Among the generation that has continually attempted to have it all, many baby boomers are now reluctantly adding a diagnosis of depression to their list of gains.
As the leading cause of disability in the United States and worldwide, major depression is an invisible disease that, for reasons unknown, is becoming the scourge of those born between 1946 and 1964. But, unlike other medical illnesses, depression is widely unrecognized and untreated, and often remains an unresolved issue throughout life.
Who’s Depressed and Why?
While baby boomers continue to gain great material rewards and success, their achievements are often the result of a stressful lifestyle. And it’s this stressful lifestyle that many experts are linking to their depression.
“We know for certain that baby boomers have a higher prevalence rate of depression than the generation before them,” says Donald A. Malone, Jr., M.D., director of the Mood and Anxiety Clinic in the department of psychiatry and psychology at the Cleveland Clinic. “The fact remains that we are not sure why—but much of the research is pointing to daily stress as a precipitator of their depression.”
While endless fatigue may seem like a fact of life to the baby boomer generation, experts warn that it should be treated promptly to head off disorders like depression, thyroid disease and sleep apnea. The main message is that depression, and other conditions that may result from fatigue, are not normal and can lead to life-threatening illnesses such as heart disease.
Malone also indicates that women are more likely to be depressed, with nearly twice as many females as males being affected by a depressive disorder each year. Once again, theory has led many experts to believe that it is a woman’s cyclical changes—such as premenstrual syndrome, postmenopausal syndrome and the hormonal changes experienced after giving birth—that cause their depression.
But depression doesn’t only affect those between the ages of 37 and 55. The National Institute of Mental Health (NIMH) indicates that nearly two million of the 34 million Americans ages 65 and older also suffer from depression. While the reasons for depression in older adults range from its concurrence with other medical illnesses such as heart disease, stroke and diabetes, to the isolated lifestyle many of them lead, the result of their chronic depression can be deadly. Older adults are disproportionately likely to commit suicide, with the highest rate occurring in white men age 85 and older.
Malone states that while depression may be prevalent among baby boomers, it is the ongoing effect of the condition throughout their lives that is cause for proper treatment now.
“Unfortunately, depression is often undetected or misdiagnosed. Recent findings indicate that many older adults who commit suicide have visited a primary care physician very close to the time of their suicide: 20 percent on the same day, 40 percent within one week, and 70 percent within one month of the suicide,” Malone says. “These numbers are startling, and gives us great cause to address the needs of those baby boomers newly diagnosed with major depression.”
A Need to Understand Depression
According to Robert Neil Butler, M.D., president and CEO of the International Longevity Center and professor of geriatrics at Mt. Sinai Medical Center in New York City, depression needs a lot more study—and research dollars—so that it may be understood better by depressed patients and the doctors who treat them. While Butler’s main emphases are the needs of the elderly, he indicates the fact that baby boomers will soon be elderly themselves is reason enough to gain an understanding of their depression.
“Why is there such a striking gender difference and a high rate of suicide among those depressed? These are topics that need studied, but more importantly, we need to educate doctors on the signs and symptoms of depression so that it may be diagnosed and treated appropriately,” contends Butler.
Who and What Can Help?
The family doctor is typically the first course of action for many with depression, and Malone indicates that 35 to 40 percent of an internist’s practice is psychiatric. “Depression is second only to hypertension as the most common chronic condition encountered in the general medical practice, with at least one in 10 outpatients having major depression,” states Malone.
With a call for internists to address the psychiatric needs of their patients, antidepressant medications are now regularly prescribed. Current antidepressant drugs effectively treat depression by influencing the function of certain neurotransmitters in the brain, primarily serotonin and norepinephrine, known as monoamines—the chemicals that allow nerve cells in the brain to communicate with each other. The benefit of the newer medications, such as selective serotonin reuptake inhibitors (SSRIs) like Prozac, is that they have fewer side effects than the previously prescribed tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs).
While both the old and new drugs effectively relieve depression, it’s important to remember that some people will respond to one kind of antidepressant, but not another. A recent study indicates that more than 80 percent of depressed patients have a response to at least one medication, but individual antidepressants are effective in only 50 to 60 percent of patients.
So, what do patients do when medication doesn’t lift their depression? Both Malone and Butler agree that too much emphasis on antidepressants has caused many to overlook the actual cause of their patient’s depression. “We’re often forgetting to look at the psychiatric root of the problem,” explains Butler. “Something that can often be addressed effectively with psychotherapy.”
Unfortunately, the fast-track life of most baby boomers has caused what Malone describes as a never-ending cycle in treating their depression. “With everyone in such a hurry, the last thing most want to hear is that they should go to therapy each week for treatment. Instead, they opt for the easy and quick route of medication, which may or may not work,” Malone says. “What they forget is that it is often their stressful lifestyle that brought them in to begin with.”
Malone states that psychotherapy may be the answer for many patients. Types of therapy include cognitive-behavioral, problem-solving and interpersonal psychotherapy. Each allows the patient to focus on the personal reasons that may lead to their depression, and many see improvement in their condition within six to eight weeks of therapy.
“While there is no quick cure that can end depression for baby boomers, there are several options that can make their lives better,” says Malone. “With more education of the doctors who treat them and better informed patients, we will hopefully see relief for a generation that is facing depression too often.”
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