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Δημήτρης Παπαδημητριάδης

Σπούδασε Ιατρική στο Πανεπιστήμιο Κρήτης και Διεθνή Πολιτική Υγείας στο London School of Economics (LSE). Εξειδικεύτηκε στην Ψυχιατρική και στην Ψυχοθεραπεία στο Λονδίνο (Royal Free Hospital & UCL School of Medicine, Halliwick Personality Disorder Service) και στην Αθήνα (Ερευνητικό Πανεπιστημιακό Ινστιτούτο Ψυχικής Υγιεινής, Περιφ. Γενικό Νοσοκομείο “Ευαγγελισμός”).Συμμετείχε στο πρόγραμμα Γνωσιακής Θεραπείας για τις Διαταραχές Άγχους του Beck Institute for Cognitive Behavior Therapy που ίδρυσε στη Φιλαδέλφεια των ΗΠΑ ο θεμελιωτής της γνωσιακής θεραπείας Dr. Aaron T. Beck.Έχει βραβευτεί για δραστηριότητές του με ειδικά τιμητικά διπλώματα από το Πανεπιστήμιο Κρήτης, την Επιστημονική Εταιρεία Γενικής Ιατρικής, την Πανελλήνια Ομοσπονδία Μη-Κυβερνητικών Οργανώσεων, την Οργανωτική Επιτροπή Ολυμπιακών Αγώνων 2004 και με το Βραβείο “Κοινωνία των Πολιτών” των Δημοσιογράφων της Ελληνικής Ραδιοφωνίας (ΕΡΑ).Διετέλεσε Γενικός Γραμματέας στο διοικητικό συμβούλιο της Ευρωπαϊκής Ένωσης Φοιτητών Ιατρικής (EMSA) με έδρα τις Βρυξέλλες και Πρόεδρος της Επιστημονικής Εταιρείας Φοιτητών Ιατρικής Ελλάδας (ΕΕΦΙΕ).Σήμερα εργάζεται ως ιδιώτης ψυχίατρoς – ψυχοθεραπευτής και συμμετέχει σε δράσεις ακτιβισμού για την προστασία των δικαιωμάτων του ανθρώπου. Λαμβάνει μέρος σε επιστημονικά συνέδρια και ημερίδες και παραχωρεί ομιλίες για την ενημέρωση σε ζητήματα ψυχικής υγείας, όλο το χρόνο, με έμφαση στην καταπολέμηση του στίγματος.

Melancholia in the Elderly

[fusion_builder_container hundred_percent=”yes” overflow=”visible”][fusion_builder_row][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”][cc_quote]Not a normal effect of aging[/cc_quote] Depression in old age is a real but treatable condition, such as diabetes and hypertension. It is not a normal effect of aging, although the elderly have an increased risk of developing it.

It is a mood disorder in which feelings of sadness, loss, anger or frustration permeate everyday life and trouble a person for weeks or more, affecting the quality of life and functionality. This is not “the blues”, or grief, for example. due to the loss of a loved one. Most of the time, it is not even about major depression that affects us adults (with an incidence of 1-5% in the elderly). It is sub- syndromic depression that afflicts 15% of all walking elderly and an even higher number betwwen those who need home care, or hospital care for any reason.

And yet, only 10% of these people receive treatment.

In the elderly, depression often occurs along with other illnesses and disabilities and lasts longer. In particular, we know that about 80% of the elderly have at least one chronic condition, while 50% suffer from two or more. Depression in old age negatively affects these coexisting diseases. For example, it doubles the risk of heart disease and increases the risk of dying from it. It also increases the risk of suicide by up to twice compared with the general population (ages 80-84), with the divorced or widowed men at a higher risk.

For all of the above reasons, we have an obligation to ensure that an older person with signs and symptoms of the disease is evaluated and treated, even if the symptoms are regarded as mild. Families have to worry about elderly relatives suffering from depression and living alone.

A parent who does not eat for more than a few days, or loses interest in activities that previously seemed enjoyable for more than two weeks, might be suffering from depression. It is very common for our elderly relatives to tell us that “they do not feel sad” or that “they do not feel alone”, simply because they do not want to be a burden to the rest of the family. Instead, they show signs of anxiety, e.g. squeezing their hands, they are agitated or irritable for no reason, or even hyperactive.

