Causes of Major Depressive Disorder among the Elderly

The major depressive disorder is more prevalent and widespread among the old people across the world. Statistics further show that massive depressive disorder is becoming widespread with the increasing number of the elderly across the globe.  Old people have gone through a lot of trigger factors in their lives like the loss of loved ones and detachment from the society and hence are the most vulnerable group of people to acquire the massive depressive disorder condition. Women stand a higher chance of being depressed in comparison to men. This study will analyze the causative factors of the massive depressive disorder among old people. It equally strives to identify new signs and symptoms that are common and consistent among depressed people. The treatment procedures are of importance to help determine the most effective treatment techniques, their efficiency and their suitability to old patients. A lot of information will be obtained from observation, experimentation and from secondary sources or through dialogue with the patients. This research, therefore, aims to collectively identify, analyze and recommend the best diagnosis and treatment remedy for massive depressive disorder among the elderly as well as to identify the loopholes in research that make the treatment of depression inefficient.

Introduction

The Major Depressive Disorder is often characterized by a constant feeling of low moods and sadness.  Major Depression is often distinct and different from the bipolar disorder because unlike in the bipolar disorder where the symptoms vary from despair to mania, in unipolar depression the feeling is of perpetual sadness. Other common names of the Major Depressive Disorder are unipolar disorder and major depression. With the ever-growing population of the older citizens, there is equally a growing rate of the major depressive disorder among this population. People from the older population often suffer from a loss of their physical, social and psychological prowess as well as social ties with friends and relatives and hence these changes lead to major depressive disorder. However, it is also essential to point out the fact that major depressive disorder is not a part of aging but is a condition prevalent among the older people. This research, therefore, strives to analyze the signs, symptoms and treatment strategies for the major depressive disorder and how it affects the elderly population.

As per a 2005 research by the American Medical Association, the prevalence of women having lifetime major depressive disorders is at 25% while that of the men is at 10% (American Psychiatric Association 2006).  These figures are a representation of the number of people suffering from depression that do not pursue continuous treatment for their condition. Although the men and the women suffer depression at different ages, research further found that 32 years was the average age where most American suffered from depression (Lam 2012). One reason as to why the women suffer more from depression in comparison to men is because depression co-occurs with other diseases and infections. People suffering from cancer, HIV, and survivors of heart attacks are reported to suffer from depression and its effects (Lam 2012). Although men exhibit similar illnesses the women are more susceptible because they often experience constant episodes of hormonal imbalance and genetic predisposition at different stages of their lives including during birth, puberty, and menopause (Friedman 2010).

Hales (2012) affirms that although the risk factor for mental illnesses is common among all the people, older people often experience a lot of stressors that accelerate the rate of their exposure to mental health problems. Most people in their old age often experience a constant loss in their capacities which ranges from the decline in their socio-economic ability to isolation and chronic pains. Furthermore, elder people are often exposed to numerous amounts of abuses which makes them volatile and vulnerable. The combination of failing health, isolation and personal loss such as bereavement and neglect or abuse often triggers massive depressive disorders among the elderly.

The causes of major depressive disorder

The major depressive disorder has a lot of causal factors which range from the genetic factors that originate from within to the environmental factors that often result from one's interaction with the surrounding. Most of the time older people often experience extreme reactions because of the activities that they partake in and their level of interaction. While older people might be delighted to interact with their grandchildren, they will often be irritated by a chronic condition or the declining social interaction frequency that they experience. As a result, their brain often functions in a different manner than that of an ordinary person. Due to their nature of interaction and experiences, older people often experience constant shifts in activities in the left frontal lobes of their brains (Lam 2012). The constant shift in the activities of their brains from delight to despair often triggers depression and stabilization of their moods depending on their thoughts and experiences.

Biologically a person's mood is often linked to the release of neurotransmitters in the brain. The release of some neurotransmitters such as norepinephrine, dopamine, and serotonin often trigger a change in a person's mood which ranges from happiness to sadness depending on the amount released to the brain (Hales 2012). Scientists have revealed several cases of imbalances in the release of the neurotransmitters in the brains of depressed people. Additionally, it is difficult to determine the occurrence and presence of the neurotransmitters in the brain which makes it difficult to ascertain the actual effect of the neurotransmitters to depressed people. However, a common treatment on depressed people is through the use of anti-depressants on their brains which act on the neurotransmitters and their receptors so as to attain a state of balance.

