨  Lifetime prevalence: 1 to 2...
Lynn Northrop, PhDEstimated number of depressed older adults                 Number of      11% clinical    Area          ...
How does depression impact health?¨  Depression is predictive of hip fracture (Mussolino, 2005), a    second heart attack...
Additional Impact of depression¨  Reduced Quality of Life¨  Lost Productivity - $44 billion cost to employers        Le...
Who gets depressed?¨  Anyone¨  You, me, everyday people and famous people¨  Rich, poor¨  Male, female¨  Young, old¨ ...
Edwin "Buzz" Aldrin, astronaut                 Abraham Lincoln, U.S. PresidentAlexander the Great, king                   ...
Lots of older people get depressed…                      Does that mean it’s                 a normal part of aging?      ...
No. Depression is a treatable medical illness.         No more common in older adults                        than younger ...
Depression is a physical illness.                   Lynn Northrop, PhD
How is depression treatedAntidepressant MedicationsTherapy  Individual,   group, IOP, inpatientMedication + TherapyECT, T...
At the cellular levelDepressionaffectschemicalsthatenablecells totalk toeachother.                  Lynn Northrop, PhD
Glucose metabolismDepressedbrains useglucosedifferently.Changethoughts,change thebrain.               Lynn Northrop, PhD
What puts people at risk for depression?¨  Chronic medical problems¨  Chronic pain¨  Poverty¨  Loss                   ...
Lynn Northrop, PhDDo situations cause depression?       Alice and Georgia lived in the same              senior housing co...
Cognitive-Behavioral Model of Depression¨  Depressed people are more likely to think    inaccurate thoughts and to believ...
Common Inaccurate Thoughts¨  All-or-nothing¨  Negative filter (on self and others)¨  Catastrophic¨  Mind-reading¨  Ta...
Common changes in behavior¨  Dropping hobbies¨  Spending more time alone¨  Sit more¨  More time in bed¨  Complain/cri...
Lynn Northrop, PhDCognitive Behavioral Model of Depression                          Thoughts        Behaviors             ...
Downward Spiral         Feel Bad                         Feel Even                                            Better      ...
Staying well…¨  Stay active               At Gary and Mary West Senior                              Wellness Center:¨  K...
Take Home Messages¨  Depression is fairly common, but not normal¨  Depression is a medical illness, not weakness, not   ...
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Depression And Aging.National Depression Screening Day.Northrop

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Depression And Aging.National Depression Screening Day.Northrop

