Question

My 81 year old mother has depression but has not responded to her antidepressants. What can I do to help her?

Answer

Depression is very common in later life. It is frequently associated with some evidence of confusion in older people. It may well be that because of this, or for some other reason, your mother never took the tablets as they had been prescribed, or may even have stopped taking them altogether. Or she may simply need a different antidepressant or higher doses. Antidepressants are effective but doctors, wisely, tend to start with a low dose and adjust the dose upwards in relation to side effects and response. There are many different types of antidepressants and it is quite possible to find one which is suitable for your mother, even if one or two unsuccessful ones are tried first. So do persevere.

Alternatively, your mother, like many older people, may have other pathologies which make the diagnosis of depression more difficult and its management less certain.

The response to treatment is related to how old the person is, i.e. the older the person, the less good the response, for how short a time the depression has been there, whether previous mood adjustment has been good, the absence of other disabling physical illnesses and perhaps even good recovery from previous episodes. Poor outcome is associated with the severity of the initial illness, poor compliance with antidepressant medication, and severe life events in the follow up period.

One should not forget non-drug measures such as activity, which is often considerably reduced in depressed people and so deprives them of social stimulation and rewarding experiences. Finally, psychotherapy may be effective, especially if the depression is mild to moderate.

In the past, older people with depression were regarded as a separate group, but recent studies have shown that the response to treatment is similar in both young and older people. So the principals of treatment are the same for adults of all ages, although it is perhaps more necessary to be worried about the risk of suicide in older than in younger patients.

Links

• A 'silent' cause of depression in the elderly