What Depression in the Elderly Looks Like & How to Get Help
When you think of depression in the elderly, what comes to mind? You aren't alone if your first thought includes stereotypical images of frail and sad-looking older adults. After all, many of us naturally associate depression with characteristics like misery and weakness. But here's the thing: Those stereotypes represent only a narrow slice of this medical condition's wide spectrum of possible effects. In fact, you might be surprised to know that many depressed people over the age of 65 don't exhibit those traits. So it's essential to understand what this illness is really all about if you want greater vitality for yourself or a loved one.
The more you know about the effects of depression in elderly people, the more empowered you'll be when it comes to creating enjoyable retirement years for you or those you care about. You'll rise above common misunderstandings and discover the benefits of having a broader, more informed perspective on the issue. For many older adults with this condition, the prognosis is good. Safe and effective treatments are widely available. You just need to know all the facts.
This article will educate you about the signs of elderly depression (also known as geriatric depression), the challenges it presents, and the options for treatment. The earlier you recognize the condition, the better. It doesn't have to cause long-term problems. With professional help, it can be overcome. You can feel good again, regardless of your age.
What Is Depression? How Does It Affect the Elderly?
Also, you should know this: Anybody can get depression. It doesn't discriminate. And older adults can get it for no obvious reason. People with depression tend to feel powerless to get rid of it.
In older people with depression, loneliness often plays a big role. However, that isn't the case for everyone. Clinically depressed people (of every age) are usually impacted by five or more of the following effects for at least two weeks:
- General unhappiness
- Sleep problems
- Feelings of worthlessness or guilt
- Inability to concentrate or make decisions
- Loss of interest or enjoyment in activities
- Weight loss or anorexia
- An impaired or agitated mental state that may cause unusual movements or behaviors
- Thoughts of suicide
Keep in mind that a lot of seniors with depression don't experience sadness as a primary symptom. The effects of their depression may be seen mostly in physical problems instead. For example, issues like chronic headaches, pain without an obvious cause, unintended weight loss, or persistently low energy or motivation may be signs that they're depressed. In addition, older adults tend to be affected by depression a little differently than their younger counterparts. Older people may have the condition for a longer time. And they often have it in conjunction with other health issues.
Estimates vary, but depressive disorders are thought to affect about 10 to 20 percent of elderly people worldwide.1 In the U.S., the numbers vary based on factors like treatment settings and the specific kinds of depression. For example, between 17 and 37 percent of elderly patients in primary health care environments have been recognized as having depression.2 Here are some of the most common types of depressive disorders in older adults:
Regardless of the type of depression you or a loved one may have, it's important to seek treatment. Geriatric depression can increase the risk of death from other medical conditions such as cardiac disease. It can also make it more difficult to recover and rehabilitate after illness, injury, or surgery.
The Differences Between Depression, Grief, and Dementia
You aren't alone if you've ever found it difficult to know whether someone was depressed, exhibiting dementia, or simply grieving over a loss. But it's essential to understand the differences so that the appropriate kind of help can be sought. Here's what you need to know:
Risk Factors for Elderly Depression
All kinds of different things can increase the odds of an older adult developing depression. The more risk factors a person has, the more likely it is that he or she will someday be impacted by this condition. For starters, depression tends to be more common in women than men, so being female is considered a risk factor. But many other physical, psychological, and social factors can also increase the risk.
