- Depressed mood most of day, nearly every day
- Marked diminished interest or pleasure in all, or almost all, activities most of day, nearly every day
- Significant weight loss when not dieting or weight gain
- Insomnia or hypersomnia nearly every day
- Psychomotor agitation or retardation nearly every day
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive or inappropriate guilt
- Diminished ability to think or concentrate, or indecisiveness, nearly every day
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
If you are seeing a number of the symptoms above in your loved one, these symptoms may be the result of a medical condition. Many people may lose or gain weight in response to side effects of a medication already prescribed. Many narcotic pain medications can cause sleep difficulties. Physiological effects of medications cannot be underestimated as possible causes. These are all scenarios where antidepressants may not be appropriate.
Has your family member recently experienced a loss? Bereavement causes depression that is natural and expected. We should be more concerned if our family is NOT affected. I cannot tell you how many times I am asked a question such as, “Mrs. Smith has been so depressed over the past few weeks after her son passed away. She really needs an antidepressant. Which one do you suggest?” Depression following the immediate death of a loved one is not a situation where medications are appropriate. Love, support, understanding, and most importantly patience are the best prescriptions. There is no timeframe for how long it will take a person to “get over” a loss. In most cases, the number of symptoms decreases and even though Mrs. Smith may never completely “get over” the loss of her son, she may get through the initial adjustment period without medication. If symptoms continue for a prolonged time, consideration may then be given.
While we are speaking of adjustment periods, the correlation between adjustment to nursing home placement and medications needs be addressed. It is difficult for anyone to adjust to living in a nursing home. People have often lived in their homes for forty or fifty years and now suddenly find themselves living in a facility. It is understandable that one be depressed. As with grief, above, we should wait to see how a person adjusts before exploring use of medications.
Anxiety should be considered as a cause of depression. Depression can cause anxiety and anxiety can cause depression. If the primary problem is anxiety, treat the anxiety and see if the depressive symptoms cease. If the problem is depression, treat the depression and see if the anxiety ceases. Too often medications are given for both conditions when only one is occurring.
Anytime a person is suicidal, either with a specific plan or without, it is my feeling that antidepressants be strongly considered. Suicidal statements can sometimes be made during attention seeking type behavior and other times may be the expression of going through a time in life of dealing with feelings about death and dying. The person who is ninety-three years old and states, “I just wish God would just go on and take me home,” is not necessarily in need of antidepressant therapy. But the person who states, “If I could get my hands on my shotgun that hangs over my bed at home, I would kill myself”, should not only be taken seriously as being in immediate danger to self and others, but also considered for assistance through medications. Determinations on issues involving suicide should always be made by a professional.
When adjustment time has been given in grieving a loss, or when having trouble adjusting to placement, then it is time to consider if medications can help. The major issue is if someone experiences five or more symptoms of a Major Depressive Episode for longer than two weeks, and this continues for a long period, they will more likely become physically ill as a result. If the depression can be treated successfully, then other problems may be less likely to arise.
People diagnosed with dementia are great candidates for antidepressants. Especially for those persons who have just been diagnosed with the disease, they are often appropriate. Those in the mild stages of dementia are often more emotionally affected by disease progression than those at the moderate or severe stages because later they may not even recognize that they are affected at all. In the early stages, one deals with acceptance of the disease and is aware of faculties deteriorating. During this time especially, they can benefit greatly from medications not only to help cope with the situation, but in alleviating symptoms of depression that actually cause dementia to progress faster if left untreated.
The dominating theme throughout consideration of antidepressant use is to assess the situation thoroughly. Consult your family physician about all medication changes you are considering. Considering all factors that may be contributing to depression and conveying results to a doctor can help get to the root of problems. The source of problems is not always clinical depression, though when it is found to be, antidepressants can be a great way to improve the quality if life for your loved ones.
Jason Young, MS is the Director of Activities & Mental Health for Sanitasole Senior Health Services. This is an information-only column and is not intended to replace medical advice from a physician. Email Jason at firstname.lastname@example.org or visit www.sanitasole.net for more information. Phone: 239.394.9931.