Elderly woman

In any case, we should suspect depression when an elderly person reports or exhibits:

• Feelings of despair or pessimism
• Feelings of guilt, worthlessness or even helplessness
• Irritability, anxiety
• Loss of interest in activities or hobbies that were previously pleasurable
• Fatigue and reduced energy
• Emotional apathy
• Difficulty concentrating, difficulty retrieving details and making decisions
• Insomnia, early awakening, or excessive sleep
• Overconsumption of food, or loss of appetite
Suicidal ideation or suicide attempts
Persistent discomfrot or pain, such as headaches, cramps, or digestive problems that do not go away even with a medical treatment

In fact, the presence of the physical consequences of depression, such as severe neck pain and persistent back pain are warning symptoms that are usually underestimated.

Old age is often accompanied by the loss of all social support systems, for example with the death of a spouse, or siblings, retirement, relocation, etc. Due to such changes in living conditions but also to the objective functional slowdown that a person experiences from the biological deterioration of age, both the family and the doctors sometimes skip the signs of depression, consequently effective treatment is significantly delayed . Because of this, many older people are condemned to struggle with excruciating feelings for no reason.

Many factors always contribute to depression, such as low levels of major chemical neurotransmitters in the brain (serotonin, norepinephrine), family history of depression and of course the traumatic events of life. In addition, they contribute to complications related to aging such as:

• The limited mobility and the deprivation of the independence that this entails
• Isolation
• Thoughts about the impending end of life
• The transition from work to retirement
• The financial difficulties
• Prolonged substance abuse
• The deaths of friends and loved ones
• The removal or alienation of children
• Widowhood or divorce
• Chronic diseases

Unfortunately, the stigma associated with mental illness and psychiatric treatment is stronger among the elderly than among the younger. Stigma can prevent the elderly from recognizing the problem and from acknowledging it. Even more so, it is common for older people and their families to attribute the symptoms of depression to “normal” reactions to life stress, frustration, or old age.

Because fatigue, loss of appetite, and difficulty sleeping are common symptoms of aging, or physical illness, it is easy to ignore the onset of depression or to misunderstand aging.

Insomnia in particular has been identified as a distinct risk factor for both the onset of depression in the elderly and its recurrence.

Sometimes depression in the elderly is expressed through physical discomfort and not with its typical mental symptoms. And this phenomenon delays, in turn, the appropriate treatment. In addition, older depressed people do not report their depression even when they admit that they are suffering from the problem because they believe that there is no hope for help.

However, managing depression requires working with a specialist. In the course of the diagnosis, the specialist will rule out the possibility of the involvement of organic disorders that may mimic the symptoms of depression, such as anemia, B12 and folic acid deficiency, hypothyroidism, etc. He will also look at any underlying conditions that may be associated with depression, such as Parkinson’s disease, cardiovascular disease, cancer, dementia (such as Alzheimer’s disease), and cerebrovascular disease.

Regarding the latter, we sometimes find that people who develop depression for the first time in old age show signs of ischemic encephalopathy from insufficient blood flow to the brain tissues usually dure to chronic arterial hypertension.

Elderly man

To better manage depression at home, our elderly fellow human beings should:

• Exercise regularly, with consent from their doctor
• Surround themselves with caring, positive people and fun activities
• Have good sleeping habits
• Be informed to recognize the first signs of depression and seek specialized help
• Avoid alcohol and drugs, including sedatives without an absolute indication for them
• Verbalize their feelings and communicate with other people they trust
• Take their medication correctly and discuss any side effects with their doctor

[/fusion_builder_column][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”][cc_quote]Spend time with our elderly relatives[/cc_quote] Unpleasant life events, including the death of a loved one, poverty and isolation, may affect a person’s motivation to continue treatment. Elderly people may also be reluctant to receive treatment due to perceived side effects or costs.

As the elderly are more sensitive to drugs, doctors have to prescribe smaller doses than those required for adults. Although co-morbidities may affect the effectiveness of antidepressants, this practice relieves most of the side effects, although I find that it is not applied consistently. Psychotherapy , which can be particularly beneficial for those who have suffered significant stressful events in their lifetime, is not offered – or does not seem accessible – to the elderly in our country.

I would like to emphasize that it is very important to spend time with our elderly relatives. Listen to them and honor their feelings. The quality time we dedicate to them, brings immediate relief and is real support. Finally, it is worth noting that it matters not to substitute older people in their activities in order to facilitate them, as this potentially reinforces their perception that they are no longer useful and competent. On the contrary, it is more appropriate to help them divide their activities into more and more distinct steps, which are performed more flexibly, and to praise them for their effort.

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