labeling is depressed throwing wants an anti-depressant or maybe do some e c t on him na hole you know at some point patients say and done unfinished i don't think that's the pressure and it but it's very individual i mean you've got to make a call when you've got to do it with some sensitivity and you know sort of look at the patient see what they're wanting to do criteria b cannot be established that are in organic factoring issued id or maintain the disturbance and the disturbance is not the normal reaction to the death of a loved one especially for older adults lose their kids uh... tragic tragic stopped circle of life gets broken your kids are supposed to be review you're not supposed to bury your kids and when you see in a ticket eighty-year-old it loses a sixty year old daughter you can expect a very prolonged bereavement from that it's very tough to get over if they ever do the sing hindi criteria he's actually are saying hey there's no schizophrenia here there's no psychosis here uh... you may get some hallucinations with depression with psychosis but otherwise this is not a psychotic disorder doctor robert spencer columbia university says the depression is very common the elderly population it's frequently neglected under diagnosed in under treated he actually suggest that your diagnostic efficacy would be better if you would throw tsn out the window and limit yourself to these four symptoms now i would never ever encourage you to through bsn out the window but you might want to put extra emphasis on these four with older adults that sleep disturbance low self-esteem loss of pleasure and change of appetite i have some other comments to make on depression in older adults you do not have a handout she'd on this so don't go flipping through the packet trying to find that you won't when i come back to the handout packet i really will give you the patriarch keep in mind that the successful suicide rate is highest in older adult populations adolescents attempt more open older adults attempt typically pick lethal means and their typically successful because they're not doing a cry for help they're not try to get attention they're done the finished some ways the depression manifests itself differently in older adults number one you get a decreased report of sadness older adults rarely endorse that they feel sad some of them grew up during the great depression of the thirties that was set that's not the life and feel so they typically don't endorse feelings of sadness they do have a withdrawal of interest in not tell you they're not motivated to do anything funny side story all tell you picnic it's fairly common that i go and i look at my patients i say so did you go to some groups this week no i didn't feel like it i had a friend went to a position complaining of zero sexual derived none and it had gone on so long to starting interfere with her husband and that they have been married twenty years twenty-plus years she goes the position in says i have no interest in sex what so ever he looked at her and say that who told you that you had to be interested in sex before you have sex you just do it i mean i'm a for sure has been to work a little bit harder to get your routes but you just do it you don't have to be interested in it i thought that was a very cold insensitive answer by the way the other part of the story is that he did put her on medication peron testosterone she said she was on testosterone for about two weeks became a flaming b was yelling at her husband was breaking things she ended up after three weeks of testosterone she threw the medication attraction she says all never take the stuff again i looked at her and i said and you thought it was easy for us to venture down the road rage stuff get off our back we're doing as well as we can anyway i thought that was very very insensitive of him to tell her that however i have borrowed that comment with my older adult patients when they look at me and say uh... why didn't feel like going to group i go through my notes i think no dis your book read different from mine does it say that you have to feel like going to group before you go you don't just go to the group if it's worth was comeback because a lot of groups are worthless come on back in at least to get some out of the room and they'll say well no i do like to feel motivated to do something for her do it if you've really do you think i really felt motivated to get this morning pursued on a drive across town to see all you folks no i'd just do now once i'm here i'm glad i'm here but i didn't wait around a few motivated to do it so i do use that with older adults and i i found it somewhat useful there is uh... and i don't you you know older adults they just don't enjoy things the way that they used to enjoy things there's also an increase in physical symptoms they'll complain of increase 