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People who have hearing loss often also have depression. What's not as well known is that people who are depressed sometimes have undiagnosed hearing loss.
The link between hearing loss and depression, especially untreated hearing loss, was reconfirmed last spring by a large-scale epidemiological study, based on the National Health and Nutrition Examination Survey (NHANES) 2005-2010. It found a significant correlation between hearing loss and depression and added some important information about exactly who was affected.
What was most interesting was that the link was found only in certain populations. There was no relationship between hearing loss and depression in those who were either culturally or functionally deaf. There was no relationship in adults 70 and older who self-reported hearing loss. In other words, older adults who accepted their hearing loss did not experience greater levels of depression. So who did?
The study found a “significant” link in women over 70 with unreported hearing loss, as well as a lesser link in men with unreported hearing loss. (Hearing tests were given to all participants over 70.) The link was also strong in younger adults, ages 18 to 69. In the younger group, the hearing loss was self reported (this group was not given hearing tests). This may be because younger people with adult onset hearing loss, even if they admit it to themselves, often have a hard time dealing with it publicly.
Now consider these factors: A large majority of the 48 million Americans with hearing loss are either unaware of it or in denial about it. Two-thirds of those 75 and over have hearing loss, much of it undiagnosed and untreated. We know antidepressants are overprescribed, and often without the oversight of a psychiatrist. Last week a GAO study confirmed that they are also vastly overused with the elderly. These are the same people who are most likely to have hearing loss.
On Monday the Federal Government Accountability Office released findings showing widespread use of psychiatric drugs by older Americans with dementia. The drugs included the “inappropriate” use of Abilify, Risperdal, Zyprexa and clozapine. Abilify, an antipsychotic intended for treatment of schizophrenia and bipolar disorder, as well as major depressive disorder in connection with other drugs, is the number 1 seller among all prescription drugs in this country. Sales between April 2013 and March 2014 ($6.9 billion) amounted to more than all other antidepressants combined.
That’s a lot of schizophrenic, bipolar and majorly depressed people. Clearly Abilify is being prescribed for more routine depression as well. Many dementias are diagnosable, but some are not. Sometimes these turn out to be hearing loss. Sometimes they even turn out to be misplaced hearing aids, especially when an older person is brought into the emergency room. It's only when the caretaker or adult family member gets there and asks where Mom's hearing aids are that it becomes clear that what looked like dementia is actually hearing loss. Given the preponderance of antipsychotics reported by the GAO study, we might well wonder if even these powerful drugs are being used where the problem is actually hearing loss. Abilify, Risperdal, Zyprexa and clozapine? Sounds more like a mental ward than an assisted living facility.
What if we did a hearing test before we prescribed those antidepressants?
Dr. Barbara Weinstein, founding executive director of the doctor of audiology program at the CUNY Graduate Center, maintains that acknowledging the relationship between hearing loss and depression is essential. “When doctors screen for depression using an aurally administered test,” she told me, “they rarely control for hearing loss. I am convinced that the validity of the scores are affected by not making sure patients can hear the questions.”
A version of this post was first published in AARP HealthTalk: http://aarp.org/2015/03/04/are-we-treating-depression-when-we-should-be…
