Depression and Older Adults

by National Institute on Aging

Everyone feels blue now and then. It's part of life. But if you no longer enjoy activities that you usually like, you may have a more serious problem. Being depressed, without letup, can change the way you think and feel. Doctors call this "clinical depression."

Being "down in the dumps" over a period of time is not a normal part of getting older. But it is a common problem, and medical help may be needed. For most people, depression will get better with treatment. "Talk" therapy, medicine, or other treatment methods can ease the pain of depression. You do not need to suffer.

There are many reasons why depression in older people is often missed or untreated. As a person ages, the signs of depression are much more varied than at younger ages. It can appear as increased tiredness, or it can be seen as grumpiness or irritability. Depression can be tricky to recognize in older adults. Confusion or attention problems caused by depression can sometimes look like Alzheimer's disease or other brain disorders.

Mood changes and signs of depression can be caused by medicines older people may take for arthritis, high blood pressure, or heart disease. It can be hard for a doctor to detect depression. The good news is that people who are depressed usually feel better with the right treatment.

What Causes Depression?

There is no one cause of depression. For some people, a single event can bring on the illness. Depression often strikes people who felt fine but who suddenly find they are dealing with a death in the family or a serious illness. For some people, changes in brain chemistry can affect mood and cause depression. Sometimes those under a lot of stress, like caregivers, can feel depressed. Others become depressed for no clear reason.

People with serious illnesses, such as cancer, diabetes, heart disease, stroke, or Parkinson's disease, sometimes become depressed. They worry about how their illness will change their lives. They might be tired and not able to deal with something that makes them sad. Treatment for depression helps them manage their depressive symptoms and improves their quality of life.

Genetics, too, can play a role. Studies show that depression may run in families. Children of depressed parents may be at a higher risk for depression. And, depression tends to be a disorder that occurs more than once. Many older people who have been depressed in the past will be at an increased risk.

What to Look For

How do you know when you need help? After all, as you age, you may have to face problems that could cause anyone to feel "depressed." Perhaps you are dealing with the death of a loved one or friend. Maybe you are having a tough time getting used to retirement and you feel lonely. Possibly you have a chronic illness. Or, you might feel like you have lost control over your life.

After a period of feeling sad, older people usually adjust and regain their emotional balance. But, if you are suffering from clinical depression and don't get help, your depression might last for weeks, months, or even years. Here is a list of the most common signs of depression. If you have several of these, and they last for more than 2 weeks, see a doctor.

• An "empty" feeling, ongoing sadness, and anxiety
• Tiredness, lack of energy
• Loss of interest or pleasure in everyday activities, including sex
• Sleep problems, including trouble getting to sleep, very early morning waking, and sleeping too much
• Eating more or less than usual
• Crying too often or too much
• Aches and pains that don't go away when treated
• A hard time focusing, remembering, or making decisions
• Feeling guilty, helpless, worthless, or hopeless
• Being irritable
• Thoughts of death or suicide; a suicide attempt

If you are a family member, friend, or health care provider of an older person, watch for clues. Sometimes depression can hide behind a smiling face. A depressed person who lives alone may appear to feel better when someone stops by to say hello. The symptoms may seem to go away. But, when someone is very depressed, the symptoms usually come back.

Don't ignore the warning signs. If left untreated, serious depression can lead to suicide. Listen carefully if someone of any age complains about being depressed or says people don't care. That person may really be asking for help.

Getting Help

The first step is to accept that you or your family member needs help. You may not be comfortable with the subject of mental illness. Or, you might feel that asking for help is a sign of weakness. You might be like many older people, their relatives, or friends, who believe that a depressed person can quickly "snap out of it" or that some people are too old to be helped. They are wrong.

A health care provider can help you. Once you decide to get medical advice, start with your family doctor. The doctor should check to see if your depression could be caused by a health problem (such as hypothyroidism or vitamin B12 deficiency) or a medicine you are taking. After a complete exam, your doctor may suggest you talk to a mental health worker, such as a social worker, mental health counselor, psychologist, or psychiatrist. Doctors specially trained to treat depression in older people are called geriatric psychiatrists.

Don't avoid getting help because you may be afraid of how much treatment might cost. Often, only short-term psychotherapy (talk therapy) is needed. It is usually covered by insurance. Also, some community mental health centers may offer treatment based on a person's ability to pay.

About the Author

www.nia.nih.gov
NIA, one of the 27 Institutes and Centers of NIH, leads a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life. In 1974, Congress granted authority to form NIA to provide leadership in aging research, training, health information dissemination, and other programs relevant to aging and older people.