Depression or Dementia: How to Tell [Interview][Transcript]

Dr_Gary_Moak_Depression_DementiaGuest: Dr. Gary Moak
Presenter: Neal Howard
Guest Bio: Gary S. Moak, MD, is a past president of the American Association for Geriatric Psychiatry and 2011 recipient of its clinician-of-the-year award. He is a practicing geriatric psychiatrist with over thirty years experience treating older adults with a wide range of psychiatric and behavioral problems related to diseases of aging. Dr. Moak is assistant professor of psychiatry at the Geisel Medical School at Dartmouth, where he serves as Chief of Geriatric Psychiatry at the New Hampshire Hospital. In addition to his clinical work with older adults and their families, he teaches medical students and doctors in training about mental health and aging and the treatment of late-life mental health problems. Dr. Moak regularly speaks to audiences of older adults and members of their families about mental health and aging.

Segment overview: Dr. Gary Moak, MD, a geriatric psychiatrist, and author of the book, BEAT DEPRESSION TO STAY HEALTHIER AND LIVE LONGER: A Guide For Older Adults And Their Families, discusses the differences with depression, Alzheimer’s, and other diseases in older adults.


Health Professional Radio – Depression or Dementia

Neal Howard: Hello and welcome to Health Professional Radio. Our guest in studio today is returning to speak with us about Geriatric Depression, Dr. Gary S. Moak. He’s the past President of the American Association for Geriatric Psychiatry and the 2011 recipient of the Clinician of the Year Award, he’s a practicing Geriatric Psychiatrist with over 30 years experience, treating older adults with a wide range psychiatric and behavioral problems. In addition he’s the Author to the brand new book, Beat Depression to Stay Healthier and Live Longer: A Guide for Older Adults and Their Families. Welcome to Health Professional Radio Gary.

Dr. Gary Moak Thank you, it’s a pleasure to be back.

N: Thank you so much for returning. When you were here before in another segment, we talked about your reasoning behind writing your book, Beat Depression to Stay Healthier and Live Longer, we talked about some of the conversations that you’ve had with this wide variety of patients throughout your 30 year career. We also discussed some of the problems associated with the misdiagnosis of some of the illnesses associated with aging, how some of these misdiagnosis can really result in some very tragic results. Talk about some of the differences between depression, which is often misdiagnosed as Alzheimer’s or maybe even Dementia when depression is a very treatable mental illness.

M: Right. So the big problem is inherent in the word depression itself because we use that both professionally and in our general culture to mean a number of different things including normal human experiences. We all feel depressed from time to time, we reuse it to refer to symptoms we have when we’re feeling depressed or suffering from depression, a depressive illness but even doctors and even psychiatrists for that matter use it as a short hand to refer to a diagnosis. They usually know which type of depression they mean and it’s often implied but not made explicit. So the problem is that depression, when we talk about depression we have to be careful to decide are we referring to symptoms, and are those symptoms specific for depression or could they be caused by something else not depression at all or do we mean a specific disease? So patients and their families and even their healthcare providers need to not respond to the presence of a symptom and treat a presumed illness based on that, no more than someone will treat a complaint of pain without looking into the cause of the pain and making a correct diagnosis of the pain before embarking on some form of treatment. Depression, clinically significant depression is usually considered a condition in which people have an unhappy, sad, morose, gloomy mood or the mood can be anxious, worried or even empty or irritable and associated with loss of interest in activities, negative thoughts about themselves, pessimism, undo-guilt, maybe even irrational fears and worries and lots of thoughts about death or even suicide and sometimes forgetfulness, confused thinking, distractibility and some of these symptoms can be caused by general health problems so conditions like congestive heart failure, chronic lung disease, underactive thyroid, B12 deficiency, Diabetes if it’s not well controlled, vitamin D deficiency perhaps, low testosterone levels in older men.

N: All of these?

M: All of these are conditions that can cause some of the symptoms without it necessarily being depression per se and there are a number of medications that are prescribed for physical problems whose side effects may include depressive symptoms.

N: Before we get into some of the side effects and the medications, when we’re talking about the symptoms of depression and some of these other diseases, in your book, Beat Depression to Stay Healthier and Live Longer, do you offer I guess advise or even acknowledge that sometimes symptoms may look different to a health care provider, a health professional as opposed to a family member who maybe the first line of defense in the diagnosis?

M: Yes, absolutely and it may look different to different health professionals. So the critical role of family members is that they’ll recognize that there’s something abnormal, something is different and wrong with an older relative. A number of medications can have symptoms that overlap with those of depression, a number of the cardiovascular medicines, especially some of the older ones used to treat high blood pressure can affect brain neurotransmitters that are involved in depression and actually lead to some symptoms of depression. A number of sedative type of medications which commonly prescribed for sleep or given to patients who might be depressed but have symptoms of anxiety are given to calm the anxiety without recognizing that they may cause or worsen depression. Certain medicines used to treat certain kinds of epilepsy can cause depression as a side effect and hormonal treatments particularly some of the hormonal treatments used to treat prostate cancer may cause depression as a side effect, you may be aware there’s a recent study that just came out in a prestigious medical journal showing that patients treated with hormones used to reduce levels of testosterone and other androgens commonly lead to depressive symptoms in older men being treated for prostate cancer. So recognizing that that’s a possibility, one of the things that healthcare professionals should do with any older adult with depressive symptoms is review all the medicines they’re on to make sure there are no medicines that could be causing the depressive symptoms and eliminate those that can be eliminated, that requires a very comprehensive, holistic approach which is what makes Geriatric Medicine and Geriatric Psychiatry both very demanding and daunting to some but also very challenging and rewarding to those who practice it and practice it well because it’s an opportunity to look at the whole person, look at their entire health and by recognizing problem where it’s coming from, to intervene in a way that really can make a very big difference in a way that can be lifesaving to older adults and very rewarding for people that practice in this area and as you know healthcare is a changing target, new information comes out every month but my book is available online and it’s extensively referenced with what at the time it was published was the most up-to-date research available at the time. In fact my website where we do have some information posted about Geriatric problems and Geriatric Psychiatry and that’s, a long URL but if you spell it out just as it sounds and another good place for information is the website of the American Association for Geriatrics Psychiatry.

N: You’ve been listening to Health Professional Radio, I’m your host Neal Howard. Our guest in studio today has been Dr. Gary Moak, Geriatric Psychiatrist with over 30 years of experience treating older adults with a wide range of psychiatric and behavioral problems related to diseases of aging. Discussing his new book, Beat Depression to Stay Healthier and Live Longer: A Guide for Older Adults and Their Families. It’s been a pleasure having you here with us today Dr. Moak.

M: Thank you. It’s been a pleasure to be on.

N: Transcripts and audio of this program are available at and also at and you can subscribe through our podcast on iTunes.

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