Seeing the Light

By Lara Piu

Dispelling myths about senior depression

According to a recent study by the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately one in five Americans suffers from mental illness. That equates to roughly 42.5 million people, and Arizona seniors are among the top populations suffering – in United Health Group’s 2018 America’s Health Rankings Senior Report, Arizona ranked 31 in overall health, plummeting eight spots since last year. During that time, a 15 percent increase in senior suicides was also recorded.

Mental Health America ranks our sunny state even lower, naming it 49th in the country for overall mental health, with high numbers of mental illness cases and low access to care. Medicare regulations might explain some of these statistics, explains Dr. Kristen Ray, DBH, LPC, Behavioral Health Director, Counseling & Social Health at Bayless Integrated Healthcare. According to the doctor, psychologists and clinical social workers are the sole professionals approved to provide mental health services to people with Medicare. The exclusion of counselors, marriage and family counselors, and supervised associate level clinicians limits their options.

In addition, mental illness is often misunderstood, especially when it comes to depression in seniors, says Keith Crnic, Ph.D. He’s the Department of Psychology Foundation Professor at Arizona State University and a Resident and Board Chair for the Institute for Mental Health Research (IMHR), a Valley-based nonprofit that brings mental health education and awareness to the public.

“In a lot of ways, mental health is misunderstood. It still represents a stigma for individuals with mental health problems,” Dr. Crnic explains. “This is a health problem like any other health problem.”

Depression myths

Overall thinking about depression in seniors is widely based on myths, Crnic warns. Some of those myths include:

  • They’re not trying.
  • They’re lazy.
  • This is a choice.
  • They are really different from us.

One of the most common myths, according to Crnic, is that people with depression are inherently different. “It doesn’t make them not normal, it just makes them struggling in certain areas,” Crnic says. “There’s almost no one who’s never felt depressed at some point… we’ve all been there. The difference between those of us that have these normative periods of feeling depressed and those of us who have clinical depression is the extent and frequency to which it lasts. But the experience is qualitatively similar.”

And perhaps among the most unfortunate myths is that senior depression is normal.

“People need to understand that depression is not a normal part of aging. Even though they are facing life circumstances that are different than the earlier stages of life – like loss of spouses and friends and freedoms – it shouldn’t be normal to associate depression with aging,” Crnic says. “It’s still an issue that needs to be addressed and treated. We don’t want people to think that it’s okay… that sadness and depression is tolerable. It shouldn’t be tolerable. They are no less important and no less worthy of being addressed.”

Depression warning signs

The signs of depression can be, but are not necessarily always, different in older people, Crnic notes. Dr. Ray offers 10 main signs to look for, commenting, “If you are, or know someone, who is experiencing the following symptoms daily or every other day for more than two to four weeks, professional help is recommended.”

  • Feeling sad, empty, or hopeless
  • Diminished interest or pleasure in all, or most, activities
  • Significant changes in weight (gain or loss)
  • Difficulty falling and/or staying asleep
  • Feelings of restlessness or being really slowed down
  • Fatigue or loss of energy
  • Feelings of worthlessness or excessive/inappropriate guilt
  • Decreased ability to concentrate
  • Reoccurring thoughts of death
  • Self-medicating through drugs and alcohol or taking more medication than prescribed

Treatment options

Traditional depression treatments include psychotherapy, anti-depressant medication, cognitive behavioral therapy, exercise, social support groups, and community service. But as noted earlier, those options depend on one’s healthcare plan and/or ability to pay out of pocket.

“Psychotherapy is an effective intervention, which helps people identify problems, provides support, education, and understanding to resolve or manage the current problem or conflict,” Ray says. “This will hopefully help to prevent, resolve, or manage similar problems in the future. This can be done with individuals, families, groups, and/or couples.”

In addition to traditional therapies, healthcare facilities are now pioneering integrative mental, behavioral and physiological care. One example is Bayless Integrated Healthcare’s recently opened Integrated Addiction Treatment Center in Phoenix, which specializes in this approach.

“We provide all of these modalities in one place to destigmatize obtaining treatment, increase the communication between patients and their providers, and decrease barriers to access to care,” Ray says. “We find that many people who often wouldn’t seek mental health treatment will meet with a professional in their primary care setting. Also, patients are more likely to receive information and help regarding their mental health if their behavioral health provider is part of their primary care treatment team, as they often have long and trusting relationships with their primary care provider.”

Help at home

Some healthcare services, like counseling and telehealth, are available in the home, depending on the person’s coverage. This comes in handy when transportation and medical issues come into play.

“Supporting caregivers of the elderly is also necessary,” Ray adds. “Providing in-home support to family and friends who take care of our aging population helps to keep helpers in helping roles.”

She says other in-home activities which support mental health can include daily walking; participating in family events; calling friends and family members routinely; playing games like crossword puzzles, word searches and cards; and volunteering.

Learn more

To continue the much-needed discussion on mental health issues, IMHR and IMHR Epicenter will offer a series of free monthly educational sessions. Created for both mental health professionals and the general public, these events will share information and the latest research on mental health issues. The dates and topics that will be covered in this series include:

  • June 14, 2018
    • Autism with Dr. Shenfeng Qiu, Assistant Professor, University of Arizona
  • July 12, 2018
    • Mental Health and Aging with Dr. Rebecca Fega, Resident, University of Arizona
  • August 9, 2018
    • Women’s Mental Health with Dr. Heather Bimonte-Nelson, Arizona State University
  • September 13, 2018
    • PTSD: Veterans’ Mental Health with Dr. Leah Doane, Arizona State University
  • October 11, 2018
    • Depression with Dr. Deveroux Ferguson, Assistant Professor, University of Arizona
  • November 8, 2018
    • Culture and Mental Health with Dr. Jeanette Smith, Phoenix Children’s Hospital

All events are open to the public and will be held from 5 to 7 p.m. at IMHR Epicenter, 1415 N. First Street, Phoenix. Admission is free with advanced registration. To RSVP, contact Gwyn Hutchinson at 480-276-3968 or For more information, visit