A few weeks after my dad was unexpectedly left a widow at age 64, he told a doctor he knows that he’d been prescribed an antidepressant for depression. What the doctor told him next, changed his life.
“He told me, ‘you’re not depressed. You’re sad. And you should be, because your wife just died.'”
The doctor was right. My father was not suffering from depression, but rather from the normal grief that comes with a major loss. He didn’t need pills, he needed permission to grieve. Then a few weeks later, the cloud he was living under began to lift.
While my father’s sadness was normal, depression is not, yet it affects an estimated 7 million Americans age 65 or older, according to the Georgetown University School of Nursing & Health Studies.
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Of these older people with depression, about 80% can be treated successfully with medication and therapy. The key here is getting them proper help.
So how can you tell if you or a loved one is experiencing normal grief or is truly depressed? I talked to a few experts to find out:
While there are many awesome things about aging, including grandchildren and retirement, there are life stressors common to older people that can really — for lack of a better word — suck.
“In old age, sadness is normal,” says Denver psychologist Melissa Henston. “So much loss. Loss of loved ones and friends, loss of physical ability and health, loss of cognitive capacity, loss of stature in the world. ”
After you’ve lost something, whether it be a person close to you, a career or your health, it’s normal to grieve that loss. In fact, it’s healthy to.
“I encourage my clients to mourn the losses as they occur,” says Henson, who specializes in geriatrics and says there’s no set timeline for grief.
But while grief and sadness is normal, depression is not.
Henston points out that the difference between someone who comes through these losses relatively unscathed and someone who spirals into depression is simple. It’s called coping.
“It is normal to have sad events, but it is how we cope that will make or break us,” she says. “A person can be sad but still do life. They can manage finances, go out with friends, sleep regularly, in general keep doing life,” she says. All of this is normal.
Depressed people have a much harder time coping.
A depressed person may drink too much, eat too much or sleep too much (or too little), and they tend to isolate from others. They may have thoughts of suicide and feelings of helplessness and hopelessness.
“We cross the line when (sadness) diminishes life to the point that we would no longer recognize it as life but simply going into existence,” says Henston.
Grief can share many of the same symptoms as depression. Brooklyn psychiatrist Dr. Edward Gelber says, “intensity and duration” are what typically differentiate grief from depression.
With normal grief, depressive symptoms such as sleeplessness and disinterest in socializing will dissipate over time. There may be ebbs and flows — sporadic bursts of intense grief are normal — but a person will eventually have more good days then bad.
With depression however, negative feelings are intense and persistent and don’t let up over time. While a grieving person will inevitably have more good days then bad, Gelber says depressed people will have “some good days, but they are going to be outnumbered by the bad ones.”
So if you’re experiencing normal grief, can you, should you, treat it?
When it comes to medicating grief, some doctors will prescribe antidepressants to quell the mild depression that comes from loss, but some experts warn medicating sadness can disrupt the natural healing process. Anti-anxiety meds can provide relief for the grieving. Sleeping pills can help with sleeping problems, but they can be addictive, so talk to your doctor about how to properly wean off of them, and when.
Perhaps the best treatment for grief is therapy. Individual talk therapy or group therapy can help you move through the normal grieving process.
For depression, Renston says the best treatment combo involves therapy and medication. But she warns some antidepressants are not well suited for older adults.
“They have not been tested on older adults, and may have more side effects or be less effective, or worse, cause symptom elevation,” she says. “It’s best to work with a geriatric psychiatrist who understands the problems facing older adults and their multiple medical problems.”
Medication may take some tweaking to perfect and it takes time to kick in, so don’t give up if you don’t experience a mood shift right away.
If you notice behavioral changes in a loved one, it may be time to intervene. But there’s a right way and a wrong way to do it.
“Asking if someone is feeling depressed is a loaded question. Asking if they would like to go see a therapist can be a loaded question as well,” says Renston, who adds that older people especially may feel a stigma associated with seeking mental healthcare.
So how to help an older person who may not acknowledge they’re depressed?
Renston recommends offering to get them out of the house to eat, see a movie or shop.
“If they respond positively, than they might make it out of depression without a lot of intervention,” says Renston.
If they resist, it may mean they need professional help.
“Most older adults are more amenable to see a medical doctor first,” says Renston. If that doesn’t work, seek out a psychologist or psychiatrist who specializes in gerontology.
Have you experienced depression or grief in yourself or with a senior loved one? What was your experience like and how did you recover? We’d like to hear your stories in the comments below.