depression and aging.national depression screening day.northrop
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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