MEDICAL MATTERS:The over-60s need to be reminded that they are not forgotten in their battle with depression, writes Harry Barry.
IT IS widely accepted that we have a large cohort of young people under 30 suffering from depression, many hidden and in pain. Less well known is the existence of another large group in our population also struggling with this illness.
Many remain hidden, some in such despair that taking their own lives seems the only way to end the inner torment.
They are the "forgotten ones" - the over-60s.
There may be many reading this article, quietly, stoically enduring the inner pain, total exhaustion, difficulties with appetite, sleep, concentration, memory and drive; the preoccupation with minor ailments; the complete disappearance of normal enjoyment in life; the constant anxiety, the feelings that they are worthless and of no value - "no one would really miss me", and the "pain would be over".
Some will be living in rural isolation, others in the noise and clamour of our busy towns and cities. Some will be alone, either widowed or single, others in good relationships, surrounded by those they love, yet still in real despair.
Some are working, others retired. For depression knows no frontiers, and can visit any of us at this age. Some will be using alcohol, either secretly or otherwise, to help deal with the pain.
The causes of depression in the elderly are diverse. Some will have it all their lives carrying it into their later years. But many will suddenly develop it for the first time in their 60s and onwards.
The reasons are both biological and social in nature.
As we get older, our mood cables start to shrink, and we get a gradual reduction in the number of neurons in the brain, making us more vulnerable.
The real enemy, however, is hidden damage, from atherosclerosis, to tiny blood vessels supplying the nerve tracts to the front part of our brain, particularly the left frontal lobe.
This subtle vascular ischemia makes the onset of depression more likely and is, in my opinion, one of the main biological reasons for the appearance of depression in the elderly.
If we have a large stroke affecting the left side of the brain we are almost inevitably going to develop depression, although it is usually unrecognised and untreated.
Sometimes depression may develop secondary to other illnesses in this group.
Half of those who develop Parkinson's disease will develop it due to disruption of their dopamine mood cable. It may occur as a result of an under- active thyroid gland, or with dementia.
But most in my experience will have no obvious physical illness present.
Of the social causes, loneliness is the most important. As we get older, the loss of loved ones, especially spouses, takes a heavy toll on our emotional coping mechanisms, at a time when we are least able to handle it.
Many elderly living in cities are lost in the concrete jungle and are socially very isolated. Rural isolation is also a huge problem in parts of Ireland where we are losing some of our elderly to the white flag of suicide, as depression, loneliness and isolation combine.
Many elderly people feel useless, and a burden on those around them. If illness visits in conjunction with depression, this feeling is heightened.
For those coping with an elderly spouse suffering from dementia, strokes and so on, the stress endured may overwhelm their coping mechanisms and depression can result.
Another hidden issue is the abuse of alcohol by this age group, at a stage of life when the brain is least able to cope with it, and this may be increasing risks of both depression and suicide.
To treat depression in this age group we must firstly recognise it, something we to date have been very slow to do.
All of us need to look out for the warning signs in our elderly relations, families, friends and neighbours. All those who look after them in nursing homes also need to be on the alert.
When identified, the treatment as always must be holistic. Proper nutrition is vital; 30 minutes of exercise, if possible, is another cornerstone; avoiding alcohol; and supplements are often helpful.
If mood is very low, drug therapy can be of great help and has transformed the lives of many. Counselling, particularly bereavement counselling, can help greatly. Simple CBT (cognitive behavioural therapy) exercises can help others.
I also feel that loneliness and social isolation must be tackled. I often suggest a pet, as I feel the emotional nourishment gained is invaluable.
Encouraging the elderly to attend a day-care centre is another powerful way to help fight loneliness.
The nourishment of young children can also be of assistance. Love, physical contact, the reassurance that they are "not forgotten" can, with all the other therapies, transform the lives of many of our elderly.
Dr Harry Barry is a GP in Drogheda, who has written a book titledFlagging The Problem: A New Approach To Mental Health (Liberties Press, €19.99)