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Medicine | THE HEALTHY MAN

Being a grumpy old man is no joke

March 10, 2003|Timothy Gower | Special to The Times

We've all known a grumpy old man or two. Maybe he was the guy down the street who chased you off his lawn when you were a kid. Hollywood turned grumpy old men into comic icons in two movies starring Jack Lemmon and Walter Matthau. While we sometimes laugh off the chronic crabbiness of an older friend, we're just as likely to dismiss it as an unfortunate, but inevitable, part of getting old.

Sometimes, though, geriatric grouchiness may be a sign of a serious problem: depression, which afflicts about 15% of older Americans. But mental health experts say that depression among the elderly needn't be so common because it is not a normal -- or inevitable -- part of aging. For most seniors, it can be successfully treated using a wide range of therapies.

"Not every grumpy old man is depressed," says Dr. Dilip V. Jeste, director of geriatric psychiatry at UC San Diego. "But in older people -- men especially -- depression may not manifest itself in the classical way." In other words, instead of appearing sad and blue, an older man who is depressed may be irritable and anxious. Other aging depressed patients also may express feelings of guilt and regret about things they did -- or didn't do -- during their lives. Symptoms of depression in the elderly can include loss of appetite and interest in favorite activities, disturbed sleep and even constipation. Certain chronic or frequent pains, such as arthritis, may feel worse than usual.

Just as all grumpy old men aren't depressed, older men or women who develop any or all of these symptoms aren't necessarily suffering from mental illness. But these warning signs shouldn't be ignored, because the risks associated with depression are too serious for any man with the blues to try and "tough it out."

Although depression is more common among older women, the condition seems to hit aging men harder, though no one is sure why. In a Dutch study published in 2000, severe depression appeared to increase death rates among elderly men and women alike. However, mild depression seemed to increase death risk among the men, while it had no effect on mortality among women. Researchers at Ohio State University found that depressed men and women are equally likely to suffer heart attacks, but that men die more often as a result.

Depression is known to be a leading cause of suicide, and American men older than 60 are far more likely than any other group to take their own lives. It's worth noting that 75% of seniors who commit suicide have seen their general practitioner within the previous month, according to a survey in the American Journal of Geriatric Psychiatry.

Jeste says many seniors who could be helped slip through the cracks because of age bias. "Even clinicians have a tendency to think that if a 78-year-old man is feeling depressed, it's OK for that age," he says. But although old age may be a time when we lose loved ones and experience physical decline, Jeste says seniors should not have to suffer sour moods as a way of life. Antidepressants can be an effective first step, he says, though he believes psychotherapy is important too.

Some research suggests that older folks may be able to chase the blues away. A team at Duke University, in Durham, N.C., found that patients over 50 who suffered from major depression improved in mood as much as other patients given antidepressants, simply by meeting for supervised aerobic exercise three times a week. "The social support may have contributed to their feeling better," says psychologist James Blumenthal, who led the study. He believes that getting fit helps too, because it increases self-confidence and a sense of control over one's environment.

Hormone therapy one day may be used to boost the spirits of some aging depressed men, according to a study published in January by psychiatrist Harrison G. Pope and colleagues at McLean Hospital in Belmont, Mass. Testosterone levels drop in some males as they grow older.

Jeste says male baby boomers are less likely than older men to deny or hide depression. Perhaps this is one case in which sons can teach their fathers a lesson. "It's an illness, like arthritis or diabetes," says Jeste. "It's nothing to be ashamed of."

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Timothy Gower can be reached by e-mail at tgower@attbi.com.

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