Get Off The Couch Baby Boomers, Or You May Not Be Able To Later
Coping With Depression When Treatment Doesn't Work
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But research suggests physical recovery from binge TV-watching gets harder in our 50s and as we get older.","publishDate":1504645325,"status":"inherit","parent":435195,"modified":1504645377,"caption":"Young bodies may more easily rebound from long bouts of sitting, with just an hour at the gym. But research suggests physical recovery from binge TV-watching gets harder in our 50s and as we get older.","credit":"Lily Padula for NPR","description":"Young bodies may more easily rebound from long bouts of sitting, with just an hour at the gym. 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FM","link":"/"}},"futureofyou_435195":{"type":"posts","id":"futureofyou_435195","meta":{"index":"posts_1591205157","site":"futureofyou","id":"435195","score":null,"sort":[1504767708000]},"guestAuthors":[],"slug":"get-off-the-couch-baby-boomers-or-you-may-not-be-able-to-later","title":"Get Off The Couch Baby Boomers, Or You May Not Be Able To Later","publishDate":1504767708,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>Count the number of hours you sit each day. Be honest.\u003c/p>\n\u003cp>\"If you commute an hour in the morning and hour after work — that's two hours, and if you sit at an eight-hour-a-day desk job that's 10,\" says epidemiologist \u003ca href=\"https://publichealthonline.gwu.edu/academics/faculty/profile/loretta-dipietro/\">Loretta DiPietro\u003c/a> of the Milken Institute School of Public Health at George Washington University.\u003c/p>\n\u003cp>\"Then you come home at, say, 6 p.m., eat dinner and crash into your recliner for another three to four hours,\" says DiPietro. \"That's 13 to 14 hours of sitting.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">'Sitting and watching TV for long periods, especially in the evening, has got to be one of the most dangerous things that older people can do.'\u003ccite>Loretta DiPietro, Milken Institute School of Public Health\u003c/cite>\u003c/aside>\n\u003cp>Being immobile like that for many hours each day does more than \u003ca href=\"http://www.npr.org/2011/04/25/135575490/sitting-all-day-worse-for-you-than-you-might-think\">raise the risk of a host of diseases\u003c/a>. DiPietro and her colleagues have good evidence that, as the years wear on, it actually reduces the ability of older people to get around on foot at all.\u003c/p>\n\u003cp>In a \u003ca href=\"https://academic.oup.com/biomedgerontology/article/4056501/The-Joint-Associations-of-Sedentary-Time-and\">study\u003c/a> of sitting and walking ability that surveyed people ages 50 to 71 across 8 to 10 years, those who tended to sit the most and move the least had more than three times the risk of difficulty walking by the end of the study, when compared to their more active counterparts.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Some ended up unable to walk at all. The study appears in the current issue of \u003cem>The Journals of Gerontology: Medical Sciences\u003c/em>.\u003c/p>\n\u003cp>Prolonged sitting and TV watching were particularly harmful, DiPietro found, especially when combined with low levels of total physical activity. Young bodies may rebound from prolonged sitting with an hour at the gym, she says. But that seems less true in late middle age.\u003c/p>\n\u003cp>\"Sitting and watching TV for long periods, especially in the evening,\" she says, \"has got to be one of the most dangerous things that older people can do.\" And the period studied — the mid-1990s to 2005, or so — was even before the advent of rampant online streaming of shows, she notes. The problem today is likely even worse.\u003c/p>\n\u003cp>\"Before binge watching, at least when a show ended you got up and walked around,\" DiPietro says. \"It's now possible to watch several hours without moving.\"\u003c/p>\n\u003cp>Though being sedentary at work is also a risk, office employees tend to at least get up now and then, walk down the hall to the printer or restroom, and go to lunch, she says. Or at least workers used to do that. Increasingly, she says, many of us of all ages are engineering much of that \u003ca href=\"http://www.npr.org/2011/04/25/135575490/sitting-all-day-worse-for-you-than-you-might-think\">light activity\u003c/a> out of our lives.\u003c/p>\n\u003cp>\"We now use the Internet to go shopping, order groceries, send messages, and even gossip,\" DiPietro says. \"We used to walk down the hall and gossip; now we send it via email or text.\"\u003c/p>\n\u003cp>To measure the effect of prolonged sitting on mobility, DiPietro and colleagues took data from the large NIH-AARP Diet and Health Study of men and women ages 50 to 71. The participants were all healthy when the study started in 1995 and 1996.\u003c/p>\n\u003cp>The researchers recorded how much those in the study watched TV, exercised or did gardening, housework or other physical activity at the beginning of the investigation. They included \"light\" physical activity like \"puttering around, walking to get the mail, or walking to the car\" says DiPietro.\u003c/p>\n\u003cp>[contextly_sidebar id=\"JplsgjbFNSHSR0iTZQ6WE14V3wQoqauF\"]The results: Those who watched five or more hours of TV per day had a 65 percent greater risk of reporting a mobility disability at the study's end, compared with those who watched less than two hours per day. DiPietro says this association was independent of their level of total physical activity and other factors known to affect the ability to easily move around.\u003c/p>\n\u003cp>She offers an antidote: Get up at least every 30 minutes when staring at a screen.