Not meaning to depress you, it’s time to have a serious discussion about depression – and in particular, depression and your overall health.   Turns out that depression is bad for you.  It can literally shrink your brain and set you up for all sorts of health issues.  While many of us think we have some understanding of depression, most of us will underestimate the impact our mood has on our health.  Current research supports that depression is not simply a psychological problem, but a syndrome that has marked impact upon both our mind and body.  If you read no further, please note that depression is treatable.  This is why recognizing depression is so important in terms of our overall health.

Just what is depression and what does the psychiatrist mean when he talks about clinical depression?  Depression can be a simple symptom that does not tell us much about the underlying illness, much like what a sneeze is to the flu or shortness of breath is to underlying congestive heart failure.  Psychiatrists will speak of the clinical syndrome of depression, known as Major Depression, as not just a single symptom but a cluster of recognizable symptoms. Major Depression is characterized not only by  persistent negative mood, but occurs with other symptoms such as sleep and appetite disturbance, lack of interest, irritability, and negative thought. Clinical depression is not a transient reaction, but persists over time and impacts upon day-to-day function and quality of life.

The DSM-IV, the guide to psychiatric diagnosis, defines the criteria for the diagnosis of Major Depression as follows:

  • Persistent Sad or  “empty” mood
  • Loss of interest in ordinary pleasurable activities, including sex
  • Decreased energy, easily fatigued
  • Sleep disturbance including insomnia, early morning awakening or sleeping too much
  • Eating disturbance including loss of appetite and weight or  over eating
  • Difficulty concentrating, remembering, and indecisiveness
  • Feelings of guilt, worthlessness, helplessness, hopelessness
  • Thoughts of death and suicide
  • Irritability
  • Excessive crying
  • Chronic aches and pain
  • Symptoms are present most of the time, most days for at least 2 weeks

Clinical depression is common in seniors — about 3% of the population over 65 suffers from major depression.   But in community surveys, nearly 25% of seniors have reported significant depressive symptoms though they would not necessarily meet strict diagnostic criteria for major dpression.  In special populations, such as those living in nursing home, the incidence of depression is quite a bit higher.

What is important is that there is compelling evidence that depression in the elderly can lead to increased disability, poorer health outcomes and increased mortality.  While suicide rates in older adults are the highest for any segment of the population, researchers note it is the negative impact of depression influencing a number of disease states that is of equal concern.  In the year 2000, The World Health Organization found that depression is the leading cause of disability and the 4th  leading contributor to the global burden of disease.  In a study that looked at a variety of chronic medical illness ranging from arthritis, chronic pulmonary disease, heart disease, diabetes, and cancer, the severity of depression was the single most important factor in predicting overall health status outcomes, general health status, disability, and sense of well-being.  But here is the take home message:  the same researchers reported that treatment of depression was associated with improved health outcomes, quality of life, and overall decreased disability.

Geriatric psychiatrists will preach that depression is not a normal part of aging.  In fact to re-look at all of these statistics, the reader should note that most seniors are not depressed, and in fact are quite content, thank-you.  However, for those suffering with even minor symptoms of depression, further assessment with your doctor or with a mental health professional is a good idea and can make a significant difference.  Late-life depression is treatable, and those who recover from depression have improved physical and social functioning.  But keep in mind, most older people with clinical depression do not receive adequate treatment.  Estimates suggest that fewer than 10 % of older patients with depression ever seek treatment.

In the next few columns we will continue exploring depression and your health including understanding stress, mood, and chronic illness and specifically looking at what we know about heart disease and depression.

By Michael A. Keys, MD

Dr. Keys is a geriatric psychiatrist, Adjunct Associate Clinical Professor of Psychiatry at the University of Cincinnati College of Medicine, and Director of The Senior Health Program at the Lindner Center of HOPE, Mason, Ohio.