Community Care Resources - Depression

Depression is not just “feeling blue” or “down in the dumps.”  It is not just being sad after a loss.  It is not an ordinary part of aging.  Depression is a medical disorder — just like diabetes, high blood pressure, or heart disease — that requires attention.  Day after day depression affects thoughts, feelings, physical health, and behaviors.

Why is it important?

  • 5% to 10% will experience a depressive disorder that is serious enough to require treatment.
  • About 80% respond well to treatment and achieve a complete and lasting recovery.
  • 90% will NOT seek out the help or their depression will be missed or ignored, denying them beneficial treatment for mental health problems.(1)

Common Causes

  • Health problems:  Illness and disability; chronic or severe pain; cognitive decline; damage to body image due to surgery or disease.
  • Loneliness and isolation: Living alone; a dwindling social circle due to deaths or relocation; decreased mobility due to illness or loss of driving privileges.
  • Reduced sense of purpose: Feelings of purposelessness or loss of identity due to retirement or physical limitations on activities.
  • Fears – Fear of death or dying; anxiety over financial problems or health issues.
  • Recent bereavements –death of friends, family members, and pets; the loss of a spouse or partner.(3)

Key Considerations

Depression red flags include:

  • sadness
  • fatigue
  • abandoning or losing interest in hobbies or other pleasurable pastimes
  • social withdrawal and isolation (reluctance to be with friends, engage in activities, or leave home)
  • weight loss or loss of appetite
  • sleep disturbances (difficulty falling asleep or staying asleep, oversleeping, or daytime sleepiness)
  • loss of self-worth (worries about being a burden, feelings of worthlessness, self-loathing)
  • increased use of alcohol or other drugs
  • fixation on death; suicidal thoughts or attempts

Often presents atypically which may include:

  • cognitive impairment
  • physical symptoms
  • non-specific features of irritability
  • calling out and restlessness
  • may co-exist with dementia

Factors suggestive of higher risk of suicide include:

  • older males
  • somatic complaints
  • agitated
  • sleeplessness
  • evidence of plan/intent
  • significant loss of support

References

1.   Mood Disorders Society of Canada.  Retrieved Feb. 2014 from:
      http://www.mooddisorderscanada.ca/

2.   Public Health Agency of Canada.  Aging and Seniors.  Retrieved Feb. 2014 from:     
      http://www.phac-aspc.gc.ca/seniors-aines/index-eng.php

3.   Robinson, L., Segal, J. & Smith, M. (2014) Depression in Older Adults & the Elderly
      Retrieved Feb. 2014 from:
      http://www.helpguide.org/mental/depression_elderly.htm

Recommended Readings / Guidelines

1.   Canadian Coalition for Seniors’ Mental Health. (2006). National Guidelines for Seniors’ Mental Health:
      The assessment and treatment of Depression.  Canadian Journal of Geriatrics,  2006 volume 9, supplement
      Retrieved March 2014 from:
      http://ccsmh.ca/national-guidelines-for-seniors-mental-health-project/

2.   Dickinson, J., Gorber, S.C., Jaramillo, A.,  Joffres, M.,  Lewin, G., Pottie, K., Shaw, E. and Tonelli, M. 
      Canadian Task  Force on Preventive Health Care, Recommendations on screening for depression in
      adults
.  CMAJ  June 11, 2013  vol. 185 no. 9.  Retrieved March 2014 from:
      http://www.cmaj.ca/content/185/9/775.full.pdf+html

3.   National Institute for Health and Clinical Excellence.  (2009).  The treatment and management of depression
      in adults
.  Retrieved March 2014 from:  
      http://www.nice.org.uk/nicemedia/pdf/CG90NICEguideline.pdf

4.   Registered Nurses’ Association of Ontario.  (2004). Caregiving Strategies for Older Adults with Delirium,
      Dementia and Depression
.  Retrieved March 2014 from: 
      http://rnao.ca/bpg/guidelines/caregiving-strategies-older-adults-delirium-dementia-and-depression

5.   Registered Nurses’ Association of Ontario.  (2003).  Screening for Delirium, Dementia and Depression in the
      Older Adult
. Retrieved March 2014 from: 
      http://rnao.ca/bpg/guidelines/screening-delirium-dementia-and-depression-older-adult