\u003c/p>\n\u003cp>\"And if you insist on staying seated during that 15 second interval between episodes,\" DiPietro says, \"at least stand up, march in place, jump around, kick legs — do anything to move about for at least one to two minutes.\"\u003c/p>\n\u003cp>The result of that would be \"phenomenal,\" to mobility, she says, and be at least a start toward heart health, too.\u003c/p>\n\u003cp>\u003ca href=\"https://www.nationaljewish.org/doctors-departments/providers/print/print-controller?printpath=/Doctors-Departments/Providers/Physicians/Andrew-M-Freeman&size=large\">Dr. Andrew Freeman\u003c/a>, who directs cardiovascular prevention and wellness at National Jewish Health in Denver, and represents the \u003ca href=\"https://www.acc.org/#sort=%40fcommonsortdate86069%20descending\">American College of Cardiology\u003c/a>, says people should do even more higher intensity exercise regularly — at least to the point of being \"breathless.\"\u003c/p>\n\u003cp>But that doesn't necessarily mean jogging around the neighborhood, he says. It can be as simple as walking at a slow pace.\u003c/p>\n\u003cp>In an older population, Freeman says if you're going to be sedentary, you should try to be \"as active\" as you can when not sedentary. That may sound like common sense, he says, but the findings of the DiPietro study underscore the importance. Just five minutes a day of brisk movement, he says, is beneficial.\u003c/p>\n\u003cp>For Denver businesswoman Liz King, that translates to a 20-minute daily walk during the week, and longer on the weekends. King says she's joined walking groups — including the national program \u003ca href=\"https://www.nationaljewish.org/treatment-programs/directory/cardiology/walk-with-doc\">Walk With A Doc\u003c/a> — as a way to build more activity into her day.\u003c/p>\n\u003cp>King is 61 years old and very busy starting a vegan food company in Denver — but does it, pretty much, sitting down, she says.\u003c/p>\n\u003cp>\"When you have your own business, you have a little more flexibility,\" she says. \"But I'll tell you one thing that's constant — that's eight hours, at least, of looking at the screen and sitting in the chair.\"\u003c/p>\n\u003cp>And, for her, being glued to the computer — and the chair — doesn't necessarily stop when the work day ends.\u003c/p>\n\u003cp>[contextly_sidebar id=\"2HaGoHwIzRO6oc9LT4do01EduUx8KarZ\"]\"The inbox that may be overflowing,\" she says. Or she's doing homework for an online course. She'll check in with a chat session or with other family and friends online.\u003c/p>\n\u003cp>Then there's about an hour or more of watching television, King says. It all adds up.\u003c/p>\n\u003cp>So she makes sure to get out and walk at least a little bit, every day. She varies the pace, she admits, and laughs.\u003c/p>\n\u003cp>\"If I'm walking solo I'm probably walking at a more leisurely pace,\" she says, \"because I tend to take a picture of the occasional wildflower, or the clouds that are in a wonderful formation.\"\u003c/p>\n\u003cp>But on a speedier walk with a group, she keeps up.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>It's all a big win for King's health, Freeman says, because she's away from the screen and moving. Exercise, he says, is nature's best medicine.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Get+Off+The+Couch+Baby+Boomers%2C+Or+You+May+Not+Be+Able+To+Later&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"If you sit too much during middle age — at work and at home — your ability to exercise or even walk in late decades is at risk, a study hints. And, of course, your risk of heart disease climbs, too.","status":"publish","parent":0,"modified":1504646406,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":32,"wordCount":1136},"headData":{"title":"Get Off The Couch Baby Boomers, Or You May Not Be Able To Later | KQED","description":"If you sit too much during middle age — at work and at home — your ability to exercise or even walk in late decades is at risk, a study hints. And, of course, your risk of heart disease climbs, too.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Get Off The Couch Baby Boomers, Or You May Not Be Able To Later","datePublished":"2017-09-07T07:01:48.000Z","dateModified":"2017-09-05T21:20:06.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"435195 https://ww2.kqed.org/futureofyou/?p=435195","disqusUrl":"https://ww2.kqed.org/futureofyou/2017/09/07/get-off-the-couch-baby-boomers-or-you-may-not-be-able-to-later/","disqusTitle":"Get Off The Couch Baby Boomers, Or You May Not Be Able To Later","nprByline":"Patti Neighmond\u003c/br>NPR Shots","nprImageAgency":"Lily Padula for NPR","nprStoryId":"547580952","nprApiLink":"http://api.npr.org/query?id=547580952&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2017/09/04/547580952/get-off-the-couch-baby-boomers-or-you-may-not-be-able-to-later?ft=nprml&f=547580952","nprRetrievedStory":"1","nprPubDate":"Mon, 04 Sep 2017 08:43:00 -0400","nprStoryDate":"Mon, 04 Sep 2017 05:10:00 -0400","nprLastModifiedDate":"Mon, 04 Sep 2017 15:29:54 -0400","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/me/2017/09/20170904_me_get_off_the_couch_baby_boomers_or_you_may_not_be_able_to_later.mp3?orgId=1&topicId=1128&d=208&p=3&story=547580952&t=progseg&e=548407186&seg=3&ft=nprml&f=547580952","nprAudioM3u":"http://api.npr.org/m3u/1548415579-0fe4ef.m3u?orgId=1&topicId=1128&d=208&p=3&story=547580952&t=progseg&e=548407186&seg=3&ft=nprml&f=547580952","path":"/futureofyou/435195/get-off-the-couch-baby-boomers-or-you-may-not-be-able-to-later","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/me/2017/09/20170904_me_get_off_the_couch_baby_boomers_or_you_may_not_be_able_to_later.mp3?orgId=1&topicId=1128&d=208&p=3&story=547580952&t=progseg&e=548407186&seg=3&ft=nprml&f=547580952","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Count the number of hours you sit each day. Be honest.