1. Depression and Aging

2. Welcome and Thank You
Alone we can do so little,
together we can do so
much.
~ Helen Keller
Lynn Northrop, PhD

3. National Depression Screening Day
¨ 1991 – 20 years next year!
¨ Initiated by Douglas Jacobs, MD, a Harvard
psychiatrist
¨ Now run by SMH, Inc., a non-profit based outside of
Boston which Jacobs heads
¨ Raises awareness about depression and depression
treatment
¨ Screenings occur in every state in the US
¨ Screens more than a half million people per year
Lynn Northrop, PhD

4. What is Depression?
Major Depressive Episode* = symptoms for 2 weeks or more
Depressed or irritable mood AND Older adults
at least 4 below: More likely to report
¨ Loss of interest or pleasure physical symptoms
¨ Change in weight or appetite Less likely to report mood
¨ Change in sleep symptoms
¨ Change in psychomotor activity More likely to report
problems with memory
¨ Fatigue or low energy
¨ Worthlessness or guilt
Apathy and withdrawal
more common
¨ Cognitive dysfunction
Diminished self-worth is
¨ Recurrent thoughts of death
more prominent
- self or others (suicidal ideation)
¨ Interferes with functioning Lynn Northrop, PhD

5. Mood Disorders
• Major Depressive Disorder
• Dysthymia
• Minor Depression
• Bipolar Disorders (I&II)
• Hypomania
Lynn Northrop, PhD

6. How common is major depression?
¨ 21million people in US with Major Depressive
Disorder
¨ Lifetime prevalence: 1 to 2 out of 10 people
¨ Older and younger adults have same risk
¨ More common in medically ill of any age
¨ Very common among caregivers (more than half)
Lynn Northrop, PhD

7. Lynn Northrop, PhD
Estimated number of depressed older adults
Number of 11% clinical
Area
people age 65+ depression
California 3,866,140 42,5275
SD County 325,615 35,818
La Mesa 11,605 1,277
City of San
128,008 14,080
Diego

8. How does depression impact health?
¨ Depression is predictive of hip fracture (Mussolino, 2005), a
second heart attack (Carney and Freedland, 2007), stroke
¨ Treating depression reduces arthritic pain (Lin, 2003)
¨ OA treated for their depression are 45% less likely
to die in next 5 years (Univ. of Penn, 2007)
¨ Correlation with adherence and health behavior
¨ 30,000 deaths by suicide in the US
 more than alzheimers, homicide, liver disease, arteriosclerosis, or HTN
 Suicide 50% higher in older adults
Lynn Northrop, PhD

9. Additional Impact of depression
¨ Reduced Quality of Life
¨ Lost Productivity - $44 billion cost to employers
 Leading cause of disability in US (NIMH)
¨ Lost, damaged relationships
¨ Less likely to take meds as prescribed, follow
medical advice, etc.
¨ When all else is equal, depressed elders more
likely to be placed in nursing home.
Lynn Northrop, PhD

10. Who gets depressed?
¨ Anyone
¨ You, me, everyday people and famous people
¨ Rich, poor
¨ Male, female
¨ Young, old
¨ People of all races, religions, ethnicities,
occupations, IQ s
¨ People across history
Lynn Northrop, PhD

11. Edwin "Buzz" Aldrin, astronaut Abraham Lincoln, U.S. President
Alexander the Great, king Greg Louganis, U.S. diver and Olympic gold medallist
Hans Christian Anderson, author Robert McFarlane, former US Nat’l Security Adviser
Drew Barrymore, actress Marilyn Monroe, actor
Ludwig von Beethoven, composer Sir Isaac Newton, physicist
Marlon Brando, actor Florence Nightingale, British nurse
Dick Cavett, broadcaster Richard Nixon, U.S. president
Ray Charles, R&B performer Deborah Norville, television journalist
Winston Churchill, British prime minister Dolly Parton, singer
Dick Clark, entertainer (American Bandstand) Jimmie Piersall, baseball player
Calvin Coolidge, U.S. president William Pitt, Prime Minister
Francis Ford Coppola, director Sylvia Plath, poet
Charles Darwin, explorer and scientist Edgar Allen Poe, writer
Kitty Dukakis, former First Lady, Mass. Jackson Pollock, artist
Thomas Edison, inventor Cole Porter, composer
Ralph Waldo Emerson, writer Yves Saint Laurent, fashion designer
Sigmund Freud, psychiatrist Charles Schulz, cartoonist (Peanuts)
Dwight Gooden, baseball player George Stephanopoulos, political advisor
Tipper Gore, wife of U.S. Vice-President Darryl Strawberry, baseball player
Phil Graham, owner, Washington Post Spencer Tracy, actor
Stephen Hawking, physicist Ted Turner, founder, CNN Network
Andrew Jackson, U.S. President Mark Twain, author
Thomas Jefferson, U.S. President Vincent Van Gogh, artist
Larry King, talkshow host Walt Whitman, poet
Robert E. Lee, U.S. general Jonathan Winters, comedian
John Lennon, musician Natalie Wood, actor
Lynn Northrop, PhD

