Medications--Medications are a choice in treating depression. However, in later life there is an increased sensitivity to medication and an increased incidence of untoward effects due to aging differences in absorption, distribution, metabolism and elimination of drugs. Therefore doctors start with lower doses and increase them more gradually. This makes it essential that family members and other supporters monitor the person closely, and be especially aware of early signs of Tardive's Dyskinesia. Patients and supporters need to learn about the medications and possible side effects before they are administered. The medications must be carefully managed.

There are many "alternative" therapies such as food supplements and herbs that people have found to be effective with fewer side effects. A visit to a naturopathic physician can be less intimidating and very worthwhile.

To avoid medication problems:

• take medications only on the recommendation of a trusted health care professional and using them only as prescribed

• be aware of possible side effects including Tardives Dyskinesia and reporting them to the physician

• consistently using the same pharmacist for all prescriptions to avoid problems with drug interactions

• developing and using systems to be sure the medication is taken regularly

• report any lapses in medication treatment to the physician

• insist on regular blood testing

• pay close attention to lifestyle issues such as diet, exercise, light and rest

• avoid the use of alcohol while taking psychiatric medications

Therapy works well when the person has good powers of insight. Self observation may help the person to cope better with various traumas and loss that are part of old age. Difficulties, limitation and problems connected with age must be taken into account and not minimized. Home visits may enhance the therapists understanding of presenting problems.

Hospitalization--Hospitalization is usually not the treatment of choice. It is only used:

• to prevent suicide

• for safety and protection

• if supporters cannot provide care

• when medications need to be closely monitored-especially when they are first administered

• if the person is agitated or out of touch with reality

Suicide in the Elderly

Suicide attempts in the elderly are very serious in both medical and psychological terms. They tend to be very determined to die and use methods which tend to insure their success. Failure is most often due to the unforeseen intervention of others.

• Highest rates of suicide are among those over 60, especially men. They use "harder" methods.

• Elders may allow themselves to die through neglect, refusing food, not taking medications, etc.

• They are not as apt as younger people to tell others of their intention.

Family members, health care providers and other supporters should be aware of the following suicide risk factors:

• 27 of 30 suicides were by people who had been diagnosed with depression
• divorce, widowhood or single status--marriage has a minimizing effect
• males are at high risk within six months after the loss of a partner
• lower socioeconomic status
• retirement of those who have few other interests
• living in a urban area
• persistent insomnia
• marked feelings of guilt and inadequacy
• estrangement from family and friends
• extreme isolation
• hypochondriac delirium
• agitation
• alcoholism
• organic mental dysfunction
• depression induced by a physical disorder
• painful, debilitating and/or terminal illness
• the threat of extreme dependency or institutionialization

To prevent suicide and improve the quality of life, pay close attention to all lifestyle and health issues. In addition, give them lots of opportunities to express themselves. Let them talk as much as they want or need to. Work with them to develop a system of close supporters. Help them find meaningful things to do with their time. Work with health care providers to address sleep and anxiety issues. Medication and/or short term hospitalization may be necessary. Family members and health care professionals need to take preventive action, even if the person don't want them to-it may be necessary to save their life.

Information File and Treatment Plan

Keep all information on health care and depression, including information on medications and test results, in a special file for easy access.

Include in this file a plan of how the person would like to be treated and who is responsible for making treatment decisions in the event that they are unable to make decisions for themselves.

This plan includes:

• a list of symptoms which would indicate the person cannot make decisions for themselves

• family members, supporters and health care professionals they want to make decisions for them

• preferred, acceptable and unacceptable medications, treatments and treatment facilities.

Everyone who might be called on to make decisions needs to have a copy of this plan. Remember-even though the person may be deeply depressed, they need to feel that they are in control of their lives as much as possible.

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