\u003c/p>\n\u003cp>\"If you commute an hour in the morning and hour after work — that's two hours, and if you sit at an eight-hour-a-day desk job that's 10,\" says epidemiologist \u003ca href=\"https://publichealthonline.gwu.edu/academics/faculty/profile/loretta-dipietro/\">Loretta DiPietro\u003c/a> of the Milken Institute School of Public Health at George Washington University.\u003c/p>\n\u003cp>\"Then you come home at, say, 6 p.m., eat dinner and crash into your recliner for another three to four hours,\" says DiPietro. \"That's 13 to 14 hours of sitting.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">'Sitting and watching TV for long periods, especially in the evening, has got to be one of the most dangerous things that older people can do.'\u003ccite>Loretta DiPietro, Milken Institute School of Public Health\u003c/cite>\u003c/aside>\n\u003cp>Being immobile like that for many hours each day does more than \u003ca href=\"http://www.npr.org/2011/04/25/135575490/sitting-all-day-worse-for-you-than-you-might-think\">raise the risk of a host of diseases\u003c/a>. DiPietro and her colleagues have good evidence that, as the years wear on, it actually reduces the ability of older people to get around on foot at all.\u003c/p>\n\u003cp>In a \u003ca href=\"https://academic.oup.com/biomedgerontology/article/4056501/The-Joint-Associations-of-Sedentary-Time-and\">study\u003c/a> of sitting and walking ability that surveyed people ages 50 to 71 across 8 to 10 years, those who tended to sit the most and move the least had more than three times the risk of difficulty walking by the end of the study, when compared to their more active counterparts.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Some ended up unable to walk at all. The study appears in the current issue of \u003cem>The Journals of Gerontology: Medical Sciences\u003c/em>.\u003c/p>\n\u003cp>Prolonged sitting and TV watching were particularly harmful, DiPietro found, especially when combined with low levels of total physical activity. Young bodies may rebound from prolonged sitting with an hour at the gym, she says. But that seems less true in late middle age.\u003c/p>\n\u003cp>\"Sitting and watching TV for long periods, especially in the evening,\" she says, \"has got to be one of the most dangerous things that older people can do.\" And the period studied — the mid-1990s to 2005, or so — was even before the advent of rampant online streaming of shows, she notes. The problem today is likely even worse.\u003c/p>\n\u003cp>\"Before binge watching, at least when a show ended you got up and walked around,\" DiPietro says. \"It's now possible to watch several hours without moving.\"\u003c/p>\n\u003cp>Though being sedentary at work is also a risk, office employees tend to at least get up now and then, walk down the hall to the printer or restroom, and go to lunch, she says. Or at least workers used to do that. Increasingly, she says, many of us of all ages are engineering much of that \u003ca href=\"http://www.npr.org/2011/04/25/135575490/sitting-all-day-worse-for-you-than-you-might-think\">light activity\u003c/a> out of our lives.\u003c/p>\n\u003cp>\"We now use the Internet to go shopping, order groceries, send messages, and even gossip,\" DiPietro says. \"We used to walk down the hall and gossip; now we send it via email or text.\"\u003c/p>\n\u003cp>To measure the effect of prolonged sitting on mobility, DiPietro and colleagues took data from the large NIH-AARP Diet and Health Study of men and women ages 50 to 71. The participants were all healthy when the study started in 1995 and 1996.\u003c/p>\n\u003cp>The researchers recorded how much those in the study watched TV, exercised or did gardening, housework or other physical activity at the beginning of the investigation. They included \"light\" physical activity like \"puttering around, walking to get the mail, or walking to the car\" says DiPietro.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The results: Those who watched five or more hours of TV per day had a 65 percent greater risk of reporting a mobility disability at the study's end, compared with those who watched less than two hours per day. DiPietro says this association was independent of their level of total physical activity and other factors known to affect the ability to easily move around.\u003c/p>\n\u003cp>She offers an antidote: Get up at least every 30 minutes when staring at a screen.\u003c/p>\n\u003cp>\"And if you insist on staying seated during that 15 second interval between episodes,\" DiPietro says, \"at least stand up, march in place, jump around, kick legs — do anything to move about for at least one to two minutes.\"\u003c/p>\n\u003cp>The result of that would be \"phenomenal,\" to mobility, she says, and be at least a start toward heart health, too.\u003c/p>\n\u003cp>\u003ca href=\"https://www.nationaljewish.org/doctors-departments/providers/print/print-controller?printpath=/Doctors-Departments/Providers/Physicians/Andrew-M-Freeman&size=large\">Dr. Andrew Freeman\u003c/a>, who directs cardiovascular prevention and wellness at National Jewish Health in Denver, and represents the \u003ca href=\"https://www.acc.org/#sort=%40fcommonsortdate86069%20descending\">American College of Cardiology\u003c/a>, says people should do even more higher intensity exercise regularly — at least to the point of being \"breathless.\"\u003c/p>\n\u003cp>But that doesn't necessarily mean jogging around the neighborhood, he says. It can be as simple as walking at a slow pace.