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NIMH Alerts Physicians to Depression Among Elderly

Suicide among the elderly is a major public health problem, and one that is increasing yearly. Nearly all these deaths result from undiagnosed and untreated depression. Research has shown that even though 40 percent of the elderly who commit suicide visit their primary care physician in the week before taking their own lives, their depression is not recognized or treated. These chilling facts are contained in a recent Consensus Statement Update by lead author Dr. Barry D. Lebowitz of NIMH, and other experts on mental health and the elderly.

"The failure to diagnose and treat depression in older people is tragic," said Lebowitz, "because the condition is highly responsive to treatment." A major reason practitioners fail to recognize depression is that elderly people do not mention depressed mood. They complain of sleeping and eating problems, lack of energy, loss of enjoyment, inability to concentrate, and aches and pains. When these complaints occur in an old person with physical ailments, the physician is likely to focus on the somatic problems and ignore the depressive symptoms.

"As more people are living longer, and families are faced with responsibilities for long-term care of elderly parents, there is increasing interest in what can be done to improve their quality of life and overall health," said Lebowitz. "Recognition and treatment of depression is one of the best investments we can make," he added.

Effective treatment for depression in the elderly may be medication therapy or psychotherapy or a combination of the two. "But depression is like arthritis and other chronic recurrent conditions requiring long-term treatment," Lebowitz said. "The challenge is not just to make people well but to keep them well and prevent relapse. Generally the treatment that gets a person well is the treatment that will keep him or her well." Elderly people with long-term depression will need treatment for the rest of their lives, he added.

The new article updates findings from a Consensus Development Conference on Diagnosis and Treatment of Depression in Late Life held at NIH in 1991 and was published to make practitioners aware of information that has come to light since the original conference. It appeared in the Oct. 8 issue of the Journal of the American Medical Association. A copy can be obtained through the NIMH fax-on-demand system. Using a fax machine with a telephone handset, dial (301) 443-5158 and follow the recorded directions; request document number 97-4084.

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