Causes, Mechanism, and Diagnosis of Depression - Essay Example

Running Head: Main Causes of Depression for Older People Name: Course: College: Tutor: Date: Introduction Depression is a condition on the state of mind where a person experiences a lot of sadness, desperation, has a sense of hopelessness and even dejection. Studies by other scientists and the National institute of mental Health, agree that depressive illnesses are disorders of the brain and technologies like magnetic resonance imaging have been used in studies and have shown difference of the depressed people’s brain from brains of normal people. MRI images from patients show abnormality in some parts of the brain that are responsible for behavior, sleep, appetite thinking, and even mood. Depression is a common disorder but serious and needs treatment. Studies indicate that though serious, if treated the disorder can be cured. In contrast to various studies, depression as a condition is not exclusive to older ages but felt across all the ages; young and old though the older group is more vulnerable than the younger ones. The symptoms of this condition are also often similar in both groups though in the older group it might be hard to detect them. Research by the Black Dog institute (2008) indicates that the older groups have a tendency of under-reporting the cases since they might not know when they are sad, down or even depressed. Despite all the studies though, there is no single isolated known cause of depression. It is however attributed to a combination of biochemical, genetic, environmental and psychological factors that can be managed or treated. Depression in Older Adults General mistakes have been made by people assuming that depression is normal part of aging. This condition however is not a normal part and studies show that most seniors feel satisfied with their lives despite increased physical ailments Gallo et al (1999). With this in mind, once an older person suffer from depression it is easily ignored as the older adults might exhibit variation and difference symptoms which does not necessary need to have been experienced earlier either through mood, behavior or misfortune. Research done in other different areas of the world indicates that there is high prevalence of this condition in older people. Almeida et al (1997) showed that depressive symptoms and tension are highly prevalent in late life in São Paulo, and referred to the evidence that depression was associated with increased burden on primary health care services. Another study done in China placed the prevalence of depressive disorder symptoms in nursing homes between 30-75% and those presenting with the depression disorders well over 20%. Other reporting data from 15 centers around the world stated that nearly half of the subjects with ICD-10 anxiety or depression were not recognized as having such a disorder by the primary care physicians responsible for them Satorius et al (1996). Lack of this detection has been seen to some extent to contribute to the low figures reported on the prevalence of the condition. Prince et al (1999) by contrast however in his analysis from subjects aged over 65years in 14 centers in Europe showed that there is no overall tendency for the prevalence of depression disorder cases to fall or rise with age. According Palson et al (1997), old people aged between 65 to 75 years tends to experience depression which over shadows marked depression prevalence later than 75 years. Having all this surveys conducted all over, it is deduced that depression appears to exist along a continuum but clinically significant depression is common in old age. According to the National Institute of mental Health (2008), the prevalent old aged depression is non-melancholic type occurring at 10% of the aged adults. This depressive state causes considerable disablement and distress and may persist unrecognized for years. This probably is attributed to deterioration of older people health status leading to their depression. Different forms of Depression Depression affects both men and women but it is known to affect women more than men since there are more women diagnosed with depression in any given year than men Kessler et al (2003). The National Institute of mental health and other scientists state that some of the most likely potential causes of depression on women are genetic, biological, chemical, hormonal, environmental, psychological and social factors that interact to cause in a person and to some extent same to men. However, some studies indicate that some types of depression tend to run in the families, suggesting a genetic link. However people without family histories of disorders tend to suffer depression as well thus not excluding the environmental factors that can lead to this disorder Tsuang (1990). According to the National Institute of mental Health, depressive disorders are known to exist in several different forms. The most common forms are the major depressive disorder and dysthymic disorder. The Major Depression: This type is distinguished by a grouping of symptoms which affects ability of a person to work, study, eat, sleep, and leisure. Scientific studies indicate that this kind of depression is disabling and prevents a person from functioning normally, it is said to occur once in someone’s life time but more often it recurs through out a person’s life. Dysthymic disorder/dysthymia: Is characterized by long-term although has less severe symptoms that can not impair someone though may result to uneasiness. Individuals with dysthymic disorder have frequent encounter of major depression too with recurring incidences of major depression. Despite the above mentioned depressive disorders, there are some other forms of disorders that exhibit different characteristics or may develop under unique circumstances. This has however blown a lot of disagreement from some of the scientists on how to characterize them. These disorders include: Postpartum depression: This condition is diagnosed if a new mother develops severe depressive episodes within one month after delivery Altshuler et al (1998). It is known that women are particularly vulnerable to depression after giving birth when the responsibilities of caring for new born and hormonal changes kick in overwhelmingly. Other women who experience postpartum depression however are also known to often have had prior depressive episodes, though those experienced during pregnancy often go undetected. The Psychotic depression: This condition arises due to depression disorders accompanied hallucinations, delusions and loss of touch with reality. The Seasonal affective disorder (SAD): This condition is characterized by inadequate natural illumination especially during winter season and begins with depression disorder. The depression according to the medical journals generally lifts during spring and summer Rohan et al (2004). Causes of depression in older people Healthy always individuals have low prevalence of experiencing the depression disorders. Causes of the depression in older people have been a subject of study in many parts of the world. According to Chaim (1994) study in the Institute of Mental Health hospital, the causes of depression were grouped into; biological causes, psychosocial causes, physical ailments and medication. The National Institute of mental Health though adds to the groups the cause by loss in old age. However, previous studies by Brown et al (1978) had picked an argument that suggested that all depression is caused primarily by psychosocial factors. It has been found in out in various studies that not many patients who present with the depression disorders had family histories of the same to suggest genetic