My mother is in a nursing home and has stopped eating. Her doctor believes she is depressed. She never had a mental disorder before. Is this possible?

Depression can occur throughout the life span. Even without a history of depression, an older person can become depressed, especially in the context of life stressors. Depression may be masked by medical conditions in older persons. Older adults are less likely to present to their physician with complaints of depression. Physical symptoms of depression may be difficult to differentiate from symptoms of any medical illness the person has or side effects from medication. Sometimes, when depressive symptoms are recognized, it is then falsely assumed that the depression is a normal reaction to changing life circumstances. It is important to recognize depression in older people, because there is a high rate of suicide in this population. Older white men in particular are at the greatest risk for suicide, highlighting the importance of identification and treatment.

Treatment of depression is the same in the older population, although there is higher potential for side effects, and there is more concern for interactions with other medications that may be taken. TCAs and MAOIs have more troublesome side effects for older adults than the SSRIs. SSRIs also need to be chosen carefully because of the potential for harmful drug-drug interactions. Sertraline is commonly prescribed because of its profile in this regard.

In addition to medication management, psychotherapy also should be recommended as part of the treatment. Modification in the therapy may be needed to account for any age-related cognitive changes. A manual-based cognitive therapy treatment has been developed for late-life depression. Interpersonal psychotherapy has also been studied and has been found to be effective for late-life depression.

I have low thyroid and take medication. I have been depressed as well. Will my depression get better on the thyroid treatment?

Endocrine disorders[1] such as hypothyroidism are associated with psychiatric symptoms, particularly depression and anxiety. Hypothyroidism[2] is a condition that occurs more frequently in women. Symptoms of hypothyroidism that can look like a major depressive episode include:

• Inattentiveness

• Slowing of thought

• Weakness

• Poor memory

• Depressive mood

• Anxiety

• Insomnia

• Psychosis

Typically, physical symptoms are present that are consistent with a thyroid condition and may include dry skin, thin and dry hair, constipation, stiffness, a coarse voice, facial puffiness, and carpal tunnel symptoms. If a thyroid condition is suspected, blood tests can be done to assess thyroid functioning. If hypothyroidism is present, the treatment for it is typically thyroid supplementation. In many cases the depression will remit, but some patients will still require treatment for the depression.

Thyroid hormone is often used as an augmenting agent in cases of refractory depression or if only a partial response to an antidepressant is achieved. Thyroid hormone is taken with an antidepressant. No correlation exists between thyroid function and the response to thyroid hormone supplementation, and thus normal thyroid functioning and laboratory studies do not preclude a trial of thyroid medication if antidepressants are not working.

  • [1] a disorder of the endocrine system. Endocrine glands release chemicals (also known as hormones) directly into the bloodstream whose actions occur at another site. Endocrine glands include the thyroid, ovaries and testes, adrenals, and pancreas.
  • [2] decreased or absence of thyroid hormone, which is secreted by an endocrine gland near the throat and has wide metabolic effects. When thyroid hormone is low, metabolism can slow, leading to symptoms that can mimic clinical depression.
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