Clients are asking... Should my grandmother be taking anti-depressant medication? Breakthrough Spring 2004

At the Centre

"I recently picked up a prescription for an antidepressant for my grandmother. She had a heart attack six months ago, and hasn't recovered as quickly as she would have liked, but is that a reason for her to start an antidepressant?

Wende Wood and Biljana Marinkovic, CAMH pharmacists, respond:

While depression later in life is not uncommon, occurring in 15 per cent of the general population, it is not a normal part of growing older. Your grandmother may be at risk, because depression is more common in women, especially those who have had a heart attack. Besides medical conditions such as heart disease, stroke, diabetes, arthritis or cancer, other potential triggers or causes of depression in older adults include social isolation, grief, placement in a nursing home or loss of normal abilities of vision, hearing and mobility.

Symptoms of depression can include persistent sadness and crying, low energy, changes in eating, loss of pleasure in usual activities, and difficulty sleeping, concentrating and making decisions. Your grandmother may also worry excessively, pace, fidget, neglect her appearance, lose weight or complain about physical symptoms such as pain, headaches, upset stomach and fatigue. Sometimes some of these symptoms in older individuals may  get missed because of multiple  physical illnesses, or may be mistaken for dementia.

There are a number of effective treatments for depression, and often a combination of more than one type is best. First it is important that your grandmother be encouraged to be as active as possible. This will not only help with her depression, but with her heart problems as well. Try to go for walks with her, encourage her to go to a drop-in center and join activities with other seniors. This may be difficult for her at first, but human contact and encouragement is important for her recovery.

One of the tools that can be used to help treat your grandmother's depression is an antidepressant medication. As with anyone starting an antidepressant, she should be reassured that while it won't work right away, she should see some improvement in symptoms in four to six weeks.

Side effects are most common at the beginning of treatment, and older adults are often more prone to them due to decreased liver and kidney function and additional effects from multiple medications. She should start on the lowest dose possible to avoid or minimize side effects such as nausea, drowsiness, and activating symptoms such as anxiety or insomnia.

One particular area to monitor is your grandmother's eating patterns. This can often be a prominent symptom in older adults; they simply don't eat well or at all. Sometimes they will eat if they are out or a meal is prepared for them, but do not have the energy or motivation to cook for themselves. This can be especially important early in treatment, because taking medication with food can help alleviate some of the concerns about nausea. Keep checking in with her as treatment continues, because if she starts eating less after a few weeks, then the nausea may return.

Because she may be seeing more than one doctor, and is likely taking several medications, it is important that all of her prescriptions are filled at the same pharmacy. Also, given the human tendency to become forgetful as we age, she may want to consider a pharmacy that packages medications in blister packages or 'dosettes.' It would also be helpful for her to carry a list of all her medications with her to each of her appointments.

Finally, it is important to remember that treatment with an anti-depressant continues even after your grandmother feels better. One of the most common mistakes people make is stopping the medication once they are feeling better, which unfortunately leaves them at risk of relapsing. Treatment with an anti-depressant should last at least one year, and perhaps even indefinitely. Make sure your grandmother discusses length of treatment with her doctor, and if she decides to stop treatment, be sure it is tapered slowly to avoid possible withdrawal symptoms.

Treatment of depression in older adults is similar to that of younger adults, and because of this, extra consideration needs to be given to dosing, monitoring side effects and drug interactions. The anti-depressant is an important part of treatment,  but should not be the only approach used. Having supportive family members such as yourself will be very important to your grandmother and her recovery process.

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