\u003c/p>\n\u003cp>In an older population, Freeman says if you're going to be sedentary, you should try to be \"as active\" as you can when not sedentary. That may sound like common sense, he says, but the findings of the DiPietro study underscore the importance. Just five minutes a day of brisk movement, he says, is beneficial.\u003c/p>\n\u003cp>For Denver businesswoman Liz King, that translates to a 20-minute daily walk during the week, and longer on the weekends. King says she's joined walking groups — including the national program \u003ca href=\"https://www.nationaljewish.org/treatment-programs/directory/cardiology/walk-with-doc\">Walk With A Doc\u003c/a> — as a way to build more activity into her day.\u003c/p>\n\u003cp>King is 61 years old and very busy starting a vegan food company in Denver — but does it, pretty much, sitting down, she says.\u003c/p>\n\u003cp>\"When you have your own business, you have a little more flexibility,\" she says. \"But I'll tell you one thing that's constant — that's eight hours, at least, of looking at the screen and sitting in the chair.\"\u003c/p>\n\u003cp>And, for her, being glued to the computer — and the chair — doesn't necessarily stop when the work day ends.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\"The inbox that may be overflowing,\" she says. Or she's doing homework for an online course. She'll check in with a chat session or with other family and friends online.\u003c/p>\n\u003cp>Then there's about an hour or more of watching television, King says. It all adds up.\u003c/p>\n\u003cp>So she makes sure to get out and walk at least a little bit, every day. She varies the pace, she admits, and laughs.\u003c/p>\n\u003cp>\"If I'm walking solo I'm probably walking at a more leisurely pace,\" she says, \"because I tend to take a picture of the occasional wildflower, or the clouds that are in a wonderful formation.\"\u003c/p>\n\u003cp>But on a speedier walk with a group, she keeps up.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It's all a big win for King's health, Freeman says, because she's away from the screen and moving. Exercise, he says, is nature's best medicine.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Get+Off+The+Couch+Baby+Boomers%2C+Or+You+May+Not+Be+Able+To+Later&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/435195/get-off-the-couch-baby-boomers-or-you-may-not-be-able-to-later","authors":["byline_futureofyou_435195"],"categories":["futureofyou_1"],"tags":["futureofyou_532","futureofyou_1075","futureofyou_743","futureofyou_1275"],"featImg":"futureofyou_435196","label":"futureofyou"},"futureofyou_257328":{"type":"posts","id":"futureofyou_257328","meta":{"index":"posts_1591205157","site":"futureofyou","id":"257328","score":null,"sort":[1475860619000]},"guestAuthors":[],"slug":"coping-with-depression-when-treatment-doesnt-work","title":"Coping With Depression When Treatment Doesn't Work","publishDate":1475860619,"format":"standard","headTitle":"Future of You | KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Rini Kramer-Carter has tried everything to pull herself out of her dark emotional hole: individual therapy, support groups, tai chi and numerous antidepressants.\u003c/p>\n\u003cp>The 73-year-old Los Angeles musician rattles off the list: Prozac, Cymbalta, Lexapro.\u003c/p>\n\u003cp>“I’ve been on a bunch,” she said. “I still cry all the time.”\u003c/p>\n\u003cp>She has what’s known as “treatment-resistant depression.” It’s commonly defined as depression that doesn’t respond to two different medications when taken one after the other, at the right dose and for the right amount of time.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-medium wp-image-224252\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/DepressedMan-800x453.jpg\" alt=\"DepressedMan\" width=\"800\" height=\"453\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/DepressedMan-800x453.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/DepressedMan-400x227.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/DepressedMan-768x435.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/DepressedMan-1180x669.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/DepressedMan.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/DepressedMan-960x544.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Nearly 16 million adults have major depression, and up to \u003ca href=\"http://www.ajgponline.org/article/S1064-7481%2816%2930126-9/fulltext?rss=yes\">a third\u003c/a> do not respond to treatment. The disease afflicts people of all ages, but experts say that as many as half of older adults don’t get better with standard treatment.\u003c/p>\n\u003cp>Mental health experts expect treatment-resistant depression to become more widespread as baby boomers age. Boomers already have been identified as having \u003ca href=\"http://www.gallup.com/poll/181364/reports-depression-treatment-highest-among-baby-boomers.aspx\">higher rates\u003c/a> of depression than previous generations, and over time their depression may no longer respond to medication.\u003c/p>\n\u003cp>“We are seeing treatment-resistant depression more, and we are recognizing it more,” said Helen Lavretsky, a geriatric psychiatrist at UCLA. “And in older adults, the answer to understanding what it is and what to do about it is more complicated than in younger adults.”\u003c/p>\n\u003cp>The consequences among older adults can be devastating. Persistent depression can raise the risk of early death and suicide, expedite memory decline and lead to a loss of independence.