Depression in the Elderly
Depression in the elderly is a widespread problem that is often not diagnosed and frequently undertreated. While 25 out of every 200 adults over age 65 in the United States suffer from depression, it affects a much higher percentage of people in hospitals and nursing homes. Despite its frequency and seriousness, many older people will not admit to the signs and symptoms of depression for fear that they will be seen as weak or crazy, and because they are unaware that the condition can be treated.[1,2] While emotional experiences of sadness, grief, response to loss, and temporary “blue” moods are normal, depressive disorder and persistent depression that interferes significantly with ability to function are not a normal part of aging.
When depression occurs in late life, it sometimes can be a relapse of an earlier depression. When depression occurs for the first time in older adults, it can be a reaction to a medical illness. It may be complicated by brain disorders that occur with age, such as Alzheimer’s disease. Depression is also a side effect of many drugs commonly prescribed for the elderly. The following can also cause depression in the elderly.
- Changes within the family
- Chronic pain and illness
- Difficulty getting around
- Frustration with memory loss
- Loss of a spouse or close friend
- Trouble adapting to a life change, such as moving from a home to a retirement facility
When someone is already ill, depression can be both more difficult to recognize and more difficult to endure. Symptoms are often ignored or confused with other ailments common in the elderly, such as the following.
- Alzheimer’s disease
- Heart disease
- Parkinson’s disease
- Thyroid disorders
Symptoms of Depression in Older Adults
Symptoms of depression may be hard to identify in older adults Particularly in older men, depression may present itself through not emotional but physical symptoms such as aches and pains or digestive problems. Possible symptoms of depression include:
- Abnormal thoughts about death
- Abnormal thoughts, excessive or inappropriate guilt
- Aches and pains
- Change in appetite (usually a loss of appetite)
- Change in weight
- Unintentional weight loss (most common)
- Weight gain
- Depressed or irritable mood
- Difficulty concentrating
- Fatigue (tiredness or weariness)
- Feelings of worthlessness or sadness
- Irresponsible behavior
- Loss of interest or pleasure in daily activities
- Memory loss
- Plans to commit suicide or actual suicide attempts
- Temper, agitation
- Thoughts about suicide
- Trouble sleeping
- Daytime sleepiness
- Difficulty falling asleep (initial insomnia)
- Waking up many times through the night (middle insomnia)
- Waking up early in the morning (terminal insomnia)
Depression and Suicide
Depression is one of the conditions most commonly associated with suicide in older adults, and older Americans are disproportionately likely to die by suicide.[4,5] The highest suicide rates of any age group occur among persons aged 65 years and older. It is estimated that 20 percent of people more than 65 years old who commit suicide visited a physician within 24 hours of their act, 41 percent visited within a week of their suicide and 75 percent have been seen by a physician within one month of their suicide.
Several factors relative to those over 65 years old will play a role in future suicide rates among the elderly, including growth in the absolute and proportionate size of that population; health status; availability of services, and attitudes about aging and suicide. For more information about suicide, contact the following resources:
National Suicide Prevention Lifeline
National Institute for Mental Health
Substance Abuse and Mental Health Services Administration
Suicide Prevention Resource Center
Surgeon General’s Call to Action to Prevent Suicide
Treatments for Depression
Antidepressant medications or psychotherapy (often referred to as “talk therapy” or simply “therapy”), or a combination of the two, can be effective treatments for late-life depression. A study showed that about 80 percent of older adults with depression recovered with combined treatment and had lower recurrence rates than with psychotherapy or medication alone.[6,7] However, another study of depressed older adults with physical illnesses and problems with memory and thinking showed that combined treatment was no more effective than medication alone.
Antidepressant medications affect brain chemicals called neurotransmitters, which are chemical messengers for information about emotions, behavior, body temperature, appetite, or many other functions. While there are many medications for depression and different medications work for different people, all medications take about four to eight weeks to work. Studies showed that patients age 70 and older who became symptom-free and continued to take their medication for two more years were 60 percent less likely to relapse than those who discontinued their medications.
Psychotherapy involves talking with a specially trained health professional such as a psychologist or licensed professional counselor to deal with depression, thoughts of suicide, and other problems. Research shows that certain types of psychotherapy are effective treatments for late-life depression. Strategies for treating depression in this context may include recognizing factors that contribute to depression and working to improve these, changing patterns of negative or distorted thinking, or learning new coping skills.
Caring for a Depressed Elder
If you think your loved one may be depressed, make sure she receives a complete physical checkup. If she is confused or withdrawn, try to accompany her to the doctor and provide important information. If your parent is diagnosed with depression, ask for a referral to a geriatric psychiatrist who specializes in depression in the elderly.
