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School of Medicine
Johns Hopkins Bayview News - Reclaiming Life
Date: June 3, 2013
The first step in treating depression is understanding it
Lee Fink (center) with her sons Robert (left) and George (right). Fink’s sons recognized that her symptoms of depression had returned and sought medical treatment right away.
Lee Fink, 98, has been through a lot in her lifetime. The Great Depression. Several wars. The loss of a child. The deaths of two husbands. And despite it all, she tried to remain optimistic. “This is what life is,” she says.
With Fink’s cheery attitude and quick wit, you would never know that she was diagnosed with depression—a common mental health disorder among older adults that is usually attributed to illness, trauma or a major life event.
Fink first felt symptoms of depression in the 1940s, when her 6-week-old son died. Like any parent who has lost a child, she felt guilt and grief. She sought help from her primary care doctor, and after talking with him, she felt better.
Decades later, her depression returned when her first husband became ill and she had to help with his home dialysis. Fink was overwhelmed with such a big responsibility and afraid she would cause her husband harm during his treatment. She sought help from a therapist, who officially diagnosed her with depression and prescribed antidepressants. Constantine Lyketsos, M.D., director of the Department of Psychiatry at Johns Hopkins Bayview, says Fink’s feelings are typical for those diagnosed with depression. “It’s a common misconception that people only feel sad when they’re depressed,” he says. “Depression is a mood disturbance with multiple symptoms. People feel unwell or not like themselves. They’re worried or anxious.”
Dr. Lyketsos adds that it’s important for families and caregivers to pay particular attention to the moods of older adults (see below). “If there is any significant change in behavior for an extended period of time, it’s important to receive medical treatment,” he says.
Recognizing the Signs
Robert Kolodner, Fink’s son and a licensed psychiatrist, is very familiar with the symptoms of depression. About eight years ago, he recognized a drastic change in his mother’s personality and mood. Even though her depression was controlled with medication on and off through the years, Kolodner knew his mother needed medical treatment right away.
“My mother has always been a ‘glass-half-full’ kind of person,” he says. “During this time, she was a different person. She was completely removed, much more defensive, confused and had a hard time making decisions.”
Fink was taking antidepressants at the time, but had stopped responding to them. She was admitted to a local psychiatric hospital where she was weaned off the medicine and given electroconvulsive therapy (ECT). ECT uses electrodes to “jumpstart the brain” and treat severe depression that has not responded to medication or other therapies.
Finding What Works
Fink received ECT for several years to prevent her depression from relapsing. At first she responded well. But when she went long periods of time without ECT, the symptoms of her depression returned.
In 2011, Fink was admitted to the Lakeside Medical Unit at Johns Hopkins Bayview. Physicians stopped ECT and introduced social stimulation into her treatment. “She slept a lot,” says Kolodner. “But the nurses and doctors noticed that when she was around people or participated in activities, she perked up. She was much more herself.”
Lyketsos says it’s important to try different therapies to see what works best for each patient. “Depression isn’t just caused by one thing,” he says. “It’s a complex disorder that can require a number of treatments. We just have to find what patients are most responsive to.”
Fink’s depression is currently in remission and stays that way with social stimulation. She is an active resident of an assisted living facility in Columbia, Maryland, where she keeps her dance card pretty full.
“There’s something to do here every day,” she says. “And I do my best to keep myself busy and active.”
Adds Robert, “It’s amazing how much she’s flourished. She has a great attitude and continues to live life to the fullest.”
Symptoms of Depression in Older Adults:
- Persistent sadness
- Significant changes in personality or behavior
- Difficulty with memory or concentration
- Difficulty with overall functioning
- Social withdrawal
For more information or to schedule an appointment, call 410-550-0016.