We enjoy the little things. Psychologist on how to avoid depression in retirement

The period of late adulthood (starting from the age of 60) is characterized by specific changes in the emotional sphere of a person: uncontrolled affective reactions, a tendency to causeless sadness, tearfulness.

A decrease in emotionality deprives new impressions of brightness, hence the attachment of older people to their past. One of the most common experiences is aging anxiety. This is a kind of defense mechanism that allows you to avoid strong emotional outbursts in truly critical situations. Another defense mechanism is emotional detachment , outwardly manifested as indifference. Relatives say about such a person: he hears and sees only what he wants. But emotional detachment helps to avoid deep suffering - such as the death of loved ones.

In addition to the active use of defense mechanisms, age-related situational depression is typical of old age - a uniform and persistent decrease in mood. Subjectively, it is experienced as a feeling of uselessness, uninterestingness of everything that happens. There are three main ways in which age-related depression manifests itself.

Hypochondriacal fixation

A person constantly listens to painful symptoms and vividly discusses them with others. For him, the most valuable idea is treatment, procedures, doctor’s appointments and medications. To some extent, this is also a protective mechanism: close attention to one’s illness allows one not to notice old age as such. Indeed, when describing their condition, people strive in every possible way to emphasize the dissimilarity of their symptoms with the manifestations of senility: after all, the disease can be cured, but old age is forever. Accordingly, perceiving the signs of old age as symptoms of illness, a person denies his own aging.

If you don't need me

– In communicating with their elderly relatives, many have heard reproaches: I completely forgot, you don’t come, you don’t call, you don’t need me. Even “thanks for calling” sounds like a reproach. What to do?

-You need to grow up. It will no longer be possible to re-educate your parents, but it is still possible to change yourself in relation to them. Parents often become attached to their children, seeing the meaning of life in serving them. A friend of mine raised her daughter alone. The child grew up sickly. But now she is already an adult woman who lives far from Chelyabinsk. To be closer to her daughter, the mother is ready to sell everything here and go to her, but the daughter is already tired of being a mother hen. The tragedy is that they love each other, but cannot be together because one is encroaching on the personal freedom of the other. There is a term “psychological donation”, when parents cling to their children with questions: “Why didn’t you come for a long time, didn’t call, didn’t come?” Perhaps it is psychologically necessary. But “donation” should not be a burden. In order not to aggravate the situation, you need to accept your parents for who they are. Most often, they need a little attention from us: pop in for a cup of tea on the weekend, please them with new warm socks or mittens, call after work for 3-15 minutes.

Maybe your mother is used to loving by giving: “If I can’t give you anything more, then you don’t need me. If you don’t need me, then you don’t love me,” this is also often reasoned. She wants to be useful in at least something! Therefore, if she wants to knit a scarf for you or invites you to take gifts, do not refuse, because she needs it more than you.

– Do you need to work in retirement?

– When you work at 1-2 rates all your life, you have no time to think. The initial task is to be on time. Have time to take your child to kindergarten, school, section, and not be late for work. Have time to submit a report or project on time, have time to cook dinner. Minor troubles knock eternal questions out of your head: who am I, what am I, what am I for? When a person retires, he is faced with the fact that he does not know how to structure his free time. Then, in order to keep themselves busy, those who have retired go to work as watchmen and security guards, so that idleness does not bother them and there is no depression or binge drinking.

Tendency towards fiction

Moreover, these inventions will indicate the special significance of the person. He strives to tell actual episodes from his biography with exaggeration of his own participation, or he can invent whole stories.

If senile anxiety, emotional withdrawal and, to a certain extent, depression perform peculiar protective functions, then the feeling of uselessness contributes to both psychological and biological withering. It is often accompanied by a feeling of insecurity. Unfortunately, this perception of life is typical for older people, although it may not at all correspond to the real life situation: older people can have caring relatives, be of real benefit, but still feel a sense of uselessness.

The feeling of uselessness has two sources. The first is when a person ceases to be needed by himself and projects this attitude onto others. The second source is human weakness. With retirement, the number of ways to be needed decreases due to a decrease in material wealth and physical strength, and this can be perceived as a threat to a person’s integrity.

An integrated approach to the treatment of depressive conditions in elderly patients

Clinically, a depressive episode is manifested by main and additional symptoms. The main ones include: a depressed mood, not typical for a given person, for most of the day, almost every day, highly dependent on the circumstances and lasting for at least 2 weeks; loss of interest or pleasure in activities usually enjoyable for the individual; loss of energy or increased fatigue. Additional symptoms include: lack of self-confidence or decreased self-esteem, unfounded self-blame or excessive and inappropriate feelings of guilt; recurrent thoughts of death or suicide or any manifestations of suicidal behavior; signs of difficulty thinking or concentrating, such as indecisiveness and doubt, or corresponding complaints; gloomy and pessimistic expectations about the future; any sleep disturbances (2 hours less or more, night awakenings); change in appetite (decrease or increase) with a corresponding change in body weight [1].