A historical back check into the lives of the depressed patients often found cases of trauma and abuse at different stages of the depressed people's lives. Most of the depressed people as states by the American Psychiatric Association (2006) of the older generation often experience a state of neglect and isolation into the homes of the elderly. Additionally, they often suffer from bereavement and social isolation from their relatives and friends and hence develop trauma. Women and children who experience incidences of sexual abuse, rejection and even physical abuse are more susceptible to depression and develop major depressive condition due to their experiences. Traumatized patients often undergo counseling and therapies which aid them to recover from the traumatic experiences, however, some people often lack the counseling therapies and sessions and hence are left to cope with the post-traumatic events of their own. The lack of help after a traumatic event triggers incidences of mild to severe depression which may later result in massive depressive disorder. People of the older generation often experience major lifetime losses like bereavement, financial constraints, and the loss of their physical abilities coupled with the increase in lifestyles diseases and chronic pain which makes them more prone to depression and its effects.

Elder women who are approaching menopause often experience hormonal imbalances in their bodies and hence plunge into depression (Hales 2012). Elderly people often experience different types of illnesses, that could sometimes be life-threatening, disabling or painful. Some of the diseases or their treatment procedures often directly or indirectly trigger episodes of depression among the elderly. Some common diseases like stroke, Parkinson's disease, and cancer are likely to trigger incidences of depression among the elderly due to their nature of treatment and the painful experiences on the patient's side. When people undergo medication, they are likely to develop tendencies of depression because of the side effects of the drugs. For the older people, their bodies have a lower metabolic rate in comparison to the younger generations and hence results to more intense cases of depression (Friedman 2010). Friedman (2010) ascertains that research has proven that drugs for certain medication like blood pressure, painkillers, heart diseases and steroids for instance often result in depression when used by elderly patients.

Signs and symptoms of major depressive disorder

Just like many other depression conditions, the major depressive has a lot of indicators which occur at different times in different people. Unlike the normal people who exhibit episodes of lowliness, sadness or lack of interest in some activities for a while, depressed people often have such a feeling throughout their lives until they get help. Clinical depression has a standard set of symptoms which should be consistent and be at least 5 or more in the depressed patient. One of the most common symptoms of depression among the elderly is a depressed mood which occurs frequently and makes them low, blue or sullen. In the view of a peripheral spectator, they may appear as if they want to cry. From an external observation, the depressed people may often sit alone and appear to be empty or dysfunctional. Additionally, depressed people may suddenly lose interest in their previous pleasure activities and withdraw all their previous interest completely. Older people have common incidences of withdrawal and a total loss of interest in life and other activities like eating, socializing, exercising and even cleaning and hence prefer to sit still and await their dying moments. Researchers explain that this symptom is often accompanied by deep thoughts and a general feeling of helplessness and despair (American Psychiatric Association 2006). The elderly people at this stage do not have much to look forward to as they often have much of their lives behind them.

Massive disorder depression and sleep have a close correlation. Sleep is often considered as a key ingredient for depressed people even though an in-depth research by Hales (2012) states that the deficiency of sleep could also act as an anti-depressant therapy for depressed people. Ironically, most of the anti-depressant drugs that are administered worsen sleep in the depressed patients and hence alter their sleeping patterns most of the time. Although depressed people often have a common deficiency and disrupted sleeping patterns, this symptom is usually undertreated or over treated through the use of the antidepressants (Hales 2012). Despite the conflicting and confusing role of insomnia in depressed people, it is apparent that the treatment patterns are a key consideration when deciding the best treatment therapies for depressed people. It is inevitable to address the sleeping trends and elongate them as evidenced by research so as to ensure that the depressed patients receive enough time to adjust, metabolize and recover from the effects of the anti-depressant drugs that often take a long time to take effect. Sleep, therefore directly affects the levels of depression and functionalities of the depressed patients.

Older patients with massive depressive disorder often experience fatigue most of the time due to the treatment and nature of the condition. Friedman (2010) states that the women are generally more prone to be fatigued when depressed. Fatigue is also one of the most common symptoms that depressed people experience. Further research among the old patients with the massive depressive disorder condition has states that lethargy often emanates as a result of the disturbance of the sleeping patterns. The ration of the disturbed people with sleeping patterns is almost directly proportional to the ration of depressed patients that experience fatigue. Fatigue in depressed patients also often occurs as a result of the constant thoughts and both physical and emotional struggles that the patients engage in order to remain normal or restore the pre-fatigue conditions. When the victims suddenly feel overwhelmed, dejected and helpless they are equally fatigued and unable to carry on with their lives.

Depressed patient experience different types of cognitive dysfunction in the sense that most of them often have a difficulty in thinking and concentrating on a single agenda. Several tests have been conducted on older patients through the use of the neuropsychological test batteries so as to determine their concentration spun (Hales 2012). Results indicate that the older patients often experience difficulty in concentration because they exhibit neuropsychological differences in their verbal fluency, memory, executive dysfunction and attention. Most of the old depressed people have different conditions and brain functionality in their brains as compared to the younger people. Older depressed people for instance experience memory deficits, recurrent depressive episodes, memory deficits and in some cases a reduced hippocampal volume. Although old people often exhibit memory loss, the major depressive disorder aggravates the rate of memory loss and makes their condition even worse.

