A Guide to Mental Wellness in Older
Age: Recognizing and Overcoming Depression
Treatment Options for Late-Life Depression
is treatable. Treatment will reduce your pain and suffering
caused by the symptoms of depression.
The first treatment may not work—you may have
to try one or two different methods before finding
the best one for you. Try not to get discouraged—it
may take some time to recover.
The most prescribed
treatments for late-life depression are medication
and psychotherapy (talk therapy). Medication
is often necessary to balance the chemicals in your
brain, but psychotherapy can help you cope with your
feelings and help change some of the patterns in your
life that may have contributed to the illness. In some
cases, the physician will suggest medication as a necessary
first step until your symptoms have lessened enough
to benefit from psychotherapy. In many instances, psychotherapy
is as effective as medications for depression.
Great progress in the treatment of depression
has occurred in the past ten years with the development
safer, and easier to use medications for depression.
Although some people don’t understand why they
need to take medication for what they may consider
to be a weakness, depression should be thought of as
any other illness. Depression is no different than
other illnesses like diabetes or high blood pressure—it
can be successfully treated.
Antidepressants are the
types of drugs normally prescribed for people diagnosed
with depression. Antidepressant
medications are not habit forming. There are more than
20 antidepressants available, however, not all antidepressants
are as effective for people over 60 years of age as
they are for younger persons. In addition, it is important
for your physician to know all of the medications you
are currently taking—including vitamins, herbal
supplements, alcohol and tobacco, and recreational
drugs—because the combination of medications
can impact the effectiveness of your treatment. You
should also be honest with your physician about your
consumption of alcohol and tobacco. Antidepressants
may take longer to start working in older adults than
in younger adults.
All medication treatments have some
side effects. Side effects can include drowsiness,
dry mouth, muscle aches,
light-headedness, diarrhea or constipation. Your physician
will want to work with you to see which medicine you
can tolerate the best because it is very important
to keep to your treatment plan. No two people respond
the same way to the same medicine—while one person
can have total improvement with one medication, another
person with similar symptoms may not benefit or may
experience different side effects. Never stop your
medication or adjust the dosage on your own. If you
and your doctor decide it is time to stop medication,
you may agree on a schedule to decrease the dosage
You should start to feel some relief from
your depression two to eight weeks after you start
although it may take up to three to four months for
substantial improvement. Continue taking your medicine
even if you begin to feel better. Sometimes physicians
prescribe lower loses of antidepressants for persons
over 65 years because of their increased
sensitivity to medications. This may make the recovery
period a bit longer. Depression can reoccur if medications
are stopped too soon or stopped without gradually tapering
off. Antidepressants are usually prescribed for three
to six months to provide initial relief from depression
and then continued for a minimum of an additional six
months for maintenance of care.
There are different
classes or types of drugs that can be prescribed for
depression. Each class of medicines
or drugs acts a little differently on the brain and
may have different side effects. Side effects usually
happen early in treatment or after a dosage increase—and
they may disappear over time. The following table shows
which drugs are grouped in a class and their possible
side effects. The drug’s scientific or common
name is listed first and the brand name is in parentheses.
Classes of Medications Used in Treating Depression
in Older Adults
Examples of the medications used to treat depression
are listed. This is not a complete list.
|Classes of Medications
||Examples: Scientific Name and Brand Name of Drugs
Included in the Class
||Possible Side Effects
|SSRIs (selective serotonin reuptake inhibitors)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Paroxeltine (Paxil)
- Sertraline (Zoloft)
- Trazodone (Desyrel)
- Upset stomach and other gastrointestinal
- Sexual dysfunction
- Possible sedation—Trazodone
|TCA (tricyclic antidepressants)
- Desipramine (Norpramin)
- Nortriptyline (Pamelor)
- Dry mouth or eyes
- Urinary retention
- Rapid heart beat
- Low blood pressure
- Low blood pressure
- Liver disease or liver toxicity–Do not use
Managing Side Effects of Medications Used in
Treating Depression in Older Adults Side Effects What
You Can Do
||What You Can Do
- Take medication at bedtime.
- Try caffeine (coffee, cola, etc.). Check with
your physician first.
|Dry mouth or eyes; urinary retention; rapid heartbeat
- Drink more fluids.
- Chew sugarless gum.
- Use artificial tears, eye drops.
- Increase fiber in diet.
- Talk to your doctor about switching to another
- Symptoms should improve in 1-2 weeks.
medication with meals.
- Ask your doctor about
Jitters or tremors
- Ask your physician to start with small dose.
your doctor about reducing the dose for a temporary
period of time.
- Talk to your doctor about the
symptoms—he/she may add a mild sedative for a
- Ask your doctor if you should decrease the dose.
to your doctor about taking acetaminophen
(Tylenol) or ibuprofen (Advil, Motrin).
- Take the medication in the morning.
- This side effect may be part of the depression
or caused by another medical disorder. Talk to
- Ask your doctor if you should decrease
- Ask your doctor about a trial of Viagra
- Ask your doctor if you should
consider changing medication.
