Making the diagnosis of depression is much more challenging in the elderly, especially those who are physically frail. Many physicians feel rushed and don't take enough time to look for the subtle signs suggesting depression in the older patient. Complicating factors include deteriorating mental function, the possible side effect of medication or coexisting medical illness with overlapping symptoms.
Physical exercise can be a wonderful treatment for depression but often difficult to do in the geriatric population. Many older patients are reluctant to take pills for depression even though medication is highly effective and usually without significant side effects when carefully chosen. In the elderly a full improvement may take as long as two to four months of therapy but some improvement should start within four weeks. I always start with lower doses of depression medicine and advance gradually until benefit is realized.
Too often the elderly depressed patient is either under-treated or not kept on medication, as recommended, for six to 12 months after achieving full remission. As in the teenage population it's important to monitor for suicide risk particularly in the early stages of treatment.
Dr. Josh Schwartzberg has practices in Willsboro and Lake Placid. He can be contacted at 877-DOC-JOSH.