Treatment for major depressive disorder

Most of the depressed people often tend to concentrate on the negative incidences and occurrences in their lives. As a result, one of the most recommended treatments for depressed patients is through the use of psychotherapies. Cognitive therapists often prescribe and administer this type of treatment and hence help the depressed patients to identify the tendency and rate of the occurrences of the negative thoughts. They equally help the patients to lessen their expectation and instead work with realistic results as opposed to unattainable goals that lead to depression. Depressed people especially the old often tend to exhibit a poor interpersonal reaction with other people and hence get a lot of negative feedback that crushes their spirit and desire to interact. Hence the cognitive therapists have the role of equipping the depressed people with socializing skills and which have tested positive to depressed people who tend to lift their depression tendencies and develop meaningful relationships in their place. The talk therapies are particularly effective in older people who seem to respond more. However, an important point to consider is that most talk therapies are not effective when used alone and, therefore, should be accompanied by other forms of medication. The therapists in this type of treatment also risk bringing unpleasant memories and thoughts to the depressed people which will make them even more depressed (American Psychiatric Association 2006).

Another common treatment for depression is through the use of anti-depressants which vary depending on their usage and the patient's response (Friedman 2010). Doctors and researchers have found conflicting results from using anti-depressants as a way of treating depression. The antidepressant medicine like the SSRIs, for instance, have been tested and found to reduce mild, moderate and server incidences of depression by a big margin (Lam 2012). The use of drugs in treating massive Depression disorders among the older people is advantageous in the sense that it reduces episodes of relapse among the patients. Antidepressants have to be taken in the recommended doses and could alternatively be combined with other drugs to ensure that the patients receive effective treatment. The duration of the administering the antidepressants could last 16-20 weeks after the recovery phase so as to help prevent the patient from relapsing. The Selective Serotonin Reuptake Inhibitors (SSRI) are some of the most effective drugs that are given to old people who are depressed (Lam 2012). However, if they fail to respond to the drug, they could be switched to an alternative drug like bupropion and venlafaxine which are recommended for the elderly patients with depression (Hales 2012).

The light and the electro conclusive (ECT) therapies are some of the therapies given to patients with massive depressive disorders (Friedman 2010). Although the use of (ECT) has met a lot of controversies and oppositions with the claims that it causes a lot of pain and suffering to the patients it is often administered in well-prescribed doses and the patients are usually sedated. Various tests by (American Psychiatric Association 2006) suggest that the Electro conclusive therapy is much more effective and convenient for use when the other types of medical treatments have failed. In the case of a violent patient who is a potential threat to themselves, the (ECT) therapy could also be put to use. Although the use of medication and therapies is effective in treating old patients with major depressive disorder, it is also important to factor in the lifestyle changes for the depressed people.

Conclusion

With the increasing number of the aging population, there is also an increase in the number of elderly patients with massive depressive disorder. Massive depressive disorder is mainly caused by factors such as the genetic composition of the patients, effects from other medication, biological factors including the release of too many neurotransmitters in the brain. Older patients with a history of either physical or emotional abuse are also likely to suffer from depression.  Some common symptoms of massive depressive disorder among the elderly is constant episodes of fatigue, disturbance in the sleep patterns, lack of interest in everything and in some instances cognitive dysfunction. Doctors have prescribed a number of treatment which includes the use of cognitive therapies which the counseling therapies use to help the patients eradicate negative thoughts from their minds. Through the use of drug such as Selective Serotonin Reuptake Inhibitors which could help older patients to recover from mild or severe incidences of depression. The electro conclusive and light therapies are also some means that could be used to treat old people who are depressed. Old patients with massive depressive disorder can also prevent episodes of relapse when they change their entire lifestyle and embrace new activities that bring out positivity in them. Although the elderly are susceptible to suffer from massive depression disorder, there is an advancement in the diagnosis and treatment procedures which makes them responsive to treatment.

References

American Psychiatric Association. (2006). American Psychiatric Association practice guidelines for the treatment of psychiatric disorders. Arlington, Virg: American Psychiatric Association.

Friedman, E. S., & Anderson, I. M. (2010). Managing depression in clinical practice. London: Springer.

Hales, D. J. (2012). Focus major depressive disorder: Maintenance of certification (moc) workbook. American Psychiatric Publishing Inc.

Lam, R. W. (2012). Depression. Oxford: Oxford University Press.