\u003c/p>\n\u003cp>\u003cstrong>Why Antidepressants Aren't Enough\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>The phenomenon isn’t well studied, but psychiatrists believe there are several reasons why depression in older adults may not respond to treatment. For one thing, if a person has been depressed and taken different medications for a long time, it can diminish their effectiveness. Patients also may neglect to take their medication as prescribed, because they have memory problems or they believe they no longer need it.\u003c/p>\n\u003cp>“Sometimes people say, ‘I’m better. I don’t need this,’ and stop the medicine,” said Anthony P. Weiner, who directs outpatient geriatric psychiatry at Massachusetts General Hospital. “Then the symptoms recur … and if the person goes back on the medicine, it may not be fully effective.”\u003c/p>\n\u003cp>Seniors are also more likely to have chronic medical illnesses, which raises the risk of depression. Their illnesses may make it more difficult for them to recover from depression. And it can mask whether antidepressants are working, because symptoms of chronic illness can be mistaken for depression — and vice versa.\u003c/p>\n\u003cp>Poverty, isolation, pain, grief over the loss of a spouse, or being a caregiver can also lead to or intensify a senior’s depression. And no matter what medication the patients take, Lavretsky noted, those external factors don’t go away.\u003c/p>\n\u003cp>“Either they change their perspective or they change their circumstances, or the depression just persists,” she said.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-medium wp-image-225685\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/depressedwomanrain-800x473.jpg\" alt=\"depressedwomanrain\" width=\"800\" height=\"473\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/depressedwomanrain-800x473.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/depressedwomanrain-400x236.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/depressedwomanrain-768x454.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/depressedwomanrain-1180x698.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/depressedwomanrain.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/depressedwomanrain-960x568.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>Antidepressants can help seniors gain some perspective. But Lavretsky and others agree that even if the medications are effective, they shouldn’t be used in isolation. “It’s an emotional experience,” Weiner said. “The whole answer isn’t just, ‘Oh, here take a pill.’ There is such a central role for psychotherapy.”\u003c/p>\n\u003cp>Kramer-Carter, who speaks slowly and hugs everyone she meets, has felt depressed for as long as she can remember. As a young adult, she worked as a secretary and a proofreader but got fired more than once because she had trouble getting out of bed and making it to work on time. She went to the emergency room many times and in her 30s, she was diagnosed with depression.\u003c/p>\n\u003cp>Now, she spends a few days each week driving her husband, Eugene Carter, to medical appointments. When she feels up to it, she volunteers delivering food to poor families.\u003c/p>\n\u003cp>Kramer-Carter checks all the boxes for being at high-risk of treatment-resistant depression. She is a long-time caregiver, first for her parents and now for her husband, a stroke survivor with short-term memory problems. Her own list of health problems is long: diabetes, high blood pressure, arthritis, fibromyalgia and gout.\u003c/p>\n\u003cp>“Who wants to be aching all the time?” she said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'If I can stay in bed all day, that’s what I do.'\u003ccite>Rini Kramer-Carter\u003c/cite>\u003c/aside>\n\u003cp>Money problems don’t help either. The couple depends financially on Social Security. If she had more money, she said she would go to the theater or see live concerts. She misses both.\u003c/p>\n\u003cp>“We wouldn’t be so stuck,” she said. As it is, they spend everything on food, rent and other bills.\u003c/p>\n\u003cp>“It’s a constant struggle,” she said. “You have to borrow from Peter to pay Paul.”\u003c/p>\n\u003cp>Despite the prevalence of treatment-resistant depression, \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3363299/\" target=\"_blank\">few resources\u003c/a> exist to help psychiatrists make treatment decisions. Clinical trials have been scant, and there are no universally accepted protocols for the condition. The risks and benefits of different medications for older adults are largely unknown.\u003c/p>\n\u003cp>Given a shortage of geriatric psychiatrists, decisions on treatment are often left to primary care providers, who may not have relevant training or might be reluctant to take on such complicated care.\u003c/p>\n\u003cp>Doctors with patients who don’t respond to traditional therapies frequently make ad hoc decisions about whether to change the dosage, add a medication or switch to a new one.\u003c/p>\n\u003cp>“The clinicians use their best experience and trial and error,” said Evelyn Whitlock, chief science officer at the Patient-Centered Outcomes Research Institute. “They try something, and if it doesn’t work, they try something else.”\u003c/p>\n\u003cp>Trial and error is not ideal, she said. Many of these people have been living with depression for so many years, and providers need to be able to provide them with effective treatment.