In older patients, depressive disorders are more severe than in younger patients and have the following characteristic features:

• mutual overlap of somatic and mental symptoms;
• minimal expression of sadness;
• somatization/disproportionate complaints associated with somatic disorder;
• neurotic disorders with recent onset of depression;
• conditions with vague complaints of pain;
• deliberate self-harm;
• depressive “pseudo-dementia” - reversible, noticeable difficulties in concentrating and remembering;
• development of depression due to dementia;
• apathy, low level of motivation;
• sleep disturbance;
• confusion;
• increased irritability and sharpening of pathological personality traits [2,3].

Often depression in an elderly patient is combined with cognitive impairment.

Biochemical disorders play an important role in the pathogenesis of depression. Depression is characterized by a disturbance in the homeostasis of the nervous system with a pathological increase or decrease in central inhibition, where gamma-aminobutyric acid (GABA) plays a major role [4]. GABA is formed from L-glutamate by the enzyme glutamate decarboxylase and is metabolized by GABA transaminase to succinic acid semialdehyde, which in turn is converted to succinate in a dehydrogenation reaction [5]. GABAergic mechanisms are deeply associated with the pathogenesis of depressive and anxiety disorders; they form a single depressive-anxious continuum. First of all, GABA is involved in the suppression of oxidative stress characteristic of stressful conditions with an increase in lipid peroxidation. In depressive disorders, homeostasis is significantly disrupted with the formation of pathologically abnormal levels of key hormones - adrenocorticotropin, cortisol and testosterone, corticoliberin, catecholamines, oxytocin, renin, prolactin and vasopressin. The main role in regulating the described disorders is traditionally assigned to GABAA, but in recent years GABAB receptors have also attracted increasing attention in this area [6]. The GABA system constantly interacts with the NMDA system; excessive NMDA activity is also inhibited by GABA [7].

GABA modulates the conduction of nociceptive signals and the development of depression of cortical neurons [4]. A lack of GABA may be one of the conditions contributing to the combined development of migraine and depression in a patient, and preventive therapy that modulates GABAergic transmission in the central nervous system may be pathogenetically justified for the treatment of both diseases [4]. In this regard, the search for GABAergic drugs that can be used as a component of complex therapy for depression is justified.

The presence of depression in elderly patients necessarily requires the appointment of appropriate antidepressant therapy, in the absence of which it is extremely difficult to achieve a significant clinical effect. In this case, broad-spectrum antidepressants should be used (selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants), affecting not only emotional, but also cognitive, motor, behavioral, somatic symptoms of depression and at the same time being well tolerated.

The complex of basic therapy for depression can be supplemented with the drug Picamilon , which will help optimize treatment.

The nootropic drug "Picamilon" has an active substance - nicotinoyl-gamma-aminobutyric acid (N-nicotinoyl-gamma-aminobutyric acid sodium salt). Important effects of this drug are dilation of cerebral blood vessels, as well as tranquilizing, psychostimulating, antiplatelet and antioxidant effects. The active substance of the drug improves the functional state of the brain by normalizing tissue metabolism and influencing cerebral circulation, and an increase in the volumetric and linear velocity of cerebral blood flow, a decrease in cerebral vascular resistance, suppression of platelet aggregation, and improvement in microcirculation are recorded. The action of Picamilon at the receptor level is realized through the chloride channels of GABAA receptors [8].

When taken as a course, Picamilon increases physical and mental performance, reduces headaches, improves memory, and normalizes sleep; helps reduce or eliminate feelings of anxiety, tension, fear; improves the condition of patients with motor and speech disorders.

The drug is widely used for a number of indications, in particular: for cerebrovascular insufficiency, asthenia; with anxiety, irritability, emotional lability; asthenia of various origins; for relief of acute alcohol intoxication; for encephalopathies, and also - as part of complex therapy - for the prevention of migraines. Picamilon has a well-tested safety profile in clinical settings.

Thus, Picamilon can be used as part of complex therapy for depression in elderly patients with pronounced signs of irritability, anxiety, and cognitive decline.