inheritance. Therefore biological effects mostly suggesting cause are found to be on the minimal in the studied cases. Physical health Physical illness, Depression, and disability are all interrelated directly or indirectly. The physical impairment of a person can cause depression especially if it has direct effects on the cerebral functionality of the adult. The kinds of effects on the brain may affect the sleep causing a lot of fatigue and loss of appetite and may even lead to disability. According to the studies done by Chaim (1994) some of the physical illnesses that can cause depression include infections (influenza, viral pneumonia), endocrine illnesses, collagen diseases, neurological conditions, neoplasms and nutritional deficiencies (pellagra and vitamin B12 deficiency) Social isolation and loneliness Old age depression in most cases encouraged by social isolation and loneliness which old people do experience in majority of cases. This is simply because most old people have either lost touch with their, culture of origin and active participation in local community work due to physical deterioration and depression. Loss in old age Many old adults are known to rely on people close to them and even have a attachment to people who seem to give hem attention. Loss of such people in their lives sometimes can become so traumatizing for them and may lead them into a depressive state of mind. These situations sometimes trigger onset of some physical ailments and even lack of appetite. Psychosocial causes Studies by Chaim (1994) concluded that old age is frequently said to be a time of deprivation and the elderly usually have problems of poor health, poor eyesight and poor mobility. At this age also loss of some things; loss of income, status and useful roles of hose around them and in the society may follow retirement. With losses all round an elderly is most likely to fall into depression. Previous studies have demonstrated that depressed patients experience more serious adverse life events before the onset of the ill ness than subjects in the general population, (Paykel et a!, 1969; Brown et a!, 1973) This thus brings a view that depression in the old age is brought about by such kind of deprivation, study by Gelder (1989) supposes that there is no evidence for such an association. He states that it is the ability to form a relationship that affects the way an elderly person reacts in the face of such life events. Medical causes Drugs also are known to be a cause of depression especially when abused. Drug abuses on the other hand are more often by the seniors since they try to calm their nerves by self medicating. Some of the drugs that can cause depressive symptoms include steroids, antihypertensive, diuretics, beta-blockers, hypnotic/ anxiolytics, alcohol, oestrogen Chaim (1994). Signs of depression It is not easy to detect depression due to multiplicity of issues, however, older individuals and other age grouping depicts similarity of depressions signs. A comparison with younger people, indicate that older people under report depressive symptoms and may not acknowledge when some of their moods change. Some of these symptoms may either be chronic unexplained physical symptoms, memory loss or even behavioral changes. Chronic unexplained physical symptoms Older individual in most cases experience a number of long term and recurrent physical symptoms with little medical documentation. This symptoms involves; loss of weight, insomnia, pains, dizziness and chronic aches. Memory loss This condition is very common in old age depression but memory changes sometimes may develop to memory impairment. On the onset of this one may think it is dementia and the older person and the family both become faced with a dilemma and fail to see the depression. Depression treatment recovers the memory to some extent and hence it is essential. Behavioral changes According National institute of Mental Health (2008), behavioral changes vary from one individual to another and these changes include; Agoraphobia; the fear of open places, this leads to refusal to eat, alcoholism, dirtiness, drug overdose. A situations where older individual is preoccupied by changing their will, gives away personal possessions, talks about death, takes an unprecedented interest with firearms should not only alert friends moreover family of the possibility of depression, but also suicide risk. Interventions Depression disorders found in our society are not a mystery neither hard for them to be managed once they occur. These conditions can be cured though it depends on the severity of the person and the preference, experience and technique of the physician. Medication: Medication is applied majorly in severe depression disorders. In this kind of treatment antidepressant medication is usually required. It has been noted however that in older people elimination and metabolism of the drugs is low thus medication has to be started on a lower dose and increased gradually to minimize the side effects. According to the Black Dog institutes (2008), in older people, interaction of the drugs however can occur normally though some drugs eg. Tricyclic antidepressants can have side effects thus are used less often. Some of the newest and most popular types of antidepressants according to the National Institute of Mental Health are called selective serotonin reuptake inhibitors (SSRiS). This types of antidepressants are more popular than the Tricyclic (TCAs) and Monoamine Oxidase Inhibitors (MAOIs) since they have fewer side effects, they include; fluoxetine (Prozac), citalopram (Celexa), sertraline (Zoloft) and several others. Electroconvulsive therapy (ECT): This method in other studies is known to be reliable and efficient in elderly depressed patients’ management. The method is recommended in management of melancholic and psychotic depression and furthermore, in a situation where depression medication has failed to some extent. However, care is taken in account when handling anesthetic although older people do tolerate treatment well (NIMH, 2008). Psychotherapy: Psychotherapy is recommended for management of melancholic depressions. In the treatment of older patients, it is often that shorter therapy courses are done but the treatment response is as good as in young people. The psychotherapies are efficient in management of depression. The psychotherapy method is divided into two main categories; Interpersonal therapy (IPT) and cognitive-behavioral therapy (CBT) and. Depressed individuals are taught on how to live and think positively, and changing negative behavior as this contributes directly to depressive disorders. These individuals are also taught on stress management and problem solving techniques. The National Institute of Mental Health (2008), suggests different forms of depression treatment such as active participation in social roles, healthy physical activities and music which has known to be therapeutic for depressed patient Since most of the depression disorders are brought about by the changes in ones surrounding environment, it is suggested that lifestyle change in mid life may be the key to prevention of occurrence of this condition in older age. So controlling the known risk factors may prevent depression. These include: increased physical exercise, weight control, moderate alcohol consumption, consumption of a diet rich in fish, grains and greens, reduction of high blood pressure, ceasing cigarette smoking, reduction of cholesterol and lipid levels. Other means or lowering the depression risks include; active involvement in social activities, earlier management of chronic disorders, and psychological (Black Dog institute, 2008). 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