Guest: 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, talks about his book, BEAT DEPRESSION TO STAY HEALTHIER AND LIVE LONGER: A Guide For Older Adults And Their Families.
Health Professional Radio – Geriatric Psychiatry
Neal Howard: Hello and welcome to Health Professional Radio. I’m your host Neal Howard, thank you for joining us today. Our guest in studio today is Dr. Gary Moak, author of Beat Depression to Stay Healthier and Live Longer: A Guide for Older Adults and Their Families and he’s here to talk with us today about aging, depression and folks that are aging, not always simply because they’re aging, are they depressed and being depressed isn’t necessarily associated with aging. Our guest in studio is a practicing Geriatric Psychiatrist with over 30 years experience treating older adults with a wide range of psychiatric and behavioral problems related as I said to aging. Welcome to Health Professional Radio Dr. Moak.
Dr. Gary Moak Thank you, I’m glad to be on.
N: Now you are a practicing Geriatric Psychiatrist, past President of the American Association of Geriatric Psychiatry and also the 2011 recipient of its Clinician of the Year Award, if I’m understanding that correctly, is that right?
M: Yes, that’s correct.
N: Been doing this for 30 years, is this what you were initially interested in when you went into healthcare as a psychiatrist or was psychiatry always your first choice?
M: I was actually interested in Neurology as a medical student but my interest really had to do with brain diseases and their impact on people’s mental experience and emotions and behavior and I was fortunate to have exposure to some training in psychiatry with some pretty interesting patients and some pretty interesting teachers and came to discover that psychiatry held much more interest for me and will likely hold more interest over the course of what I hoped would be long and fruitful career. And then once I got into psychiatric training, the geriatrics really became much more interesting as well. Geriatrics is a challenging area that’s really at the intersection of Neurology which is what I’ve been interested in originally, Traditional Psychiatry and Primary Care Medicine because many of the mental health problems that affect older adults are seen among people that had been mentally healthy their entire lives and become psychiatrically ill for the first time, later in life due to other illnesses associated with the aging process, wear and tear on the brain. That’s just part of the aging process with response to some of the stresses of growing older that they’re not able to cope with because of changes in their health as a result of aging. So a Geriatric Psychiatrist has to be a little bit of a Neurologist or Psychiatrist than a Primary Care Doctor all at once and that really seem like a challenging way to practice and its scenario where patients will often can’t find Geriatric Specialist or a crying need which existed then and unfortunately still exist now, so it seem like a good opportunity to do some good.
N: Why is it there’s such a need to delve into the depression as a major concern for the elderly? I mean we hear about depression all the time in folks that are a lot younger.
M: To put it in perspective, so depression is really a very serious, disabling and costly condition across the entire age span and currently the World Health Organization considers depression to be the second leading cause of disability worldwide. Depression I don’t think is very, depression in general I don’t think is appreciated and it can affect people of all ages. Generally speaking it affects about 1 in 10 under the age of 65 but clinically significant depression may affect as many as 1 in 5 or 4/5 of the population over the age of 65 and for these folks it becomes a bigger challenge because treating it becomes more complicated because of age related factors and people become more sensitive to the side effects of medications so treatment is a little bit more challenging. They take a lot more medications, they have many other health problems which impact the course of their depression and which may be impacted by the depression, making the impact of the depression that much greater and more devastating and the consequences can be much greater for older adults in terms of permanently disabling, life changing effects of the depression so the stakes are higher.
N: Now with those higher stakes, how often in your experience is depression misdiagnosed as something else maybe Alzheimer’s or Dementia, one as not simply depression but something other than Alzheimer’s or Dementia – it is actually severe depression. How often does that misdiagnosed, mistaken for something else?
