PSA: Depression, Aging and the Loss of Hope

In light of the suicides this week of two prominent figures who were 55+, I felt compelled to write something about depression and aging. 

Cognitive distortions are a huge part of depression which is why therapy is essential. I have worked with many clients who experience moderate to severe depression.

Without treatment (medication and therapy) major depressive disorder often gets worse with age because it takes longer to recoup and the depression episodes can become more severe and closer together. Another complication is that anxiety often becomes coupled with depression and is more pronounced with age (if not treated).  It helps to know these facts because when this aging phenomenon happens, the shame and self-blame can be immense. Maybe when they were younger, they could manage it without as much intervention, and now they can't. So I use normalization as a therapuetic tool to help clients understand that they are not at fault for their symptoms. I talk to clients about all of the above as a part of ongoing psychological education, and encourage ongoing treatment when needed, just like with any chronic physical conditions.

Tragically both Anthony Bourdain and  Kate Spade left behind young children with their suicides. I mention this in no way to blame either, but rather to illuminate some potential interventions. Something I have educated clients about is the reality of how shattering it is to a child's life when a parent commits suicide and that the child is way better off with a depressed parent who has the potential to get better, than a dead parent.

The same is true for any loved one who is left behind as the result of suicide: it is devastating. I had a client on the verge of suicide, yet stopped themselves. When I asked what stopped them, they said it was an image of their mother in the aftermath, and the pain and anguish on her imagined face that stopped them. The client's relationship with their mother was a protective factor against following through with suicide. As therapists we need to search for and strengthen these protective factors when working with clients prone to losing hope. 

In their private hell, some clients convince themselves that their loved ones would be better off without them. Despite cognitive distortions, depressed people are often very reality based, almost painfully so, and using reality to challenge their distortions and point out discrepancies can be helpful. Helping them to play the 'what if I wasn't here tape' (and connect them mentally to a loved one), with a good therapist often helps bust the distortion. Bringing the loved one to mind and acknowledging that they would not be better off without them can be a fruitful intervention for some clients. Those of us in the mental health field treating depression need to screen more for this 'better off without me' distortion in depressed clients.

The good news is that with treatment, depression and anxiety can be managed, at any age, like many health issues. The key is that what worked for a person with severe to moderate depressive disorder in their 20's, 30's,  and 40's  may not work later in life. Adjustments to medication and working with a therapist is vital. Is it hard? Yes it's hard work, but a rewarding life is possible.  I've had clients have meaningful relationships, careers, travel and become parents and grandparents. We are not responsible for having depression. It's a physiological condition that needs intervention. Seeking treatment is always the best option.  

For additional information about Major Depressive Disorder and aging:

If you are struggling with feelings of despair, please reach out for help.

In Santa Clara County you can call 24/7:

Mental Health Call Center

Phone: 1 (800) 704-0900

Or the National Suicide Lifeline for anywhere in the US