Depression leads to physical decline in older men and women

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WHILE major depression rare among older people who don't live in nursing homes or other institutions, 10 to 20 percent of elderly men and women suffer from significant symptoms of depression nonetheless. Unfortunately, because their level of depression isn't necessarily severe enough to be clinically diagnosable, they are likely to fall through the cracks of the health care profession and not get treatment for their mental outlook. That's particularly distressing in light of a newly published study from the National Institute on Aging. It shows that the more depressed an older person is, the more likely he or she will be to undergo a physical decline even if his or her depression "scare" falls below the cut-off point for major depression.

Researchers made the finding when they followed almost 1,300 men and women 71 and older for 4 years. At the start of the study, they asked the study participants a series of questions to assess whether they suffered any symptoms of depression. (Are you bothered by things that don't usually bother you?; do you feel that everything you do is an effort?; do you feel people are unfriendly?; and so on.) They also checked their physical "performance" by giving them a balance test, a timed walking test, and a test to see how quickly they could stand up from a chair (without using their arms) and sit down again five times in a row. Four years later, they had the participants repeat the performance tests.

Those who had scored highest for symptoms of depression were about 50 percent more likely than the others to have undergone a drop in physical ability. But the changes occurred on a continuum. Even those who had scored somewhat high for depressive symptoms--but not terribly, high-were likely to have experienced some decline in physical ability.

The researchers note that functioning at a high physical level at the start of the study did not "save" depressed people from physical decline. A decrease in physical capability was seen even in those depressed people who had started out with their physical functioning completely intact.

Now, being unable to get up from a chair as quickly as before may not seem like a big deal. But declines in such simple measures of physical capability suggest a greater risk for future hospitalization, nursing home entry, and subsequent disability.

How can depression lead to physical decline? The obvious explanation is that depressed people are less likely to spend time in physical pursuits that will keep their bodies in top shape. Depression could also contribute to a physical decline because unhappy people might be less likely to seek medical care should they sense something wrong with their health. But studies have also shown that psychological distress causes neural, hormonal, and immunologic alterations that could depress the body's stamina or ability to fight off illness. Of course, the physical decline works to reinforce the depression. The less you can do, the more depressed you become, and the more depressed you become, the less you feel like doing.

The good news is that depression is a treatable condition that is not a normal part of aging. People, and that includes older people, who feel generally depressed or "blue" should speak to a physician about getting treatment with a therapist, antidepressant drugs, or both. How do you know if you're depressed enough to speak to someone?

Lead researcher Brenda Penninx, PhD, says that "one of the most important signs is that the bad mood doesn't go away." Another red flag, Dr. Penninx says, is "not being able to define the cause of the depression." If you've just lost someone very close to you, she comments, you should expect to feel unhappy for a while. But if you've been chronically depressed for weeks or months and can't pinpoint why, it's time to talk to someone.

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