Depression: Nothing to be ashamed of

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Until partway through my medical school training, there were no unique medication treatments for major depression. Elavil, the first tricyclic antidepressant, was released in 1961, when I started medical school. By the time I did my rotation in psychiatry in 1965, it had already entered into common use—and from the stories we heard, it changed the effectiveness of treatment, which until then had been a combination of “talk therapy,” very non-specific medications such as barbiturate sedatives, and electroconvulsive therapy.

While I was visiting a friend’s home in London in the early 1960s, his father returned from a hospital after being treated for “nerves.” He seemed fine to me, and clearly enjoyed speaking to a medical student about his experience. He took out a small pill bottle, opened it up, poured some out and said, “These little yellow pills saved me.”

It was much later, when I started working in the field of aging, that I began to see older individuals who ultimately were diagnosed with depression. Many responded dramatically to antidepressant treatment, either with newer versions of the tricyclics, or more recently with better tolerated classes of antidepressants known as SSRIs.

Over the years, I have observed or been involved with many dramatic cases in which physicians treating older persons did not consider depressive illnesses. Once this was rectified and appropriate medication or electroconvulsive therapy was implemented, recovery and return to excellent function followed. One dramatic case comes to mind: the grandmother of one of my colleagues, who had been a very vibrant and independent 80-year old with a passion for bridge playing. Over a period of a few months, she began to withdraw, started complaining of problems sleeping, lost her appetite and, most importantly, stopped going to her bridge games. In essence she withdrew from social activities, and spent most of her time alone in her apartment.

Her primary care physician prescribed sleeping pills for her insomnia, but these medications only aggravated her feelings. “Nothing was found” to explain her weight loss, which seemed likely due to the decreased amount she was eating. At one point she told her physician grandson, “I think my time is over—I’ve had a good life.”

After an assessment, it was felt that she was experiencing a major depression. With properly dosed antidepressants over the next few weeks, she started to perk up. Within three months, according to her grandson, she was back to herself and playing competitive bridge again.

Depression in the elderly is easily overlooked and erroneously attributed to aging. When recognized and treated properly with a combination of medications, exercise, psychotherapy and/or cognitive behaviour therapy, the result can be very gratifying for all concerned.

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Dr. Michael Gordon

About Dr. Michael Gordon

Dr. Michael Gordon is Medical Program Director of Palliative Care at Baycrest Geriatric Health Care System.

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