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Roderick Boone
Roderick Boone

Sadness WORK

A lot of teens feel unhappy or moody. When the sadness lasts for more than 2 weeks and a teen has other symptoms of depression, there may be a problem. Watch for withdrawal from friends and family, a drop in their performance at school, or use of alcohol or drugs. Talk to your doctor and find out if your teen may be depressed. There is effective treatment that can help teens move beyond depression as they grow older.


Older persons with significant depression may have fewer symptoms than the number required by the DSM-IV criteria for major depression. In one study,6 older adults who expressed feelings of hopelessness or worthlessness, admitted to thoughts of death or suicide, and had at least two other symptoms of depression were at increased risk for functional disability, cognitive impairment, psychologic distress and death, even if they did not display symptoms such as sadness or loss of interest or pleasure in activities that were formerly enjoyed (nondysphoric depression). Depressive symptoms were associated with development of functional impairment as measured by performance tests (avoiding reliance on self-report of function) in a similar study.7 This article will focus on selected clinical clues to depression in late life (Table 2) and the implications for assessment and treatment of older primary care patients with depression.

It is important to assess the psychologic component of physical illness and functional impairment when examining older patients. Hopelessness, not sadness, has been associated with suicidal ideation.12 Contrary to expectation, elderly persons who commit suicide do not have increased rates of severe or terminal illness.13,14 In some cases, however, patients falsely believed that a physical illness was severe or life-threatening and acted on this assumption. Most older adults who have a physical illness, even one as serious as cancer, are not suicidal, but patients' worries about burdening others may seem disproportionate to their degree of illness.

Third, whether patients are treated with psychotherapy or pharmacotherapy, if they deny or minimize feelings of sadness, the physician should rely on other features of the patient's presentation, such as level of social activity, functioning in personal care or reduction in the symptoms discussed above, to assess response. More studies of how depression presents and responds to treatment in older primary care patients are needed.29,30

The assessment of symptoms with higher precision offers further opportunities. More complex constructs, such as sadness, could be assessed with more than one question. Self-report information can be augmented with objective data. Patient reports about sleep quality can be complemented by physiological data on sleep patterns and sleep duration. Diaries can track sleep quality and weight changes, and impaired concentration can be measured using tests such as the d2 Test of Attention [126]. 041b061a72


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