M: Well that’s really a very good question and a critical one because it’s a big part of the problem in terms of what keeps older adults from getting effective treatment. The problem with depression is we use that as a term to describe a single problem but clinically significant depression is not one problem, it’s a family of illnesses in the same way that arthritis is a family of illnesses and there are different kinds of arthritis: osteoarthritis, rheumatoid arthritis, etc. There are different forms of depression and they all may require different forms of treatment. There are also a number of masqueraders which I cover in detail in one chapter in my book, there are a number of conditions that can appear to be depression but really or not may include things like apathy, which is a condition often seen in people that have had a stroke that look like depression but really isn’t. There’s a condition called Pseudobulbar affect in which people appear sad and even cry but don’t feel sad or depressed inside and don’t have depression. People with sleep apnea which may affect 30% of older adults can cause people to have a kind of sluggish, unmotivated, unenergetic, apathetic presentation during the day and a tendency to become withdrawn from activities which may make others think they have depression. And then there are conditions like Parkinson’s disease, certain kinds of stroke conditions and dementing illnesses like Alzheimer’s that may initially appear to be depression but are not and to make it even more confusing conditions like Alzheimer’s and Parkinson’s disease often can get complicated by depression so people can have both at the same time and it takes a lot of expertise to sort out which symptoms are coming from which and what are the right treatments to address them.
N: There’s so much talk about Geriatric care not just on a physical but as you say the mental aspect of Geriatric care as well. Now in your new book, Beat Depression to Stay Healthier and Live Longer: A Guide for Older Adults and their Families, what type of suggestions do you offer as hope for some of these older adults and their families as they deal with aging themselves or the aging of a loved one?
M: So there are many and they can be kind of complicated but the most important place to start is, in terms of attitude, it means that patients and members of their families need to not be hopeless and not assume that there’s nothing left to be done which all too often is the case. Patients I’ve treated over the years and in fact members of their family assume that when an older adult has become seriously depressed that, that’s just what happens to you when you get older. That’s it’s something that should be expected, that there’s nothing you can do about it and it’s just part of the course so one has to just live with it and basically face the consequences of aging and nothing could be further from the truth. Certainly while not all health problems, physical or mental, can necessarily be cured as people get older, usually something can be done that’s helpful. And when it comes to depression, we can often do things that are remarkably helpful and I’ve seen patients who thought their lives were over, get their lives back again as a result of effective treatment and then go on and live many, very happy, enjoyable and productive years longer so the most important thing is not to get discouraged.
N: You’ve been doing this for 30 years, when did you decide to become an author and why did you write the book? What type of reception have you gotten from other physicians as they delve into your new book?
M: People are very positive. They tell me that it’s very accessible and readable for not only themselves but the lay people that have looked at it had some more comments. My experience since early part of my career was that successful treatment of depression in older adults really depended on helping them and members of their family understand the depression. Understand where it was coming from, understand what could be done about it, understand the treatment and especially understanding what to expect from the treatment and what the pitfalls might be along the way. And I found that when people understand what’s involved and what’s going on, and what the treatment will take, they’re able to work with the clinicians effectively and they’re able to hang in there and get the treatment they need and get better. So I’ve spent 30 years basically talking with patients and their families, having conversations that ended up becoming the content of this book, basically I wrote It based on my experience talking with patients and their families over 30 years. Answering the kind of questions that come often that they have and providing the information that I found they find the most helpful and because the majority of older adults with depression are not gonna have access to a Geriatric Psychiatrist or other mental health professional with specialized training in geriatrics and because this information is so important for people to have, I thought writing the book would be a good thing to do.
N: Great. 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. He’s past President of the American Association for Geriatric Psychiatry and the 2011 recipient of that organization’s Clinician of the Year award and he’s been here with us discussing his new book, Beat Depression to Stay Healthier and Live Longer: A Guide for Older Adults and Their Families, as the onset of depression late in life is often assumed by individuals and families to be, well just a natural consequence. Our guest Dr. Gary Moak says this is a misunderstanding with potentially tragic consequences as depression correctly diagnosed is one of the most treatable of mental illnesses. 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 healthprofessionalradio.com.au and also at hpr.fm and you can subscribe through our podcast on iTunes.