Depression among the elderly. The thought assaults the senses. One conjures images of wintered, diminished existences: life as relentless despair. See the dispirited old man, once proud and vital, now sad eyes glazed and emptied; the fractured, frail widow, demoralized and destitute, incapable of making basic decisions she too long deferred to others. The images fade to futility, bleak loneliness, and resignation - a living death.
Depression is not an inescapable denouement of aging. We are no longer fated to dysphoric obsolescence. Indeed, more than ever, seniors live longer, vital and productive lives, filled with joy and purpose. Conversely, depression is an ‘equal-opportunity’ mental illness: it does not discriminate rich from poor, men from women, old from young. Genetics, heredity, disease, incapacitating accidents, side effects to common medications, personality characteristics and losses: each and all of these may cause or contribute to depression.
In fact, we all feel depressed at some time in our lives. To live life is to struggle. Pain, adversity, and hardship are inevitable. Many suffer unspeakable horrors. But to be sure, depression is not the same as feeling sad, nor is depression comparable to episodes of feeling blue. The person who grieves the death of a loved one may be said to feel depressed, but even this is not depression.
Clinically depressed people may show rapid weight loss or gain. Rest is erratic: they may sleep too little or sleep too much, but never restfully. Often, the clinically depressed senior complains of multiple physical problems, such as gastrointestinal problems that do not improve even with treatment.
They often report feeling worthless or guilt-ridden, without discernible cause. They cannot think clearly, and they find it difficult to concentrate and make even simple decisions. Their thoughts tend to the morose; recurrent thoughts of death are not uncommon. They can be irritable, irascible and prone to outbursts of anger. Their behavior can become atypical and uncharacteristic. They may weep for hours at a time, for no apparent reason. Their mood is intractably sad or empty. They may isolate and insulate, and withdraw from loved ones (who themselves vacillate between worry and exasperation). Their energy abandons them, and they may complain of persistent fatigue. Believers feel deserted, or, more ashamedly, they feel they have forsaken their faith and God.
Depression descends in many forms. At its most debilitating, depression is unremitting and tenacious. Clinically depressed seniors are psychologically immobilized, trapped, and desperate. They become real prisoners of their illness. Their thoughts are deluged with negativity and irrationality. Their emotions implode with such despondence that they cannot see even a ray of hope. They feel everything and nothing. Their actions are irresolute and agitated. Their spirit is shredded. Their heart is broken. They are beaten up and beaten down. Clinically depressed people cannot simply snap out of it.
In its less overt manifestation, clinical depression infiltrates insidiously, so imperceptibly, that one is caught utterly unawares when its wake consumes. A death of a friend, retirement, medical illness: one loss following another, all piecemeal erosions of mind, body and spirit that accrue to a lifetime, culminating in depressive devolution. Each time we lose someone or something of value, a piece of us is lost too.
Sometimes depression haunts as a predisposition, its genesis rooted in painful childhood (or even adult) traumas, but whose memories are delayed until there are no more distractions, no job or children to keep us busy. Our activities help keep us functional, after all, even as we may scream silently in our own private hell. We usually know that the melancholy was there all along, always lurking, stalking, like a withering self-portrait concealed and closeted, known only to ourselves. During our generative years we hoped we would outlast it. Now, faced with the unrequited solitude of our so-called golden years, we are finally caught, snared by a life-spun web. Depression taunts as a gotcha.
Some men and women have made the tragic mistake of defining their lives - indeed their self-worth - solely by what they do. Like Willie Lowman in Arthur Miller’s Death of a Salesman, once pastured, they feel abruptly vacated, useless and obsolete. They are especially at-risk and vulnerable to illness, such as clinical depression. Depression in this form may be seen as potential gone awry, healthy lifeblood spewed in an unhealthy free-fall. Idle hands, to borrow a phrase, are the depressive’s workshop. There is the story of the man who, upon retiring, eagerly anticipated day upon day of fishing. After three months, the angler pined, “I used to fish to escape work. Now what do I do to escape fishing?” A ‘hobby’ is simply not enough. Life begs for meaning.
Yet there is good news about depression. There is hope – silver linings. Depression is an illness that is treatable. In fact, nearly 80 percent of depressed seniors who seek professional help improve significantly. Highly effective counseling and psychotherapy services are available to help depressed people restore psychological balance and reclaim their lives. Anti-depressant medications, especially the newer ones, and natural healing remedies, may be useful in ‘de-intensifying’ depressive symptoms so that a person may be more emotionally functional to solve and resolve his or her problems.
Having come of age, most of you have long since shed the need for innocence and arrogance - those twin illusions, so characteristic of youth. Frankly, you have weathered too many of life’s storms to be beguiled or deluded any longer. You know too much, you see the world as it really is. Your age now prevails upon wisdom and humility, banes and blessings, to be sure. Maintaining - or repairing - mental health requires that we attend to matters of work, love, and play. Depressed seniors must renew and re-engage themselves. The goal of life is to have goals, to work at them, to strive toward something. Infuse your life with a sense of purpose. Dare to dream a dream or two. Create a mission. The world’s a mess and it needs you now, as ever.
Author Note: Dr. Glenn B. Gelman is a Clinical Psychologist and a Personal Mentor
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Dr. Larry B. Gelman, Dr. Glenn B. Gelman, All Rights Reserved.