Questions to Ask Your Doctor About Your Medications
- What are the common name,
product/brand name and suggested level of dosage for
this medicine? Is there
a generic form and is it appropriate?
- What dosage of
medicine should I start with? Is there a preferred
method and time to take the medicine
first thing in the morning, before bed at night, with
or without food)?
- What does the physician expect the medicine to
do and how long will it take to do it?
- How well has this medicine worked for other older
- What are the possible side effects for taking this
medicine; are they usually short-term or long-term
- Is there any way to minimize the side effects?
- What restrictions need to be considered when taking
this medicine? Is it okay to drink alcohol?
- Are there any tests that need to be taken before
I begin taking this medicine and during the time I
am taking this medicine?
- How do I know when the dose may need to be changed
or the medicine stopped?
- How much does the medicine cost? Are there any
programs that may help to cover the costs of the prescriptions?
- How do I reach the doctor if the side effects
get very bad—bad enough not to be able to take
- How often do I see the doctor—when is my
- Are there other things I can do in addition to
taking the medicine to help improve my mental health?
medicines exactly as the doctor has instructed. If
you miss a dose—do not double the next dosage.
Get back on schedule and follow the prescription as
written. Do not stop taking the medication without
talking with your physician.
Psychotherapy and Counseling
Psychotherapy or talk therapy
can help you develop the skills and behaviors that make
it easier to cope
troubling events and ease the feelings of depression.
If your physician suggests psychotherapy as part of
your treatment, it may be with the physician or he
or she may refer you to another health provider such
Support and education are an important
part of depression treatment. There are several different
types of therapy.
Psychotherapy can involve yourself and your family,
who may join you for part of the sessions. Group therapy
involves a group of unrelated individuals with a common
experience. Group therapy for patients with depression
provides a communal experience of guidance and education
that can assist with treatment. One approach is not
necessarily better than another one—you should
find the one that works best for you.
Psychotherapy and counseling are important in the
treatment of depression for older adults. As older
and alter their life roles, individuals may experience
significant life crises, may lack social support systems,
and may not have the coping skills needed to deal
with these new situations. The goal of psychotherapy
discuss issues and problems in order to eliminate
or control troubling and painful symptoms. Sessions
last 45-50 minutes and focus on identifying the possible
triggers of depression and how to manage them.
ECT or electroconvulsive therapy is used as a
valid treatment option today, but the actual procedure
quite different than what has been portrayed in the
movies as a harmful experience.
The use of ECT in
treating older adults with depression can be very useful
as it is faster and safer than
medications. Older adults who have had ECT report
that there are
few side effects. ECT is normally prescribed for an
older adult who has tried several medications with
little success or has symptoms that are severe. As
course of treatment, the use of ECT and its impact
may depend on other health problems you may have.
your physician recommends ECT as a course of treatment,
it is important to discuss what to expect, how long
the treatment will last, and possible side effects.
You should feel comfortable with the process. ECT
is usually administered in the morning. The patient
given a general anesthetic and is unconscious and
does not suffer from any pain or physical convulsions.
is usually given in a series of short treatments—several
times per week over a period of time. Some patients
report that their thinking is fuzzy, and some experience
headaches, nausea and short-term memory loss—particularly
shortly after the treatment is administered. As with
medication treatments, these side effects are usually
temporary and go away after a short period of time.
ECT has been shown to be very effective, but the relapse
rate is also very high if there is no ongoing treatment
for depression. If your physician suggests ECT as
a treatment from which you may benefit, make sure
you will be monitored throughout and after the procedures.
Some herbal remedies, such as St. John’s
Wort, have received a lot of attention in recent years
being effective for the treatment of depression. The
National Institute of Mental Health undertook a research
study to determine whether there was any scientific
evidence to support the use of St. John’s Wort
for depression. Although no elderly patients were
included in the study, results showed no difference
John’s Wort and a placebo. Despite this research,
many people still promote the use of herbal remedies
as safe for treating depression. The most important
factor to consider if you are thinking of taking St.
John’s Wort or any other herbal mixture is that
natural substances are not necessarily safe. In fact,
there are studies to show that taking large quantifies
of some herbals can have very dangerous side effects.
Natural does not mean safe! Talk to your doctor if
you are taking or considering herbal remedies.
A Guide to
Mental Wellness in Older Age: Recognizing and Overcoming
Geriatric Mental Health Foundation 2004
7910 Woodmont Avenue, Suite 1050
Bethesda, Maryland 20814
Expert assistance was provided by
Lissy F. Jarvik, M.D., Professor Emerita of Psychiatry
and Biobehavioral Sciences,
University of California-Los Angeles, School of Medicine;
Susan Lieff, M.D., M.Ed., Assistant Professor, Department
of Psychiatry, University of Toronto; and Stephen
J. Bartels, M.D., M.S., Associate Professor of Psychiatry,
Dartmouth Medical School.
The Geriatric Mental Health
Foundation grants permission to print, photocopy,
and distribute this material.
Please cite the Foundation, including the address,