\u003c/p>\n\u003cp>\u003cstrong>New Approaches\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>In an effort to produce better medical outcomes for people with treatment-resistant depression, the Patient-Centered Outcomes Research Institute announced in July that it was funding \u003ca href=\"http://www.pcori.org/news-release/pcori-board-approves-40-million-improving-treatment-options-depression\" target=\"_blank\">three major studies\u003c/a> that will test different approaches to the illness. The goal of the research is to produce tangible evidence that can be used immediately to help patients and their doctors make more informed treatment decisions. [contextly_sidebar id=\"QvUjqDKFRFEtGPmtPTeoqpzPvYGJtv45\"]\u003c/p>\n\u003cp>The Washington, D.C. nonprofit, which finances health research, earmarked $40 million for the five-year studies, which it expects to begin this fall. They will include more than 2,500 patients at sites in California, Ohio, New York, Texas, Pennsylvania and elsewhere.\u003c/p>\n\u003cp>One of the studies will examine electroconvulsive therapy — its impact on quality of life and its potential for relieving the symptoms. Another will compare the effectiveness and safety of three strategies — using magnetic fields to stimulate nerve cells in the brain, adding an antipsychotic medication or switching to a specific antidepressant. The research will assess how these approaches affect the patients’ ability to function at home and work.\u003c/p>\n\u003cp>The third and largest study, with about 1,500 patients, will focus specifically on older adults, testing different drugs and studying how aging affects the risk and benefits of antidepressants. UCLA, where Kramer-Carter is being treated, is part of the third study, which will weigh life circumstances and disabilities in addition to depression.\u003c/p>\n\u003cp>The grants represent an “unprecedented opportunity to look at this population,” Lavretsky said.\u003c/p>\n\u003cp>“It will be a comprehensive look at the condition, why it happens and what are the ways of alleviating suffering,” she said. “Are there some similarities among all people with treatment-resistant depression? I suspect we will find some.”\u003c/p>\n\u003cp>On a recent afternoon, Rini Kramer-Carter visited Lavretsky at UCLA. She said the only time she truly escapes her sadness is when she plays percussion along with other musicians. But she hasn’t been playing lately, and she has been sleeping up to 20 hours a day.\u003c/p>\n\u003cp>\u003cimg class=\"size-medium wp-image-257360\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/10/Prozac-428x600.jpg\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/10/Prozac-428x600.jpg 428w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/Prozac-400x560.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/Prozac.jpg 731w\" sizes=\"(max-width: 428px) 100vw, 428px\">\u003c/p>\n\u003cp>“If I can stay in bed all day, that’s what I do,” she said.\u003c/p>\n\u003cp>Sometimes she watches TV comedies to try to dissipate her black moods.\u003c/p>\n\u003cp>Kramer-Carter said she learned about Lavretsky after seeing a newspaper ad for another research study, of a drug typically used to treat early-stage dementia. During their appointment, Lavretsky went over a list of questions included in the study. “On a scale of zero to 10, where do you place yourself in terms of depression?” the doctor asked her. Nine, she responded.\u003c/p>\n\u003cp>She told Lavretsky she sometimes felt restless and anxious, but not suicidal.\u003c/p>\n\u003cp>“Do you feel full of energy?” Lavretsky asked.\u003c/p>\n\u003cp>“Do I look like I am full of energy?” she responded with a sigh.\u003c/p>\n\u003cp>Lavretsky told her that no pill will completely fix her problems, but medication might give her more energy and the ability to cope. Kramer-Carter said she knows a drug won’t produce any miracles. She just wants some relief.\u003c/p>\n\u003cp>“I just want to be able to live my life,” she said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Treatment-resistant depression is a serious problem, particularly among older adults.","status":"publish","parent":0,"modified":1475861213,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":49,"wordCount":1561},"headData":{"title":"Coping With Depression When Treatment Doesn't Work | KQED","description":"Treatment-resistant depression is a serious problem, particularly among older adults.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Coping With Depression When Treatment Doesn't Work","datePublished":"2016-10-07T17:16:59.000Z","dateModified":"2016-10-07T17:26:53.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"257328 http://ww2.kqed.org/futureofyou/?p=257328","disqusUrl":"https://ww2.kqed.org/futureofyou/2016/10/07/coping-with-depression-when-treatment-doesnt-work/","disqusTitle":"Coping With Depression When Treatment Doesn't Work","source":"Future of You","nprByline":"Anna Gorman \u003c/br> Kaiser Health News","path":"/futureofyou/257328/coping-with-depression-when-treatment-doesnt-work","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Rini Kramer-Carter has tried everything to pull herself out of her dark emotional hole: individual therapy, support groups, tai chi and numerous antidepressants.\u003c/p>\n\u003cp>The 73-year-old Los Angeles musician rattles off the list: Prozac, Cymbalta, Lexapro.\u003c/p>\n\u003cp>“I’ve been on a bunch,” she said. “I still cry all the time.”\u003c/p>\n\u003cp>She has what’s known as “treatment-resistant depression.” It’s commonly defined as depression that doesn’t respond to two different medications when taken one after the other, at the right dose and for the right amount of time.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-medium wp-image-224252\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/DepressedMan-800x453.jpg\" alt=\"DepressedMan\" width=\"800\" height=\"453\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/DepressedMan-800x453.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/DepressedMan-400x227.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/DepressedMan-768x435.