Mind Your Mood is a series on aging, mood and brain health by Dr. Nasreen Khatri, a registered clinical psychologist and clinician associate at the Rotman Research Institute at Baycrest in Toronto. Each instalment will deal with a different aspect of depression and cognition with a corresponding "elephant in the room" symbol.
The Grey Elephant in the Room: Hope for Older Adults with Depression
The aging of Canadians is often described as a greying tsunami. Depression is one of the most prevalent mental health problems in older adults. For many individuals with a history of depression, the disorder has a waxing and waning course beginning in early adulthood and reaching a chronic pattern of mood problems by mid-life and beyond.
Depression is manifested by emotional, physical and cognitive symptoms that can include low mood, sleep and appetite disturbances and problems associated with clear thinking.
As we age, depression often presents itself as much as a disorder of cognition (including difficulty with attention, concentration, planning and decision making) as of mood. Many older people who seek help for problems with thinking and memory actually turn out to have depression -- a disorder that is far more prevalent than dementia.
Treating depression is essential if the older adults have a history of depression, since untreated depression substantially increases the risk of developing dementia later in life. The cost of depression is unsupportable, both economically (healthcare costs, loss productivity) and socially (personal suffering, relationship disruption).
At the Rotman Research Institute at Baycrest, I combine my clinical expertise in mood disorders with cognitive science to innovate and tailor Cognitive Behaviour Therapy (CBT) for older adults. CBT is an evidence-based, short-term, skills-based, structured talk therapy that helps individuals to change maladaptive patterns of thinking so that they can feel well, function effectively and reduce the risk of relapse, as well as reduce further episodes of depression by improving problem-solving skills.
In our recent research, my colleagues and I found that CBT for spousal caregivers of individuals with dementia (a group known to suffer both cognitive deficits and mood problems due to the stress of their caregiving role) improved on measures of mood and cognition -- including attention, concentration and higher level cognitive processes. The next step is to use brain imaging techniques to investigate if and how CBT impacts the brain by studying brain activity before and after CBT treatment in older adults with depression.
While we still have no known cure for dementia, we do have early evidence that tailored CBT treatment works for depression in older adults. That means older adults can recover from depression with an evidence-based, non-drug, cost-effective treatment that targets the chronic nature of the disorder, improving both mood and cognition, and thereby maintaining brain health as we age.