Bibliography

World Health Organization. ICD-10, classification of mental and behavioral disorders: clinical descriptions and diagnostic guidelines. Geneva. Switzerland. WHO, 1992. 300 p.2. Kornetov N.A. Depression in old age: diagnosis, management tactics and therapy // Clinical gerontology. 2012. T. 18. No. 11-12. pp. 49-56.3. Sekhon S, Marwaha R. Depressive Cognitive Disorders. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020.4. Kellerman, Rick D. Conn's Current Therapy 2020. Elsevier, 1545 p.5. Voitenkov V.B., Koshkin Yu.A., Vinogradova K.A., Topekha I.M., Kiseleva L.N., Kartashev A.V. Gamma-aminobutyric acid, tumor growth and metastasis // Directory of general practitioners. 2013. No. 8. P. 83-88.6. Evenseth LSM, Gabrielsen M, Sylte I. The GABA(B) Receptor-Structure, Ligand Binding and Drug Development. 2020;25(13):3093. doi: 10.3390/molecules25133093.7. Adell A. Brain NMDA Receptors in Schizophrenia and Depression. 2020;10(6):947. doi: 10.3390/biom10060947.8. Silkina I.V., Ganshina T.S., Seredenin S.B., Mirzoyan R.S. GABAergic mechanism of the cerebrovascular and neuroprotective effects of afobazole and picamilon // Experimental and clinical pharmacology. 2005. T. 68. No. 1. P. 20-24.

Preventing depression in older people

When an elderly person comes to the appropriate medical institution for help, he is provided with the necessary therapy by specialists in certain areas, including a cardiologist and rheumatologist. However, most often, depression is not easy to diagnose during an initial consultation, and therefore not all patients can receive the required treatment. Often, the manifestations of depression in older people are completely ignored, since its symptoms are very similar to other problems that arise in elderly patients.

How to lift an elderly person out of depression and prevent its negative influence?

Stick to a proper diet.

It is important to follow the following rules:

• Include a variety of foods in your diet, especially plant-based foods.
• Eat bread, flour products, cereals, and potatoes several times a day.
• Eat more fresh fruits and vegetables, eat them throughout the day (daily intake is at least 400 g). It's good if they are grown in the area where you live.
• Keep your dietary fat intake under control; its content should not exceed 30% of daily calories. We advise you to include vegetable oils in your diet instead of animal fat.
• Instead of fatty meats and meat products, eat legumes, grains, fish, poultry or lean meats.
• Include low-fat milk in your diet, and try to consume dairy products, including kefir, sour milk, yogurt and cheese, which are low in fat and salt.
• Give preference to products with low sugar content. Limit the amount of sweets and drinks containing sweeteners you eat.
• Watch the amount of salt you consume, it should not be more than one teaspoon - 6 grams per day. It is better to choose iodized salt.
• When drinking alcoholic beverages, remember that the total alcohol content in them should not exceed 20 g per day.
• Choose cooking methods that will keep your food safe. For example, steaming, microwaving, baking or boiling foods can reduce the total amount of fat, oil, salt and sugar.

It is important that the diet is varied and contains mainly products of plant origin. They contain biologically active substances and dietary fiber (fiber), which prevent the occurrence of chronic diseases, especially cardiovascular diseases and cancer.

An elderly person should eat at least 400 grams of fruits and vegetables per day. This recommendation has a scientific basis, confirmed by epidemiological studies. According to the data obtained, people who consume 400 grams of fruits and vegetables daily are less likely to suffer from cardiovascular diseases, certain types of cancer, and do not experience micronutrient deficiencies. Fruits and vegetables contain many vitamins, fiber, microelements, and antioxidants.

Ensure adequate sleep.

It is important to go to bed no later than 22–23 hours. It is during this time interval that the body is relaxed, the nervous system is in a calm state, so there are no problems with falling asleep. An elderly person needs to sleep about 7–8 hours. Often older people suffer from insomnia, so in order to fall asleep faster and easier, it is recommended to take a walk in the fresh air before bed.

We recommend

“A set of exercises for older people: body and breathing” Read more

Moderate physical activity.

To maintain body weight within the required limits (in accordance with the body mass index), you need to devote time to moderate physical activity every day. The options can be very diverse: a walk in the park, exercise, playing with children or grandchildren. You can also join a Nordic walking class or go swimming. By attending sports training you can make new acquaintances.

Try to live a full, active life.

Don’t forget to meet with friends, spend quality time for yourself, travel, visit museums and theaters. There is no need to focus on age, because this way you will be able to avoid depression.

It is important to emphasize that caring for the health of older people must be included in the group of priority tasks implemented by the rule of law. Today, unfortunately, not all retirees can live in such a way that they have enough money for travel and sports.

It will be possible to raise the level of mental health of older people if we actively promote a healthy lifestyle and healthy aging. Try to be closer to your family and friends, do not refuse help and, if possible, offer it yourself.