For example, did you know that as many as 15 percent of adults whose spouses have passed away develop depression that lasts at least a year after becoming widowed?2 Other personal and emotional risk factors include:
- A personal or family history of depression
Persistent grieving due to events such as:
- The death of a friend or family member
- Retirement from a cherished career
- An unwanted change of residence
- Traumatic experiences such as accidents or elder abuse
- Financial problems
- Social isolation (including living alone)
- Fear of dying
- Past or current substance abuse (including alcoholism)
In addition, a huge range of physical risk factors have been linked to the development of depression. That's often why some people seem to get this condition all of a sudden. Depression can go unnoticed because of physical problems that share some of its symptoms. In some cases, physical issues cause people to feel a loss of control, which can quickly lead to depressive disorders. In other cases, they cause biological changes that lead to chemical imbalances in the brain and, ultimately, depression. Those facts are especially relevant when it comes to older adults since about 80 percent of seniors have one or more chronic health issues.3
From disabilities to chronic diseases, some of the most common physical risk factors for depression in the elderly include:
- Hearing loss
- Failing eyesight
- Chronic pain
- Sleep problems
- Loss of mobility
- High blood pressure
- Heart disease
- Parkinson's disease
- Alzheimer's disease
- Rheumatoid arthritis
- Vitamin or mineral deficiencies
- Thyroid disorders
- Multiple sclerosis
- Electrolyte imbalances
Some medications have also been linked to the risk of developing or worsening depression, especially in elderly people who take multiple drugs. Examples include certain kinds of prescription medications such as:
- Sedatives and sleeping pills
- Anti-inflammatory drugs
- Beta blockers
- Antipsychotic medications
- Drugs for high cholesterol
- Estrogen replacers
- Ulcer medications
- Drugs for high blood pressure
- Calcium-channel blockers
- Chemotherapy drugs
Signs, Symptoms, and Effects of Depression in Elderly People
Unless you know what to look for, it isn't always easy to recognize depression in older adults. That's particularly true when it comes to the physical effects of depression, which can masquerade as other health conditions. So it's important to keep a full range of possible symptoms in mind, understanding that red flags may be hidden behind inaccurate assumptions about what depression is "supposed" to look like.
Everybody affected by this condition displays a different combination of symptoms. Some of the most common signs of depression in seniors include:
- Persistent sadness or despair
- Lack of self-esteem
- Frequent self-loathing
- General apathy
- Frequent forgetfulness
- Inability to concentrate
- Slower-than-normal speech or movement
- Loss of interest in previously enjoyed activities
- Social withdrawal
- Persistently low energy
- Unexplainable aches and pains
- Poor appetite
- Neglect of personal hygiene
- Grumpiness and short temper
- More frequent use of alcohol or other substances
- Suicidal thoughts
When evaluating seniors who may be depressed, professionals in geriatric mental health often ask several questions that are designed to illuminate the red flags. Older adults with depression often provide answers that show they suffer from many of the following things:
- Frequently feeling bored
- Experiencing a lack of excitement in life
- Rarely, if ever, feeling happy or in good spirits
- Having difficulty beginning new projects
- Abandoning favorite hobbies and interests
- Frequently feeling fidgety or high-strung
- Having difficulty making decisions
- Frequently getting angry over small stuff
- Feeling generally unsatisfied with life
- Believing that most people are better off than they are
- Avoiding social get-togethers
- Resisting getting out and trying new things
- Feeling that something bad is about to happen
- Feeling hopeless about the future
- Feeling empty and/or helpless
- Frequently feeling the urge to cry
- Frequently worrying about the past and/or future
- Having difficulty concentrating
- Feeling that right now is a bad time to be alive
- Disliking getting up each morning
- Feeling worthless to other people
- Experiencing troubling thoughts that won't go away
- Believing that they have more trouble with memory than most people
- Feeling less mentally sharp than they used to be
It's also important to consider some of the common differences between men and women who have depression. For example, men are sometimes more likely to feel tired, frustrated, and irritable. Depression can also make men more likely to abuse substances like alcohol, display reckless behavior, lose motivation for their hobbies, or avoid conversation.
Risk of Elderly Suicide
Seniors represent the age group with the highest risk of suicide. In fact, over 25 percent of America's suicides occur in people over the age of 65. In addition, even though depression is more common among older women, many more older men die of suicide. In particular, white males over the age of 80 have the highest risk of committing suicide. They are about six times more likely to kill themselves than people in the general population.4
That's why it is essential to communicate with depressed (or potentially depressed) seniors and listen for clues of suicidal thinking. Ask them how they feel about life. Find out if they ever think that life isn't worth living or if they ever plan or imagine doing harm to themselves. If their answers are in the affirmative, make sure you find help for them right away, such as from doctors or mental health counselors.