Day-to-day tips to support a depressed parent include the following:[12,13]
- Listen to your loved one, and graciously answer her questions, even if she asks them repeatedly
- Share old family photos to help trigger happy memories and faces.
- Arrange for family, friends and neighbors to call your parent occasionally to engage in friendly conversation.
- Encourage your parent to attend support groups, activity programs, community events and activities at the local senior center.
- If your parent lives alone, suggest that he moves into a retirement community to reduce social isolation.
- Encourage your parent to discuss with his physician ways to reduce chronic pain if present, including methods such as physical therapy or massage.
No matter what age your parent might be, if you are concerned that he or she might be suffering from depression, it’s well worth seeking our professional help.
- MedlinePlus. (August 22, 2008) Depression-elderly. Retrieved August 23, 2009 from the MedlinePlus Web Site: http://www.nlm.nih.gov/MEDLINEPLUS/ency/article/002522.htm.
- Geriatric Mental Health foundation (n.d.) Depression in Late Life: Not A Natural Part Of Aging. Retrieved August 22, 2009 from the Geriatric Mental Health Foundation Web Site: http://www.gmhfonline.org/gmhf/consumer/factsheets/depression_latelife.html.
- National Institute of Mental Health (May 18, 2009) Older Adults: Depression and Suicide Facts (Fact Sheet). Retrieved August 23, 2009 from the National Institute of Mental Health Web Site: http://www.nimh.nih.gov/health/publications/older-adults-depression-and-suicide-facts-fact-sheet/index.shtml#treatments.
- Conwell Yeates, Brent David. Suicide and aging. I: patterns of psychiatric diagnosis. International Psychogeriatrics. 1995; 7(2): 149-64.
- National Strategy for Suicide Prevention (n.d.) At a Glance – Suicide Among the Elderly. Retrieved August 23, 2009 from the National Strategy of Suicide Prevention Web Site: http://mentalhealth.samhsa.gov/suicideprevention/elderly.asp.
- Little JT, Reynolds III CF, Dew MA, Frank E, Begley AE, Miller MD, Cornes C, Mazumdar S, Perel JM, Kupfer DJ. How common is resistance to treatment in recurrent, nonpsychotic geriatric depression? American Journal of Psychiatry. 1998; 155(8): 1035-8.
- Reynolds III CF, Frank E, Perel JM, Imber SD, Cornes C, Miller MD, Mazumdar S, Houck PR, Dew MA, Stack JA, Pollock BG, Kupfer DJ. Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression: a randomized controlled trial in patients older than 59 years. Journal of the American Medical Association. 1999; 281(1): 39-45.
- Reynolds III CF, Dew MA, Pollock BG, Mulsant BH, Frank E, Miller MD, Houck PR, Mazumdar S, Butters MA, Stack JA, Schlernitzauer MA, Whyte EM, Gildengers A, Karp J, Lenze E, Szanto K, Bensasi S, Kupfer DJ. Maintenance treatment of major depression in old age. New England Journal of Medicine. Mar 16;354(11):1130-8. 2006.
- Hasselbring, Bobbie. (n.d.) How Do Antidepressants Work? Retrieved August 23, 2009 from the Discovery Channel Web Site: http://health.discovery.com/centers/articles/articles.html?chrome=c09&article=LC_33¢er=p06.
- Madhukar H, Trivedi H, Fava M, Wisniewski SR, Thase ME, Quitkin F, Warden D, Ritz L, Nierenberg AA, Lebowitz BD, Biggs MM, Luther JF, Shores-Wilson K, Rush AK, for the STAR D Study Team. Medication Augmentation after the Failure of SSRIs for Depression. New England Journal of Medicine. Volume 354:1243-1252. 2006.
- Lebowitz BD, Pearson JL, Schneider LS, Reynolds III CF, Alexopoulos GS, Bruce ML, Conwell Y, Katz IR, Meyers BS, Morrison MF, Mossey J, Niederehe G, Parmelee P. Diagnosis and treatment of depression in late life. Consensus statement update. Journal of the American Medical Association. 1997; 278(14): 1186-90.
- Segal, Jonathan. (Fall 2000) Depression in the Elderly: To Your Health-CHRC Newsletter. Retrieved August 23, 2009 from the Palo Alto Medical Foundation Web Site: http://www.pamf.org/health/toyourhealth/depressedelders.html.
- Kichura, V. (July 11, 2008). Helping Elderly Loved Ones Fight Depression. Retrieved August 23, 2009 from the Suite101.com Web Site: http://seniors-health-medicare.suite101.com/article.cfm/helping_elderly_loved_ones_fight_depression.
By C. J. Newton, MA, Therapists.com Editor