Mood and Language

I am writing this editorial as August is coming to an end and we are all a bit wistful about the winding down of summer. This has been a long arduous summer for me: no opportunity for vacation, covering two clinical services simultaneously in two separate hospitals because of physician shortages, and, most difficult to deal with, the death of my father. I can say honestly that I feel depressed today. However, I know that I am not clinically depressed. I am optimistic for the future, and I appreciate the fact that my children were home for their grandfather’s death and felt they were able to alleviate his distress and mine. I have no vegetative signs of depression. I simply have a low mood that would be natural for anybody under my circumstances. It is already improving.

However, I think the use of the word depression for a normal transient mood fluctuation as well as for a serious disease sometimes causes many of us to underestimate the gravity of the diagnosis. Depression, the disease, causes tremendous suffering and loss of life. When it accompanies other common morbidities in older adults, such as cardiac disease, it further worsens the prognosis. Depression is a serious disease in the older population, and now that effective treatments are available, it is important that the diagnosis be actively considered and searched for. Unfortunately, current medications do have side effects and limitations, so they cannot be prescribed indiscriminately. As in all areas of medicine, proper prescribing is dependent on accurate diagnosis. However, age-related changes and comorbidities can often make the diagnosis of depression in older adults challenging. We are confident that this edition of our journal, with its focus on depression, can help.

Drs. Tony Lo and Nadeem Bhanji highlight the changes in the presentation of depression with their article “Beyond Sad Mood: Alternate Presentations of Major Depression in Late Life,” and Drs. Elizabeth Santos, Lisa Boyle, and Jeffrey Lyness discuss “The Clinical Approach to Dysthymic Disorders in Older Adults.” Drs. Marie Crowe and Sue Luty discuss “Nonpharmacological Treatments for Older Adults with Depression,” while Drs. Lakshmi Ravindran, David Conn, and Arun Ravindran review “Pharmacotherapy of Depression in Older Adults.” Drs. Marnin Heisel and Paul Links discuss the “Primary Care Prevention of Suicide Among Older Adults.”

As well, we have our usual collection of columns. Dr. David Goukassian discusses “Mending the Rift: DNA Repair and Aging” while Drs. Nages Nagaratnam and Gowrie Pavan write about “Mutism in the Older Adult.” Dr. Kevin Billups informs us about “Erectile Dysfunction as an Early Marker for Cardiovascular Disease” in our CVD column, while our Dementia column, by Drs. Raj Shah and David Bennett, is about “Diagnosis and Management of Mild Cognitive Impairment.”

Enjoy this issue,
Barry Goldlist