Depression is a medical illness in which a person has persistent feelings of sadness,often with discouragement and a lack of self-worth.
Depression in the elderly is a widespread problem, but it is not a normal part of aging. It is often not recognized or treated.
Depression in the elderly
Causes, incidence, and risk factors
In the elderly, a number of life changes can increase the risk for depression, or make existing depression worse. Some of these changes are:
A move from home, such as to a retirement facility
Chronic illness or pain
Children moving away
Spouse or close friends passing away
Loss of independence (for example, problems getting around or caring for oneself)
Depression can also be related to a physical illness, such as:
Dementia (such as Alzheimer's disease)
Overuse of alcohol or certain medications (such as sleep aids) can make depression worse.
Many of the usual symptoms of depression may be seen. However, depression in the elderly may be hard to detect. Common symptoms such as fatigue, appetite loss, and trouble sleeping can be part of the aging process or a physical illness. As a result, early depression may be ignored, or confused with other conditions that are common in the elderly.
Signs and tests
The doctor or nurse will examine you and ask questions about your medical history and symptoms.
Blood and urine tests may be done to look for a physical illness.
You may be referred to a mental health specialist to help with diagnosis and treatment.
The first steps of treatment are to:
Treat any illness that may be causing the symptoms
Stop taking any medications that may be making symptoms worse
Avoid alcohol and sleep aids
If these steps do not help, medications to treat depression and talk therapy often help.
Doctors often prescribe lower doses of antidepressants to older people, and increase the dose more slowly than in younger adults.
To better manage depression at home, you should:
Exercise regularly, if your doctor says it is ok.
Surround yourself with caring, positive people and fun activities.
Learn good sleeping habits.
Learn to watch for the early signs of depression, and know how to react if these occur.
Drink less alcohol and do not use illegal drugs.
Talk about your feelings with someone you trust.
Take medications correctly and discuss any side effects with your doctor.
Depression often responds to treatment. The outcome is usually better for people who have access to social services, family, and friends who can help them stay active and engaged.
The most worrisome complication of depression is suicide.
Men make up most suicides among the elderly. Divorced or widowed men are at the highest risk.
Families should pay close attention to elderly relatives who are depressed and live alone.
Calling your health care provider
Call your health care provider if you feel persistently sad, worthless, or hopeless, or if you cry often. Also call if you are having trouble coping with stresses in your life and want to be referred for talk therapy.
Go to the nearest emergency room or call your local emergency number (such as 911) if you are thinking about suicide (taking your own life).
If you are caring for an aging family member and think they may have depression, contact their health care provider.
Cassano P, Fava M. Mood disorders: major depressive disorder and dysthymic disorder. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier;2008:chap 29.
Unutzer J. Clinical practice: late-life depression. N Engl J Med. 2007;357:2269-2276.
David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc. David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY.