Tip Sheet

Health: Beating Back the Blues

Parnel Wickham wasn't getting much comfort from traditional psychotherapy. In the late 1990s her husband of 36 years walked out on her, her mother was diagnosed with Alzheimer's and she fell on financial hard times. "What happened in my childhood or 10 years ago--that's gone. I wanted to know how to manage today," says Wickham, now 62. Eventually, she signed on for a new approach developed by researchers at Duke University to treat depression in adults over 55. Her therapists encouraged her to meet new people and to seek the company of friends whenever upsetting thoughts haunted her. After a few months of treatment, which included a course of SSRIs, her depression lifted. "It was very practical," she says. "They told you what to do and made sure you did it."

About 10 percent of adults 60 and older suffer from clinical depression, though many more may go undiagnosed. "A lot of older people aren't sure what depression is and assign its symptoms to normal aging," says Dr. Mark Miller, co-author of "Living Longer Depression Free" ($19.95; press.jhu.edu ). For those who are diagnosed, in-depth psychoanalysis isn't always the best remedy. "When you've lived for decades and decades, basing a treatment on going back and resolving the past may not be that effective," says Dr. Thomas Lynch of Duke University Medical Center. That's why more therapists are ditching Freud for newer, shorter-term approaches. These structured programs run from 12 to 30 weeks, keeping costs low. And instead of encouraging open-ended reflection and analysis, they focus on teaching patients specific skills: how to resolve conflicts with relatives or how to tolerate moments of emotional distress.

The program Wickham went through, called Dialectical Behavior Therapy, has had encouraging results. In a controlled clinical trial published in the American Journal of Geriatric Psychiatry, her therapist, Duke's Dr. Lynch, reported a 75 percent rate of remission in his patients, as compared with only 31 percent in a group treated with medication alone. (For most seniors with depression, the combination of drugs and therapy appears to work best.)

But there are many other treatment options out there. The Over-60 Program, headed by Dr. Patricia Arean at the University of California, San Francisco, offers Problem Solving Therapy ( coped.ucsf.edu ). The 12-week course helps patients identify specific problems and set goals to overcome them. Sarah Mineo, 75, an artist and playwright, signed up with the stated goal of reorganizing her messy loft. The tightly focused approach, she said, allowed her to clean up her "mental clutter," too. Patients can try a broader approach with In-terpersonal Psychotherapy ( interpersonalpsychotherapy.org ), which helps them improve relationships with friends and family in order to boost emotional well-being.

But for the elderly and depressed, finding help may be the biggest challenge. The first step is seeing a primary-care physician with a geriatrics specialty (go to the DoctorFinder at ama-assn.org ) who'll be more tuned in to the needs of older adults. If you think a relative could benefit from therapy, talk to other members of your family and approach him or her together. "If the older person sees the family united in this, they almost always will do it," says Dr. Dan Blazer, president of the American Association for Geriatric Psychiatry. Says Lynch: "Contrary to popular belief, older adults find counseling very rewarding." Wickham and Mineo would agree.