Improving Emotional Well-Being in Older Adults

by Nieske Zabriskie, ND

Depression is a condition that affects all age groups. However, in older adults, depression can be difficult to recognize due to the presence of other health problems, yet it can have serious consequences. According to the National Institute of Mental Health, major depression, the most serious form of the condition, affects 1-5 percent of older people living in the community. However, the prevalence increases to 13.5 percent of older adults that require home healthcare and 11.5 percent of those hospitalized. Additionally, the risk of developing depression in older adults increases with the presence of other illnesses and limited function. An estimated 5 million older adults in the U.S. have sub-syndromal depression, meaning they have symptoms of depression but do not fit the full diagnostic criteria for depression. Sub-syndromal depression is common in older adults and increases the risk of developing major depression. Furthermore, older adults are disproportionately more likely to die by suicide. Older adults comprise 12 percent of the U.S. population, yet Americans 65 years of age and older accounted for 16 percent of suicide deaths.¹

Major depression is diagnosed using the criteria from the DSM-IV. For the diagnosis, a patient must have five of the following during the same two-week period: (1) depressed mood, (2) loss of interest or pleasure, (3) significant weight loss or gain, (4) insomnia or hypersomnia (excessive sleepiness), (5) psychomotor (movement) agitation or retardation, (6) fatigue, (7) feelings of worthlessness or excessive or inappropriate guilt, (8) diminished ability to think or concentrate or indecisiveness (9) or recurrent thoughts of death. Alternately, some individuals meet the criteria for dysthymia, which is a milder form of depression that has been present for two years or longer.

Several factors have been associated with the onset and maintenance of depressive symptoms in later life. One study investigated potential associations with depression in 20,677 adults over the age of 60. The study showed that 8 percent of the subjects had mild or moderate depression. The study also found that depression was independently associated with numerous factors including age over 75 years; adverse childhood experiences; unhealthy lifestyle practices such as smoking, physical inactivity and alcohol use; health hazards including obesity, diabetes and high blood pressure; medical conditions such as coronary heart disease, stroke, asthma, cancer or emphysema; and social or financial strain. Furthermore, this study revealed that the risk of depression in this age group increased with an increasing number of risk factors, varying from only 3 percent in those without risk factors up to 80 percent in those with numerous factors.²

In another study, researchers evaluated elderly subjects living at home and factors that influence the development of depression. This study showed that physical symptoms, sleep pattern and life satisfaction had significant direct effects on depression and accounted for 59 percent of the variance in the presence of depression.³ Additional research has found that specific factors significantly influence the development of depression in older adults such as fatigue, which was seen in over 40 percent of older adults,⁴ and shortness of breath, which was present in 36 percent of subjects.⁵

The consequences of depression in later life are also important to consider. Depression in older adults affects everyday functioning. Research shows that depression in the elderly is associated with impaired everyday problem-solving ability, mediated through impaired learning, memory and reasoning.⁶ It is well established that dementia leads to depression. Evidence now also supports that this association is bidirectional, and depression can lead to cognitive decline and dementia.⁷ Research indicates that major depression increases the rate of cognitive decline. In one study, elderly nursing home residents were evaluated for depression and cognitive ability over 3 years. The results of the study showed that subjects with dementia or depression had an increased rate of cognitive decline, and those with both dementia and depression had the greatest rate of decline.⁸ Another study found that compared to non-depressed older adults, those with depression had a greater reduction in volume in an area of the brain known as the hippocampus, which is important for long-term memory. Hippocampal volume loss is associated with cognitive decline in the elderly.⁹ Similarly, another study showed that atrophy, or tissue wasting, of the temporal lobe in the brain and lesions in the white matter of the brain is associated with greater than 3-fold risk in developing major depression in the elderly over 5 years.¹⁰

Research has also found that depression in the elderly is associated with an increase in mortality. In one study, 1,007 elderly subjects were evaluated for depression and followed for approximately 9.2 years. This study showed that depressed subjects were at a higher relative risk of all-cause mortality, meaning death due to any cause. This study also showed that smoking, physical inactivity, low grip strength, low-grade inflammation and low plasma vitamin C levels were also associated with depression and mortality in this population.¹¹

Natural Mood Support

Several vitamins and botanicals have been shown to enhance mood stabilization. Several studies suggest that vitamin D deficiency may play a role in the development of depression in older adults. In one study, subjects 65 to 95 years of age were evaluated for depressive symptoms and serum vitamin D levels (25-hydroxyvitamin D). The results showed that 25-hydroxyvitamin D levels were 14 percent lower in the subjects with major or minor depression compared to the subjects without depression.¹² Additionally, research suggests that supplementation with vitamin D may improve depressive symptoms. In one study, adults supplemented with vitamin D for one year demonstrated significantly improved scores on the Beck Depression Inventory compared to the subjects receiving placebo.¹³ Similarly, subjects with Seasonal Affective Disorder (SAD) showed improvement in depression scale scores with vitamin D supplementation.¹⁴

Several B vitamins have also been shown to support mood. In one large study, subjects age 65 years or older were evaluated for vitamin B6, vitamin B12 and folic acid intake and depressive symptoms. The subjects were followed for up to 12 years to determine if vitamin levels played a role in the development of depression. The results showed that higher total diet and supplemental intake of vitamin B6 and vitamin B12 were associated with a decreased likelihood of developing depression. Furthermore, they showed that for each additional 10 milligrams of vitamin B6 or 10 micrograms of vitamin B12, there was a 2 percent lower risk of developing depression per year.¹⁵ Another study evaluated intake of vitamin B12 and folic acid and depressive symptoms in adults age 55 and older. This study found that the subjects with the lowest folic acid concentrations had a 72 percent increased risk of depression, and vitamin B12 deficiency was associated with 168 percent increase in risk.¹⁶ A third study found that in older adults, deficient levels of plasma pyridoxyl-5-phosphate (P5P), the active form of vitamin B6, was associated with approximately double the risk of developing depression.¹⁷

Research also indicates that St. John’s wort (Hypericum perforatum) supports mood. St. John’s wort is combined with vitamin B6, vitamin B12, folic acid, as well as the amino acids phenylalanine and tyrosine in SynCholamine™ to promote emotional well-being. One study found that in subjects with depressive symptoms, 76 percent of subjects reported improvement after supplementation with St. John’s wort for 12 weeks.¹⁸ Studies have also shown similar improvement in depressive symptoms with St. John’s wort for long-term maintenance in subjects with recurrent depression.¹⁹ A meta-analysis of 13 previously published studies concluded that St. John’s wort was similar in efficacy and adverse events to selective serotonin reuptake inhibitors (SSRIs), the primary pharmaceuticals used in the management of depression.²⁰

It is also important to support the catecholamine pathway with tyrosine and phenylalanine, which serve as building blocks for dopamine, norepinephrine and epinephrine. Noteworthy is that sufficient tyrosine is also essential for optimal thyroid hormone production as well. Clinically, supporting both thyroid and catecholamine pathways is essential for cognition, clarity and mood stabilization.²¹

Conclusion

Depression in older adults may have serious consequences, yet may be overlooked due to the presence of other health conditions. Several vitamins including vitamin D, vitamin B6, vitamin B12, and folic acid have been shown to support mood in older adults. St. John’s wort and the synergistic ingredients found in SynCholamine also help stabilize mood and can help achieve a brighter outlook for the older population as well as individuals seeking to improve their state of mind.

References

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