Mind Matters -- February 2004
Written by Ron Sterling, M.D. and Published in Northwest Prime Time Magazine


The "S" Word
by Ron Sterling, M.D. -- February 2004


    Dear Dr. Ron:

      My 68 year-old father killed himself with a handgun three years ago. It was a huge shock. He had a period of about a year before he died in which he always seemed irritable and he drank more alcohol, mostly in the evening. He said the alcohol helped him sleep. Believe me, I now know much more about depression and warning signs than I did before. Why isn't there more attention being given to depression in older people? Signed -- Wanting More Action.

    Dear Wanting More Action:

      Thank you for writing! I am sorry to hear about your father's death. Any death in a family is very painful, and suicide might be the most traumatic because of the high level of self-blame that can happen. We always wish we had been smarter or done something differently or been more aggressive in getting help. I hope you have had support in your grieving process. None of us are truly comfortable with talking about the "S" word, but if we can understand how much suicide is associated with depression, we can make a positive impact on our loved ones' lives.

      You are not alone in wanting more action about depression and suicide in older adults. Good advocacy for senior mental health concerns has been hampered by not only the usual prime culprit -- mental illness stigma -- but also by stereotypes related to age and gender. These are formidable foes. It is unfortunate that many "traditional" organizations have devoted very little of their resources to mental illness concerns. My short recommendation? Get "pushy" with AARP and other leading organizations about senior mental health. Get AARP and others to advocate for the Medicare Mental Health Modernization Act of 2003 introduced in March and April of 2003.

      The common perception is that suicide rates are highest among the young -- they aren't. Older Americans, particularly older white males, have the highest rates. It has been shown that two-thirds of people who complete a suicide suffer from clinical depression. Thus, treating depression is the most important way to prevent suicide. Family members, friends and healthcare professionals can miss depressive symptoms in older people who may often hide their feelings of hopelessness and sadness. Older adults tend to talk much more about physical symptoms than feelings.

      Depression is not a normal part of aging. Mental illnesses are real, common, no more shameful than any other medical illness, and are treatable. In fact, 80 percent of older adults with depression improve when they receive appropriate treatment. The most important thing we can do for our older friends and family is to not get lulled into thinking that just because they might not say much about how they are feeling, that it means they are doing just fine. Even healthcare professionals need to learn to ask the so-called "hard questions." Studies have shown that over 70 percent of older suicide victims had been to their primary care physician within the month of their death, many with a depressive illness that was not detected.

      We need to learn to listen carefully, ask caring, meaningful questions, and figure out how to allow people to feel comfortable about talking about worries and thoughts. We need to pay attention to signs such as continued irritability, personality changes, appetite loss, increased alcohol use, sleeping problems, not showing an interest in what used to be favorite activities, and social withdrawal.

      Sometimes, getting a loved one to accept help might mean making an appointment for them and accompanying them to the doctor's office to help them talk to the doctor about their symptoms and concerns. For more information about depression and aging, please visit Aging Brain Web Page. -- Best wishes, Dr. Ron.

        Author Bio:

        Ron Sterling, M.D. is a 64 year-old General and Geriatric Psychiatrist with a private practice in Seattle. He invites you to e-mail him at with any questions about mental wellness or emotional, relationship, or aging concerns. He is the only person who reads e-mail sent to Dr. Ron. Please be assured that your questions and identities are completely confidential and protected. For more information about Dr. Ron and for resources related to senior mental health, please go to SeniorMentalHealth.org. Read our Disclaimer.

        Thank You for Stopping By!

      Have a great day!


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RON STERLING, M.D.
General Psychiatry with Specialization in Adult Attention Deficit Disorder
SeniorMentalHealth.org
Phone: 206-784-7842
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Updated October 7, 2007
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