It's often a relative or a friend who notices depression coming on in an older person. Gently encourage them to accept help. Explain that depression is quite common and that, with help, it gets better in the great majority of people. Be clear yourself that it's not a form of 'madness', or that seeing a psychiatrist or a psychologist is a slur on the family.
What to Do
Firstly, you should encourage the person to speak to their GP. They are quite used to helping people with depression and almost all of them have had training in how to deal with it.
The time to get help is when feelings of depression in the person you care for are worse than you would expect, when it has gone on for several weeks, when it is interfering with their and your life, when they can't face being with other people or when they get to the point when life hardly seems worth living.
Mild to moderate depression is usually treated first with a ‘talking therapy’ with a counsellor. If problems persist or the depression is severe the GP may prescribe anti-depressant medication.
These involve the person experiencing depression talking to someone about the way they feel, about problems in their life and about ways of helping them to feel better. They can help both in mild and moderate depression, but also in severe depressions when medication has started to work. It does not necessarily involve 'baring your soul', which many people find off-putting, but is usually very practical. It can involve looking at ways of thinking, about yourself and the world, and which thoughts tend to make you depressed - and changing them. It can help in getting out of the trap of negative thinking that is often part of a depressive illness.
Anxiety or worry is very common and there are very effective ways of helping a person to feel relaxed and worry less. These range from relaxing cassette tapes to special techniques that can be taught. Sometimes, just talking over problems with a doctor, psychologist or nurse can make a person feel better. Sometimes depression may have been triggered by a bereavement or problems in a marriage. Bereavement counselling or marriage therapy can be very helpful.
Treatment with Medication
If the person you care for is so depressed that they have physical symptoms (such as poor sleep, poor appetite and loss of weight), your doctor may think first of prescribing an anti-depressant drug. There are several different types now available, so there should be no difficulty in finding one to suit. But it is worth remembering that all tablets may cause side effects -your doctor will warn you of the common ones. Most side effects are merely a nuisance and tend to get weaker or disappear completely after a few days -so it's worth persevering with them. It's also worth knowing that these drugs will usually not start to lift a person’s mood for a couple of weeks, although they may improve sleep quite quickly. You may find that it takes at least 4-6 weeks for the person to start to get back to normal.
These involve help with practical aspects of daily living. Depression might develop because a person is living in poor housing or a dangerous neighbourhood. If so, a social worker may be able to help the person to move. But a word of warning - it is important not to make decisions about moving when a person is still depressed because they may regret it when then are feeling better. Social workers and mental health workers can also help with finding ways to occupy people with depression and help them spend time with other people. This can be very important because many people become quite isolated when they are depressed and find it quite hard to get back into the swing of things. There may be lunch clubs, day centres and support groups where the person may go.
Not getting better
Although most people get better at home with these treatments, some people do not. If this happens, the GP may ask a psychiatrist to see them for some expert advice or refer them to the Community Mental Health Team for Older People. The GP may need a second opinion or advice about the best treatment in a particular case.
The person may be seen in an out-patient clinic or may be visited at home either by a psychiatrist or a community team member.
The first interview with a specialist psychiatrist or community team member usually takes about an hour. The depressed person may find it difficult to remember some of the details of how it all began. So, the psychiatrist may ask if a friend, neighbour or close relative can attend with them. It will help the psychiatrist to get a complete picture of the situation. The outcome may be a change in medication and a community psychiatric nurse may visit to monitor this. A referral to a clinical psychologist may also be made and the person may be asked to attend day hospital.
Coming into hospital
A small number of people need to have their depression treated in hospital. This may be because they cannot look after themselves properly at home, or occasionally because they want to harm themselves. Sometimes it may be because they need a specialist treatment that is usually only given in hospital.
Getting over a bout of depression is usually straightforward. But doctors are also interested in keeping people well and stopping it happening again. For this reason it is important not to stop any tablets for depression until the doctor advises. Even if the person is feeling back to normal, there's a chance of depression returning if they stop their tablets too quickly. Don't worry - unlike some tranquillisers, tablets for depression are not habit-forming or addictive.
If the person’s general health is good and there has been an obvious upset leading to their depression, they will probably need to stay on the tablets for only 6 to 12 months. If they have already had a number of periods of depression, the GP or psychiatrist may recommend that they stay on an anti-depressant drug for much longer. Psychological treatment also helps the person recognise the warning signs that they are becoming depressed and teaches them strategies to help manage these in the future.
Remember that older people with depression get tired easily. It's often enough to show your concern by being there - or particularly by doing something practical to help, like the shopping or cleaning. It's important to make sure they eat properly and this may mean you preparing the food for them as they may ‘not be bothered’ to prepare food for themselves.
Don't force them to talk. Don't bully them into doing things. Although getting out and getting some gentle exercise helps, it may not help if you find yourself having to nag them to do it. In fact, people will often dig their heels in if they feel they are being put under too much pressure.
Be patient. Older depressed people may constantly ask for reassurance or become convinced that they've got something physically wrong with them. It's often because they are frightened or don't understand what is happening to them. Reassure as much as you can and be a good listener. Especially reassure them that they are not going to end up 'going mad’.
Don't be embarrassed to ask whether they have felt suicidal. It's a myth that talking about it makes it more likely that someone will attempt suicide. Suicidal thoughts are a sure sign that help is needed, and most people who feel like this are relieved when someone asks about it.
Finally, don't make decisions about housing or accommodation when someone you know is depressed. They may put pressure on you and say that it's all to do with where they live. But things are not usually that simple. Many older people who move when they are depressed wish, once they have got better, that they had stayed put.
Looking after yourself
Caring for someone with depression can be exhausting and you may find yourself also becoming depressed! If you are getting worn out by everything, do ask for help. Community Mental Health Team workers can help you by arranging for your relative to go to a day centre or day hospital to give you a break. They can also help by being there for you to talk to.