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/DepressedMan-1180x669.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/DepressedMan.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/DepressedMan-960x544.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Nearly 16 million adults have major depression, and up to \u003ca href=\"http://www.ajgponline.org/article/S1064-7481%2816%2930126-9/fulltext?rss=yes\">a third\u003c/a> do not respond to treatment. The disease afflicts people of all ages, but experts say that as many as half of older adults don’t get better with standard treatment.\u003c/p>\n\u003cp>Mental health experts expect treatment-resistant depression to become more widespread as baby boomers age. Boomers already have been identified as having \u003ca href=\"http://www.gallup.com/poll/181364/reports-depression-treatment-highest-among-baby-boomers.aspx\">higher rates\u003c/a> of depression than previous generations, and over time their depression may no longer respond to medication.\u003c/p>\n\u003cp>“We are seeing treatment-resistant depression more, and we are recognizing it more,” said Helen Lavretsky, a geriatric psychiatrist at UCLA. “And in older adults, the answer to understanding what it is and what to do about it is more complicated than in younger adults.”\u003c/p>\n\u003cp>The consequences among older adults can be devastating. Persistent depression can raise the risk of early death and suicide, expedite memory decline and lead to a loss of independence.\u003c/p>\n\u003cp>\u003cstrong>Why Antidepressants Aren't Enough\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>The phenomenon isn’t well studied, but psychiatrists believe there are several reasons why depression in older adults may not respond to treatment. For one thing, if a person has been depressed and taken different medications for a long time, it can diminish their effectiveness. Patients also may neglect to take their medication as prescribed, because they have memory problems or they believe they no longer need it.\u003c/p>\n\u003cp>“Sometimes people say, ‘I’m better. I don’t need this,’ and stop the medicine,” said Anthony P. Weiner, who directs outpatient geriatric psychiatry at Massachusetts General Hospital. “Then the symptoms recur … and if the person goes back on the medicine, it may not be fully effective.”\u003c/p>\n\u003cp>Seniors are also more likely to have chronic medical illnesses, which raises the risk of depression. Their illnesses may make it more difficult for them to recover from depression. And it can mask whether antidepressants are working, because symptoms of chronic illness can be mistaken for depression — and vice versa.\u003c/p>\n\u003cp>Poverty, isolation, pain, grief over the loss of a spouse, or being a caregiver can also lead to or intensify a senior’s depression. And no matter what medication the patients take, Lavretsky noted, those external factors don’t go away.\u003c/p>\n\u003cp>“Either they change their perspective or they change their circumstances, or the depression just persists,” she said.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-medium wp-image-225685\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/depressedwomanrain-800x473.jpg\" alt=\"depressedwomanrain\" width=\"800\" height=\"473\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/depressedwomanrain-800x473.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/depressedwomanrain-400x236.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/depressedwomanrain-768x454.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/depressedwomanrain-1180x698.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/depressedwomanrain.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/depressedwomanrain-960x568.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>Antidepressants can help seniors gain some perspective. But Lavretsky and others agree that even if the medications are effective, they shouldn’t be used in isolation. “It’s an emotional experience,” Weiner said. “The whole answer isn’t just, ‘Oh, here take a pill.’ There is such a central role for psychotherapy.”\u003c/p>\n\u003cp>Kramer-Carter, who speaks slowly and hugs everyone she meets, has felt depressed for as long as she can remember. As a young adult, she worked as a secretary and a proofreader but got fired more than once because she had trouble getting out of bed and making it to work on time. She went to the emergency room many times and in her 30s, she was diagnosed with depression.\u003c/p>\n\u003cp>Now, she spends a few days each week driving her husband, Eugene Carter, to medical appointments. When she feels up to it, she volunteers delivering food to poor families.\u003c/p>\n\u003cp>Kramer-Carter checks all the boxes for being at high-risk of treatment-resistant depression. She is a long-time caregiver, first for her parents and now for her husband, a stroke survivor with short-term memory problems. Her own list of health problems is long: diabetes, high blood pressure, arthritis, fibromyalgia and gout.\u003c/p>\n\u003cp>“Who wants to be aching all the time?” she said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'If I can stay in bed all day, that’s what I do.'\u003ccite>Rini Kramer-Carter\u003c/cite>\u003c/aside>\n\u003cp>Money problems don’t help either. The couple depends financially on Social Security. If she had more money, she said she would go to the theater or see live concerts. She misses both.\u003c/p>\n\u003cp>“We wouldn’t be so stuck,” she said. As it is, they spend everything on food, rent and other bills.\u003c/p>\n\u003cp>“It’s a constant struggle,” she said. “You have to borrow from Peter to pay Paul.”