"Older people need a dream, not only a memory Long-term course and outcome of depression in later life Charles F. Reynolds III, on pages 95-99 Depression in late life is widespread and serious, and caus- es significant suffering and disability.  Like diabetes, arthri- tis, and other common illnesses in older people, depres- sion is a chronic disease and not a one-time incident. Rather, depression is a long term episodic illness that is persistently disabling.  Over the long-term, therefore, depression requires treatment, behavioral and lifestyle change, and vigilant monitoring and management.   Designing an intervention to prevent suicide: PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial) Martha L. Bruce, Jane L. Pearson, on pages 100-112 Depression is certainly a contagious disease:  anyone who has ever lived with someone suffering with depression will report that the depression affects the whole family and everyone else around. Depression affects everyone com- ing into contact with an older person. Nonetheless, recog- nition of depression in older persons remains problemat- ic. Older people themselves and their close relatives are often unwilling to acknowledge depression because of long-standing stigma about mental illness. Even primary care physicians will overlook symptoms of depression or see them as secondary consequences of other illnesses. Unrecognized or inappropriately treated depression will cause or magnify disability, and will strongly increase the risk of suicide.  Worldwide, rates of completed suicide increase with age. Treatment of depression in late life Lon S. Schneider, on pages 113-124   This unnecessary suffering and death is all the more dif- ficult to accept when we realize that a broad array of safe and efficacious treatments for depression are available and have been shown to work well in older persons. Vascular depression: a new view of late-onset depression George S. Alexopoulos, Martha L. Bruce, David Silbersweig, Balu Kalayam, on pages 68-80 Depression in late life: psychiatric-medical comorbidity Ira R. Katz, on pages 81-94 Making someone well is not the sole issue, however. The real challenge in treatment is keeping someone well by preventing relapse or recurrence.  This means that continuation and maintenance treatments are required, and might well be a lifelong necessity in some older people. Research on etiology and pathophysiology leads to the strong conclusion that physical illness, medical burden, and in some cases, cerebrovascular disease are causally implicated in late life depression, particularly the depression that has a first onset in late life. Genetics, family history and psychosocial stress do not seem to play as strong a causal role in late- onset depression as in early and mid-life. Stress and social support do alter the nature of response to treatment, however, and significantly increase the  risk  of  relapse  or  recurrence.  If  we  have learned   nothing   else,   we   have   learned   that depression is a disease, that it is not a normal part of aging, and not the expected normal response to all the stresses and strains of old age. The usual state of aging is not sadness, demoralization, or depression.  As with people of any age, older per- sons suffering from depression need and deserve our  full  efforts  in  recognition,  diagnosis,  and treatment of this illness. Barry D. Lebowitz, PhD I n   t h i s   i s s u e . . . 5 6
Vol 1 n° 2 - Depression in the Elderly
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