  1. 1. Depression and Aging
  2. 2. Welcome and Thank You Alone we can do so little,together we can do somuch. ~ Helen Keller Lynn Northrop, PhD
  3. 3. 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
  4. 4. What is Depression?Major Depressive Episode* = symptoms for 2 weeks or more Depressed or irritable mood AND Older adults at least 4 below: More likely to report ¨  Loss of interest or pleasure physical symptoms ¨  Change in weight or appetite Less likely to report mood ¨  Change in sleep symptoms ¨  Change in psychomotor activity More likely to report problems with memory ¨  Fatigue or low energy ¨  Worthlessness or guilt Apathy and withdrawal more common ¨  Cognitive dysfunction Diminished self-worth is ¨  Recurrent thoughts of death more prominent -  self or others (suicidal ideation) ¨  Interferes with functioning Lynn Northrop, PhD
  5. 5. Mood Disorders• Major Depressive Disorder• Dysthymia• Minor Depression• Bipolar Disorders (I&II)• Hypomania Lynn Northrop, PhD
  6. 6. 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
  7. 7. Lynn Northrop, PhDEstimated number of depressed older adults Number of 11% clinical Area people age 65+ depression California 3,866,140 42,5275 SD County 325,615 35,818 La Mesa 11,605 1,277 City of San 128,008 14,080 Diego
  8. 8. 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
  9. 9. 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
  10. 10. 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
  11. 11. Edwin "Buzz" Aldrin, astronaut Abraham Lincoln, U.S. PresidentAlexander the Great, king Greg Louganis, U.S. diver and Olympic gold medallistHans Christian Anderson, author Robert McFarlane, former US Nat’l Security AdviserDrew Barrymore, actress Marilyn Monroe, actorLudwig von Beethoven, composer Sir Isaac Newton, physicistMarlon Brando, actor Florence Nightingale, British nurseDick Cavett, broadcaster Richard Nixon, U.S. presidentRay Charles, R&B performer Deborah Norville, television journalistWinston Churchill, British prime minister Dolly Parton, singerDick Clark, entertainer (American Bandstand) Jimmie Piersall, baseball playerCalvin Coolidge, U.S. president William Pitt, Prime MinisterFrancis Ford Coppola, director Sylvia Plath, poetCharles Darwin, explorer and scientist Edgar Allen Poe, writerKitty Dukakis, former First Lady, Mass. Jackson Pollock, artistThomas Edison, inventor Cole Porter, composerRalph Waldo Emerson, writer Yves Saint Laurent, fashion designerSigmund Freud, psychiatrist Charles Schulz, cartoonist (Peanuts)Dwight Gooden, baseball player George Stephanopoulos, political advisorTipper Gore, wife of U.S. Vice-President Darryl Strawberry, baseball playerPhil Graham, owner, Washington Post Spencer Tracy, actorStephen Hawking, physicist Ted Turner, founder, CNN NetworkAndrew Jackson, U.S. President Mark Twain, authorThomas Jefferson, U.S. President Vincent Van Gogh, artistLarry King, talkshow host Walt Whitman, poetRobert E. Lee, U.S. general Jonathan Winters, comedianJohn Lennon, musician Natalie Wood, actor Lynn Northrop, PhD
  12. 12. Lots of older people get depressed… Does that mean it’s a normal part of aging? Lynn Northrop, PhD
  13. 13. 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
  14. 14. Depression is a physical illness. Lynn Northrop, PhD
  15. 15. How is depression treatedAntidepressant MedicationsTherapy  Individual, group, IOP, inpatientMedication + TherapyECT, TMS Lynn Northrop, PhD
  16. 16. At the cellular levelDepressionaffectschemicalsthatenablecells totalk toeachother. Lynn Northrop, PhD
  17. 17. Glucose metabolismDepressedbrains useglucosedifferently.Changethoughts,change thebrain. Lynn Northrop, PhD
  18. 18. What puts people at risk for depression?¨  Chronic medical problems¨  Chronic pain¨  Poverty¨  Loss Are these¨  Chronic Stressors CAUSES? (like¨  Isolation heat causes burns or viruses cause¨  Limited social support flu?)¨  Family history¨  Previous episode¨  Some medications Lynn Northrop, PhD
  19. 19. Lynn Northrop, PhDDo 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 -- livesnearby, family and personal history of depression, And here s the kicker… Georgia was depressed. Alice was not.
  20. 20. 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
  21. 21. Common Inaccurate Thoughts¨  All-or-nothing¨  Negative filter (on self and others)¨  Catastrophic¨  Mind-reading¨  Taking it personal¨  Should statements Lynn Northrop, PhD
  22. 22. 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
  23. 23. Lynn Northrop, PhDCognitive Behavioral Model of Depression Thoughts Behaviors Feelings Focused on the here and now more than history
  24. 24. Downward Spiral Feel Bad Feel Even Better Do Less Do More Feel Worse Feel a Little Better Do Even Do Less Something Lynn Northrop, PhD
  25. 25. Staying well…¨  Stay active At Gary and Mary West Senior Wellness Center:¨  Keep connected • Feeling fit • Yoga¨  Daily APES • Tai chi • Travel class¨  Strive for accurate • Movies thinking (not always +) • Cooking class • Book club¨  Look for the good • Civic engagement/volunteerism • Games¨  Live in the moment • Health education • Sing-along¨  Complain/criticize less • Bingo • Stress and happiness¨  Express gratitude management class • SCREENINGS every day • And more! Lynn Northrop, PhD
  26. 26. 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

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