While the months and years pass ever so quickly when we're actively engaged in life, we eventually reach a point when everything seems to come to a grinding halt. A health challenge or an illness can trigger such a change. For others, it's the death of a lifelong partner. Sometimes it occurs sooner than anticipated.

For many elderly people, the days are long and the nights are even longer. Often there seems to be little to fill one's time - a commodity there just wasn't enough of in years past. I suppose the process is predictable.

More often than not, it is challenging. Often perceived as a compromise, aging heralds progressive loss - of function, of enjoyment and of health. In our culture it frequently represents loneliness and abandonment as families grow apart, disperse and maintain less contact.

The greatest obstacle to effective treatment is establishing a correct diagnosis. It's a fact that most depressed people are not inclined to seek help.

The National Institutes of Health (NIH) Consensus Development Conference Statement (1991) suggests that depressive symptoms occur in approximately 15 percent of community residents over the age of 65. Other investigators suggest an incidence in the 25% range with escalations to 50% or more in seniors facing challenging life illnesses such as Parkinsonism or Alzheimer's disease.

Frankly, we do not know the true prevalence of depression. Ashamed to admit their real feelings, depressed people typically do not respond to questionnaires accurately. They also have a tendency to cover up symptoms of depression even during visits with their doctors.

Few seniors who could benefit from psychiatric interventions or counseling ever receive such services. According to the NIH, suicide rates in 80 - 84 year-olds (26.5/100,000 persons) are more than double the frequency noted in younger populations. Suicide is especially prevalent in elderly white men. More than three-fourths of them actually visit a primary care physician during the month before their suicide. Unfortunately depressive symptoms, especially in elderly men often remain well-hidden and untreated.

Though hard to believe, the diagnosis of depression is often missed even in patients facing the challenges of cancer. According to the American Cancer Society (ACS), the diagnosis of depression often alludes oncologists who should be sensitive to the condition. The ACS cites a study recently published in the British Journal of Cancer (April 2001), which disclosed the following: "More than a third of the time, 143 British oncologists wrongly assessed 2,297 cancer patients, missing depression and anxiety in some patients and inaccurately identifying them in others. The oncologists fared better at identifying the absence of psychological illness than at recognizing its presence."

Lesley Fallowfield, PhD, the study's senior author and professor of the Psychosocial Oncology Group at the University of Sussex, Brighton, England commented, "Psychological distress is such a common problem among patients with cancer, that it is depressing in itself that doctors are failing to detect what is a very treatable condition."

The consequences of our inability to accurately recognize depression extends far beyond just psychological implications. It clearly impacts the course of many diseases probably due to complex mechanisms activated through the mind-body connection which directly and indirectly links nervous, endocrine and immune function. Increased stress hormones levels have been considered yet other possible mechanisms are possible.

Depression's clear-cut impact beyond psychological and emotional realms is poorly understood. A study just released in the Archives of Internal Medicine (July 2001) is helping us to better understand the potential cardiovascular effects of depression in the elderly. Researchers at Emory University School of Medicine in Atlanta have shown that elderly people with high blood pressure and depression are twice as likely to suffer heart failure than seniors with high blood pressure alone. The team led by Dr. Jerome Abramson studied more than 4,000 people over the age of 60 and concluded that depression plays a rather substantial role in the progression of heart failure. It is believed that treatment of depression in many cases may produce phenomenal physical improvements.

Perhaps it's time we took a closer look at the typical constellation of symptoms associated with depression. The ACS lists them as:

• Persistent sad or "empty" mood almost every day for most of the day;
• Loss of interest or pleasure in ordinary activities;
• Eating disturbances (loss of appetite or overeating), or significant weight loss or gain;
• Sleep disturbances (insomnia, early waking, or oversleeping);
• Noticeable restlessness or being "slowed down" almost daily;
• Decreased energy, or fatigue almost every day;
• Feelings of guilt, worthlessness, helplessness;
• Difficulty concentrating, remembering, making decisions; or,
• Thoughts of death or suicide, or attempts at suicide.

As you reflect upon this checklist, see if you can recognize the above elements in yourself. While most of us feel down at one time or another, it's important to focus on and better understand the nature of your persistent feelings and symptoms. Why not take a few moments to place a check mark in the boxes that represent what you seem to be generally experiencing on a regular basis.

Remember, self-exploration isn't easy. Yet recognizing depression may be your first and most important step toward achieving a healthy and fulfilling life. In my next column, we'll address effective therapeutic strategies for depression that can help you overcome what may seem like an insurmountable problem - Mind Over Matter!