‘STIFF UPPER LIP’
Doctors say talk therapy best for guarded members of the ‘forgotten generation’ at risk for depression
Shirley Slater always considered herself a fairly resilient woman. The 84-year-old has met most of life’s challenges — marriage, children, the death of her parents — with an emotional sturdiness that is common to members of her generation, often known as the “silent” or “forgotten” generation, those born before the Second World War. But, in 2000, the death of her husband Patrick threw all of that into question.
“It just took me an awfully long time to come to terms with the fact that I wouldn’t be seeing (him) anymore,” remembers Slater. “I thought I’d lie down and die with him, to be honest. I just couldn’t work out why I couldn’t go with him.”
Sinking into a deep clinical depression, Slater was given psychotherapy, counselling and even yoga to help remove her from her rut. Although she decided not to take antidepressants for fear of becoming addicted, she was offered a prescription on several occasions.
Recently, researchers at the University of East Anglia (UEA) found that the number of people over 65 who are being prescribed antidepressants has more than doubled in two decades, rising from 4.2 per cent in the early ’90s to 10.7 per cent at the beginning of this decade. Using data from more than 15,000 pensioners across England and Wales, the study found a particular surge among care home residents.
Seen by some doctors as a “quick fix” to wider, more complex problems, the findings have raised fears that antidepressants are being thrown at elderly patients with little consideration for their longterm effects. Caroline Abrahams, charity director at Age UK, said it is “concerning that in so many cases the clinical response is to dole out pills,” adding that older patients are less likely to be offered “talking treatments” like cognitive behavioural therapy.
Dr. Elena Touroni, co-founder of the Chelsea Psychology Clinic in central London, specializes in these face-to-face “talking therapies,” and has treated a number of elderly patients with depression. She says it has historically been difficult to persuade patients in their 70s and 80s to open up about their feelings, with that generation’s “stiff upper lip” proving a cumbersome barrier, and it is promising that more pensioners are now seeking treatment from their doctor. But asking those elderly patients to discuss feelings at a weekly face-to-face therapy session might seem “a bit too far” for some particularly reserved patients, she worries.
“For that generation, the world would have been very different (during their youth) in terms of access to psychological treatment or any kind of intervention for any common mental disorder,” she says. “(Now), it’s far more likely that somebody of that generation would be open to the possibility of something being prescribed that ‘fixes’ the problem, but they’re ... not quite at the level where one might wish to discuss their internal world with another person.”
Does this reluctance to try talking therapies risk locking elderly patients on to a cycle of (potentially addictive) medication?
David Taylor, professor of Psychopharmacology at King’s College London, warns that antidepressants should certainly not be taken without careful consideration: “They often are very effective, but they do alter the function of the brain, and that’s something to be considered. When one stops antidepressants, it’s more likely than not that they will get symptoms of withdrawal. Especially if the antidepressant is taken away too quickly. Now, on the other hand, you’ve got psychological therapies, which may not work as well or as quickly, but probably don’t have the risk of adverse effects.”
The impact of mental illness on people over 65 has been highlighted by the likes of Bruce Springsteen, 70, who opened up about his lifelong battle with depression in his autobiography, Born to Run, which was released shortly after his 67th birthday. Actress Glenn Close, 72, and comedian Ruby Wax, 66, have also discussed the issue in their senior years. Touroni points to a number of “life stage factors” that make depression more likely among the over65s.
Retirement might bring a lack of structure to a person’s day, she says, giving them too much time to dwell on their own thoughts. A study published this year by the Institute of Economic Affairs found that a person’s risk of clinical depression increases by 40 per cent after retirement, despite the popular perception of your post-65 years as a time of rest, relaxation, and a spot of golf. Advice published by Harvard University’s Medical School warns that many retirees “expect to have more time — but to do what? Doing either too little or too much can lead to the same symptoms, such as anxiety, depression, appetite loss, memory impairment and insomnia.”
A person’s senior years usually means the loss of loved ones, from which it can be difficult to recover, Touroni says.
Indeed, Slater says she struggled to shake off grief for much of the next two decades after losing her husband and says counselling “didn’t help me one iota.”
Touroni adds: “There are generally a lot of existential issues that people face about coming to the latter part of their life, that pathologically can be very challenging. It increases the sense of feeling vulnerable in the world. There might also be general physical health problems. If you are somebody who might have had some underlying depression or anxiety and you have never got any help for it at an earlier point, all those feelings of vulnerability mean you are much more likely to suffer from those symptoms now.”
The UEA study found that the rise in antidepressant use was more marked among women than men, and Touroni thinks menopause may also be playing its part: “It is a psychologically challenging time in a woman’s life. If you’d had children, there might be issues about the fact that your children are grown up, and losing a sense of femininity and fertility. And it can be a distressing time for women who haven’t had children, signifying that permanent loss of possibility. There’s also hormonal changes.”
And what about men? Statins are prescribed to older men to reduce the risk of heart disease, but there have long been fears among some doctors that they can trigger depression in a small number of cases, with the U.K.’S National Health Service website listing issues such as “loss of appetite” and “difficulty sleeping” among the drug’s “uncommon side-effects.” Taylor says the widespread use of statins among older men could be playing a minor role in the increase in antidepressant prescriptions: “I think there probably is a relationship ... but I think the number of cases that are caused by statins is very small.”
Touroni thinks that doctors need to do a better job of pushing elderly patients toward talking therapies, rather than relying on the easy option of medication. “The GPS are the first point of contact and might have had an ongoing relationship with the older person, so there is a bit more trust there.”
If you are somebody who might have had some underlying depression or anxiety and you have never got any help ..., all those feelings of vulnerability mean you are much more likely to suffer from those symptoms now.