More Than a Blue Mood: Confronting Depression in Mid-to-Late Life

Anna* was no stranger to mental turmoil. For years, unshakable feelings of hopelessness and thoughts of suicide tormented her. It wasn’t until persistent leg pain led the registered nurse to a rheumatologist that her clinical depression was diagnosed.

“Nothing satisfied me, I would cry for hours,” recalled the Island Park grandmother whose depression caused marital discord and interpersonal conflicts. “I always thought something coming around the corner would make me feel better.”

Anna is one of more than 6 percent of adults in the nation who each year suffers from major depression. Experts say women experience the disorder twice as often as men, due in part to hormonal fluctuations during pregnancy, miscarriage and menopause.

Symptoms run the gamut from sleep disturbances and changes in appetite to persistent sadness and feelings of hopelessness.

Major Depression or Dysthymia?

While major depression may lift after a couple of months, those suffering from a milder form of the disorder called dysthymia experience a dip in mood and energy that can last two or more years.

Each year dysthymia affects about three percent of adults 18 and older in the United States. And like major depression, it occurs more often in women than in men.

Experts caution that although dysthymia may not appear serious, it is a severe disorder.

Daniel Klein, Ph.D., professor of psychology at SUNY Stony Brook, followed 86 clinic patients with dysthymia over five years. Nearly 80 percent of the outpatients developed major depression and were more likely to attempt suicide and be hospitalized than their counterparts with major depression. Although the study was small, Klein says the conclusion can be applied to the broader population.

Experts draw a clear distinction between dysthymia, major depression and “feeling blue.” They point out that when symptoms interfere with daily functioning and persist for more than two weeks, a closer look by a health care professional is warranted.

Targeting the Cause

There is no single cause for depression, which runs in families and has strong hereditary roots. And whether there is an absence or presence of a genetic link, the disorder often develops following an emotional trigger, such as the loss of a loved one through death or divorce, a layoff, trauma or financial adversity.

Depression can occur “out of the blue” sans family history or triggers, but “typically, there is something going on,” says William Sanderson, Ph.D., director of the Cognitive Behavior Therapy Treatment Center for Anxiety and Depression at Hofstra University.

Mid-to-Late Life Triggers

That “something” often translates into an environmental or emotional stressor, especially for adults 40 and older.

“By the time you’re in your 40s you are looking at your life and saying, ‘What have I accomplished?’” says Norman Miller, Ph.D., a psychologist in private practice in Merrick. “Or you’re a stay-at-home mother returning to work and you don’t have any skills; or you’re in a bad marriage and you divorce.

“By the 50s and 60s, you’re contemplating retirement and so much of one’s self-esteem is based upon what you do,” he continues. “The kids are grown. You may have to downsize and move because you can’t afford to live on Long Island. By your 70s, your health may fail, your spouse, friends and children may pass,” says Miller.

Environmental stressors aside, physiological changes also place adults 40 and older at peak risk. “As you age, the brain loses cells and connections and has less resilience,” says David Hellerstein, M.D., associate professor of clinical psychiatry at Columbia University College of Physicians and Surgeons.

Once depression strikes, the likelihood of experiencing a future episode increases with each recurrence, explains Mark Russ, M.D., director of acute care psychiatry, at the Glen Oaks-based Zucker Hillside Hospital of the North Shore-Long Island Jewish Health System.

Still a Social Stigma

More often than not, depressed patients end up on the examination tables of their family physicians complaining of persistent aches and pains rather than depressed mood.

“It’s the stigma, a sign of weakness, frailty or a character flaw that people don’t seek treatment,” Russ says. “It is more acceptable to present with aches and pains than emotional heartache.”

Eric Hipple knows about stigmas and heartache. After his son committed suicide in 2000, the former NFL quarterback for the Detroit Lions “faded into oblivion.”

Initially, friends reached out to the athlete but after several months, “life goes on. People don’t understand where you are coming from,” says Hipple.

“We never talked about depression in pro sports,” he adds. “You just suck it up and go.”

After 18 months of insomnia, abusing prescription pain medications and tranquilizers and an arrest for DWI, Hipple reached rockbottom and consulted a psychiatrist for treatment.

Today the 50-year-old businessman partners with the University of Michigan Depression Center and the Manhattan-based American Foundation for Suicide Prevention to raise awareness that depression is a serious medical illness.

Treatment Therapies

Hipple’s depression was treated with acombination of antidepressants and psychotherapy. The newest class of antidepressants, Serotonin reuptake inhibitors (SSRIs) includes Prozac and Zoloft. Serotonin and norephinephrine reuptake inhibitors (SNRIs), which are similar to SSRIs, include Effexor and Cymbalta. Older classes of antidepressants such as monoamine oxidase inhibitors (MAOIs) are effective. However, people taking these medications must avoid certain foods to prevent serious drug interactions.

Popular in Europe as an aid to treat mild to moderate depression, herbal supplements, such as St. John’s Wort, have not been proven effective in the United States. Studies by the National Institutes of Health found that St. John’s Wort was “no more effective than placebo in treating major depression.”

Electroconvulsive therapy, once known as shock therapy and depicted in 1975 movie “One Flew Over the Cuckoo’s Nest,” is indicated for those whose depression does not respond to medication and/or psychotherapy or for depression associated with other forms of mental illness.

Psychotherapy or talk therapy, experts say, is effective in conjunction with antidepressants or as a stand-alone treatment for both forms of the disorder. Two types of talk therapy, cognitive behavioral therapy and interpersonal therapy, help individuals learn new ways of coping with life’s problems.

To be sure, depression left untreated can lead to suicide. Each year, 32,000 Americans kill themselves, making suicide the 11th leading cause of death, according to the American Foundation for Suicide Prevention.

Mental health professionals agree that depression is highly treatable. But some are wary of taking antidepressants, because of concerns about possible side effects of sexual dysfunction and a potential for weight gain.

“Many times people wait to get treatment,” Sanderson says. “The longer you wait, the more mental health problems can become compounded.”

*Name changed to protect subject’s identity.

Don’t Be a Victim

Depression is not just a state of mind.  It’s a disease that stems from biological changes in the chemistry of the brain, a genetic link and/or environmental or emotional factors. While there’s no particular formula for preventing depression, David Hellerstein, M.D., associate professor of psychiatry at Columbia University College of Physicians and Surgeons, offers these strategies to help reduce the risk of developing the disorder:

• Keep your brain in top shape. Learn a foreign language or take up a new hobby.
• Engage in a regular exercise program to increase cell growth and stimulate cell recovery in the brain. Exercise is also thought to raise levels of neurotrophic factors, which strengthen connections between brain cells. Stronger connections improve mood and concentration.
• Maintain social relationships and forge new ones.
• Eat a proper diet.
• Minimize stressors in your life.
• Cultivate healthy sleep habits.
• Try to relax and enjoy yourself.
• Avoid negative thinking habits.
• Count your blessings. Take stock of the positive things in your life.

If you have diabetes or high blood pressure, you may be at an increased risk for depression. See your doctor regularly and keep a close eye on your blood sugar or blood pressure.

“It’s all the things your mother told you to do,” Hellerstein says.

Donna Kutt Nahas is an award-winning journalist who has contributed to Newsday and The New York Times.

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