Depression in Middle Age and Beyond

Here is some more fascinating stuff from Peter Cramer’s book Against Depression, which is his follow-up to Listening to Prozac, his groundbreaking book about depression and Prozac. This is a fascinating book, as good or better than Listening to Prozac. I continue to be impressed by his scholarship and ability to pull interesting research together. If you have any interest at all in learning more about depression, I would strongly recommend this book, which is a philosophical and scientific exploration of depression.

What about those people who have their first depression later in life? Are they similar or different to those who get depressed earlier in life?

What is interesting is that there may be a type of depression in older adults that is physically triggered. Let me tell you a story about how this was discovered.

Much of this research was conducted by K. Ranga Ram Krishnan and his group at Duke University. In the 1980’s they got their first MRI machines. These machines let you take detailed pictures of the brain without using radiation (they use magnetic resonance imagery instead.)

His group didn’t really know what to do with these new machines. So they decided to take a look at the brains of elderly depressed patients. What they found was fascinating. In 70% of the patients who had suffered late in life depressions, they found small white patches in various areas of the brain. When they autopsied some of the these patients who later died, they found that these were lesions in the brain that ranged from tiny pinpoint lesions up to rather large (2 inches in diameter) lesions. These were where silent strokes had occurred, killing the brain tissue.

Silent strokes are those strokes that happen in a part of the brain that does not control sensation or motion, so you often are unaware you even had the stroke.

This led to the realization that these people were suffering from vascular depression, that is, depression caused by damage to the brain from a silent stroke.

The main area of the brain where Krishnan found these lesions was the prefrontal cortex, or more specifically the orbitofrontal cortex, right behind the eyes.

These depressions were very similar to regular depression, with the main difference being that this group generally hadn’t suffered depression earlier in life.

The good news is that these depressions respond well to antidepressant medications, and the patients tend to get well just like regular depressions.

In summary, if you or a relative suffers a sudden depression later in life, suspect a vascular depression. And get treatment. (Also, if your elderly relative suffers a vascular depression, they may also show pseudo-dementia, which is a type of cognitive impairment which is caused by serious depression. It can look like they have suddenly developed Alzheimer’s or some other dementing disorder, but it actually is a side effect of the depression. Treating the depression will often resolve the pseudo-dementia. )

Most important, if a doctor or psychologist tells you that your older relative is depressed because they are old and sick, don’t accept this. There is no reason for the elderly to be more depressed, in spite of age or infirmity.

Copyright 2006 The Psychology Lounge/TPL Productions


Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

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