\u003c/p>\n\u003cp>Despite the prevalence of treatment-resistant depression, \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3363299/\" target=\"_blank\">few resources\u003c/a> exist to help psychiatrists make treatment decisions. Clinical trials have been scant, and there are no universally accepted protocols for the condition. The risks and benefits of different medications for older adults are largely unknown.\u003c/p>\n\u003cp>Given a shortage of geriatric psychiatrists, decisions on treatment are often left to primary care providers, who may not have relevant training or might be reluctant to take on such complicated care.\u003c/p>\n\u003cp>Doctors with patients who don’t respond to traditional therapies frequently make ad hoc decisions about whether to change the dosage, add a medication or switch to a new one.\u003c/p>\n\u003cp>“The clinicians use their best experience and trial and error,” said Evelyn Whitlock, chief science officer at the Patient-Centered Outcomes Research Institute. “They try something, and if it doesn’t work, they try something else.”\u003c/p>\n\u003cp>Trial and error is not ideal, she said. Many of these people have been living with depression for so many years, and providers need to be able to provide them with effective treatment.\u003c/p>\n\u003cp>\u003cstrong>New Approaches\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>In an effort to produce better medical outcomes for people with treatment-resistant depression, the Patient-Centered Outcomes Research Institute announced in July that it was funding \u003ca href=\"http://www.pcori.org/news-release/pcori-board-approves-40-million-improving-treatment-options-depression\" target=\"_blank\">three major studies\u003c/a> that will test different approaches to the illness. The goal of the research is to produce tangible evidence that can be used immediately to help patients and their doctors make more informed treatment decisions. \u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The Washington, D.C. nonprofit, which finances health research, earmarked $40 million for the five-year studies, which it expects to begin this fall. They will include more than 2,500 patients at sites in California, Ohio, New York, Texas, Pennsylvania and elsewhere.\u003c/p>\n\u003cp>One of the studies will examine electroconvulsive therapy — its impact on quality of life and its potential for relieving the symptoms. Another will compare the effectiveness and safety of three strategies — using magnetic fields to stimulate nerve cells in the brain, adding an antipsychotic medication or switching to a specific antidepressant. The research will assess how these approaches affect the patients’ ability to function at home and work.\u003c/p>\n\u003cp>The third and largest study, with about 1,500 patients, will focus specifically on older adults, testing different drugs and studying how aging affects the risk and benefits of antidepressants. UCLA, where Kramer-Carter is being treated, is part of the third study, which will weigh life circumstances and disabilities in addition to depression.\u003c/p>\n\u003cp>The grants represent an “unprecedented opportunity to look at this population,” Lavretsky said.\u003c/p>\n\u003cp>“It will be a comprehensive look at the condition, why it happens and what are the ways of alleviating suffering,” she said. “Are there some similarities among all people with treatment-resistant depression? I suspect we will find some.”\u003c/p>\n\u003cp>On a recent afternoon, Rini Kramer-Carter visited Lavretsky at UCLA. She said the only time she truly escapes her sadness is when she plays percussion along with other musicians. But she hasn’t been playing lately, and she has been sleeping up to 20 hours a day.\u003c/p>\n\u003cp>\u003cimg class=\"size-medium wp-image-257360\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/10/Prozac-428x600.jpg\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/10/Prozac-428x600.jpg 428w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/Prozac-400x560.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/Prozac.jpg 731w\" sizes=\"(max-width: 428px) 100vw, 428px\">\u003c/p>\n\u003cp>“If I can stay in bed all day, that’s what I do,” she said.\u003c/p>\n\u003cp>Sometimes she watches TV comedies to try to dissipate her black moods.\u003c/p>\n\u003cp>Kramer-Carter said she learned about Lavretsky after seeing a newspaper ad for another research study, of a drug typically used to treat early-stage dementia. During their appointment, Lavretsky went over a list of questions included in the study. “On a scale of zero to 10, where do you place yourself in terms of depression?” the doctor asked her. Nine, she responded.\u003c/p>\n\u003cp>She told Lavretsky she sometimes felt restless and anxious, but not suicidal.\u003c/p>\n\u003cp>“Do you feel full of energy?” Lavretsky asked.\u003c/p>\n\u003cp>“Do I look like I am full of energy?” she responded with a sigh.\u003c/p>\n\u003cp>Lavretsky told her that no pill will completely fix her problems, but medication might give her more energy and the ability to cope. Kramer-Carter said she knows a drug won’t produce any miracles. She just wants some relief.\u003c/p>\n\u003cp>“I just want to be able to live my life,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/257328/coping-with-depression-when-treatment-doesnt-work","authors":["byline_futureofyou_257328"],"programs":["futureofyou_54"],"categories":["futureofyou_452","futureofyou_1","futureofyou_73"],"tags":["futureofyou_532","futureofyou_1076","futureofyou_1075","futureofyou_592","futureofyou_204"],"featImg":"futureofyou_257332","label":"source_futureofyou_257328"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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