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A Guide to Mental Wellness in Older Age: Recognizing and Overcoming Depression

Getting Good Medical Care—Talking to Your Physician About Depression

There are many safe, effective treatments for depression and with proper care most people experience substantial improvement or disappearance of all symptoms. Although talking with your family and friends is a good beginning, it is not enough to treat depression. Do not try to treat yourself. Work with your doctor to find the best course of treatment for you.

Before You Go to the Doctor

Find a doctor you can trust—and if you feel more comfortable, take a friend or family member with you. Take a complete list of all medicines you are now taking, including prescriptions, over-the-counter medications, and vitamin, mineral and herbal supplements. Bring your health insurance information.

In the Doctor’s Office

Your physician should:

  • Ask about your symptoms
  • Ask about your general health
  • Check your medications
  • Ask about your family medical history including mental illness
  • Give you a physical exam
  • Conduct some laboratory tests

Diagnosing late-life depression is difficult. A number of physical conditions can cause or contribute to depression. For example, some diseases may cause symptoms of depression. Before prescribing any treatment, your doctor should take the time to make sure that the diagnosis of clinical depression is accurate.

Describe any difficult issues in your life that may be impacting the way you feel. Your doctor should listen to you carefully and answer your questions. It is important to have a trusting relationship with your health care provider and feel comfortable with his or her knowledge, skills, and interest in helping you. Do not leave a doctor’s office until all of your questions have been answered. It is all right for you to question the doctor about his or her experience dealing with depression in older persons. Take notes so you can remember what was said.

If you are uncomfortable with your doctor’s diagnosis or treatment suggestions, get a second opinion or change doctors. If you feel that your doctor appears unwilling to listen to you—as an older adult—or isn’t taking your complaints seriously, find another doctor. There are doctors who specialize in treating older adults (called geriatricians) as well as those who specialize in treating older adults with depression (called geriatric psychiatrists). When suggesting a treatment plan, a physician should have knowledge about which treatments are more effective for people over 60 years of age. There is very little research that is specific to people who experience late-life depression and it is important to seek out a health professional who has experience and education specific to older adults. While some primary care physicians have the training and experience to diagnose depression and prescribe medications, others do not. You should consult a psychiatrist if your symptoms of depression continue, are disabling, fail to improve after two medications have been tried, or if suicidal thoughts are present.

Mental Health Professionals

During your course of treatment, you may have contact with several different types of health care professionals.

Geriatric Psychiatrists are physicians who have completed medical school, four years of psychiatric training, and at least one additional year of training focused on illnesses of adults over 60 years of age.

Psychiatrists are physicians who have had some specialized training in late-life mental illness and are specialists in prescribing and managing medications.

Primary Care Physicians have three years of clinical training in all aspects of disease management and include family physicians and internists. Your first visit to a doctor regarding your symptoms of depression would probably be to your primary care physician or your family doctor.

Geriatricians are family physicians or internists who have specialized training in treating older adults.

Psychologists diagnose mental illness, provide psychotherapy and carry out psychological testing. If one of your treatment options includes talk therapy, you may be referred to a psychologist.

Social Workers are health professionals trained to assist patients and family members coping with difficult issues. They can provide information on housing, finance, and respite care. If you are helping a loved one who needs institutional care or is currently in a nursing home, social workers can be of assistance.

Advance Practice Nurses are registered nurses with advanced degrees. They often work in partnership with physicians. Some APRNs have specialized training in mental illness.

A Guide to Mental Wellness in Older Age: Recognizing and Overcoming Depression

© Geriatric Mental Health Foundation 2004
7910 Woodmont Avenue, Suite 1050
Bethesda, Maryland 20814
301.654.7850
info@GMHFonline.org
www.GMHFonline.org

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, phone and website.