12. Lots of older people get depressed…
Does that mean it’s
a normal part of aging?
Lynn Northrop, PhD

13. No.
Depression is a treatable medical illness.
No more common in older adults
than younger adults.
It is not any more normal
than diabetes or cancer.
Lynn Northrop, PhD

14. Depression is a physical illness.
Lynn Northrop, PhD

15. How is depression treated
Antidepressant Medications
Therapy
 Individual, group, IOP, inpatient
Medication + Therapy
ECT, TMS
Lynn Northrop, PhD

16. At the cellular level
Depression
affects
chemicals
that
enable
cells to
talk to
each
other.
Lynn Northrop, PhD

17. Glucose metabolism
Depressed
brains use
glucose
differently.
Change
thoughts,
change the
brain.
Lynn Northrop, PhD

18. What puts people at risk for depression?
¨ Chronic medical problems
¨ Chronic pain
¨ Poverty
¨ Loss
Are these
¨ Chronic Stressors CAUSES? (like
¨ Isolation
heat causes burns
or viruses cause
¨ Limited social support
flu?)
¨ Family history
¨ Previous episode
¨ Some medications
Lynn Northrop, PhD

19. Lynn Northrop, PhD
Do situations cause depression?
Alice and Georgia lived in the same
senior housing complex.
Both 85 y.o., retired, recently widowed, live alone,
very limited income, diabetes and heart disease,
chronic severe arthritic pain, one daughter -- lives
nearby, family and personal history of depression,
And here s the kicker…
Georgia was depressed. Alice was not.

20. Cognitive-Behavioral Model of Depression
¨ Depressed people are more likely to think
inaccurate thoughts and to believe them.
¨ Depressed people are more likely to behave in
ways that maintain depression.
¨ Treatment targets thoughts and behaviors.
Lynn Northrop, PhD

21. Common Inaccurate Thoughts
¨ All-or-nothing
¨ Negative filter (on self and others)
¨ Catastrophic
¨ Mind-reading
¨ Taking it personal
¨ Should statements
Lynn Northrop, PhD

22. Common changes in behavior
¨ Dropping hobbies
¨ Spending more time alone
¨ Sit more
¨ More time in bed
¨ Complain/criticize more
¨ Dismiss compliments
¨ Procrastinate
¨ Less self-care
Lynn Northrop, PhD

23. Lynn Northrop, PhD
Cognitive Behavioral Model of Depression
Thoughts
Behaviors Feelings
Focused on the here and now more than history

24. Downward Spiral
Feel Bad Feel Even
Better
Do Less Do More
Feel Worse Feel a Little
Better
Do Even Do
Less Something
Lynn Northrop, PhD

25. Staying well…
¨ Stay active At Gary and Mary West Senior
Wellness Center:
¨ Keep connected • Feeling fit
• Yoga
¨ Daily APES • Tai chi
• Travel class
¨ Strive for accurate • Movies
thinking (not always +) • Cooking class
• Book club
¨ Look for the good • Civic engagement/volunteerism
• Games
¨ Live in the moment • Health education
• Sing-along
¨ Complain/criticize less • Bingo
• Stress and happiness
¨ Express gratitude management class
• SCREENINGS
every day • And more! Lynn Northrop, PhD

26. Take Home Messages
¨ Depression is fairly common, but not normal
¨ Depression is a medical illness, not weakness, not
crazy
¨ Depression leads to many adverse consequences
(social, medical, can be fatal)
¨ Depression is very treatable
¨ Help is available
¨ If you or a loved on is depressed, get help
Lynn Northrop, PhD