If you feel that you or someone you love is in imminent danger of committing suicide, call 911 or go to a nearby emergency room. You can also call the toll-free National Suicide Prevention Lifeline at any time of day: Call 1-800-273-8255 (or 1-800-799-4889 for TTY service).
Why Depression Is Often Overlooked in the Elderly
Many older people don't receive the help they need and end up suffering unnecessarily from the full effects of depression. There can be all kinds of reasons for this. For example, depending on the individuals involved, elderly depression can be overlooked or go untreated because:
Help and Treatment for Seniors With Depression
Overcoming depression is more than possible. In fact, most elderly patients with depression can be treated, and most are able to recover. So, regardless of your age, the potential to feel happy again is very real. Nobody should view depression as anything other than a treatable illness. But ignoring it can have serious consequences, including disability or premature death. Treatment is a must.
The earlier a senior's depression is recognized, the better. Many doctors routinely screen their elderly patients for depressive disorders; however, that isn't something you can always count on. You may have to ask. A doctor may order various lab tests such as a urinalysis, an EKG, or blood tests. Abnormal results can sometimes help diagnosis a condition that may be linked to depression.
Mental health professionals are also good at recognizing the signs of depression in older people. Many communities have drop-in centers where seniors and their families can find experts and resources. They can be good places for initial screening and guidance.
Treatment for geriatric depression often involves a combination of medication, therapy, and lifestyle modifications. Other forms of treatment, such as electroconvulsive therapy (ECT) or repetitive transcranial magnetic stimulation (rTMS), are also sometimes used in very severe cases. In addition, depression is often treated alongside other medical or psychological conditions that may be at the root of the depression or contributing to it in some way.
If you don't have insurance and need help finding affordable health services in your area, check out the Health Resources and Services Administration (HRSA). The HRSA website maintains a national database of health centers where you can get services and only have to pay what you can afford.
Counseling and Psychotherapy
Therapy often works well for older adults with depression. In fact, many seniors get better results from psychotherapy than younger people do. It helps them work through the underlying issues that may be causing or contributing to their depression. And it can enable them to change their habits and patterns of thinking so that they cope better with difficult emotions. The outcome is often a better quality of life.
For older adults with mild or moderate depression (and no other complicating illnesses), therapy may offer the same effectiveness as antidepressant medication. Cognitive-behavioral therapy (CBT), in particular, is often very beneficial for seniors with depression. Most psychotherapy sessions take place in private settings on a one-to-one basis. But some people also derive benefits from various forms of group counseling, especially if they need extra support while dealing with grief, illness, or loneliness.
Along with psychotherapy, many elderly people with depressive disorders are prescribed antidepressant medications. Such drugs tend to be just as effective in older adults as they are in younger people. However, there can be some important differences. For example, the therapeutic effects of antidepressants sometimes take a little longer to kick in when taken by seniors. And older people often need to take antidepressants for a longer time while also being more aware of potentially adverse reactions with the other medications they may be taking.
In general, a senior with depression may need to be on an antidepressant for as many as six weeks until it takes full effect. But since this type of medication can sometimes make you feel a little worse before you start feeling better, some people quit taking their medications too early. In fact, as many as seven out of 10 older adults on antidepressants stop taking their medication within the first four weeks.2 So it's important to have a personal support system, especially during the early stages of pharmaceutical treatment.
It's also essential to keep in mind that different people respond differently to different medications. If one antidepressant doesn't work, then a different one might. In some cases, it takes a few rounds of different prescriptions before finding one that is effective and doesn't cause problematic side effects. The same is true when it comes to finding the most effective dose of a particular drug.
The most common types of antidepressant medications prescribed for late-life depression include:
Seniors with depression should always consult their doctors before making any big changes to their lifestyles. But developing new habits is often a critical part of getting better and preventing relapses after recovery. Although depression can make it difficult to find the motivation to make changes, support is often available to help nudge you in the right direction. Many people are able to start making changes after their antidepressants take effect. Here are some of the most beneficial changes you can make:
Electroconvulsive Therapy (ECT)
For elderly people with severe depression that worsens or persists despite other treatments, ECT is often a safe and effective way to reverse the symptoms. While under general anesthesia, a brief seizure is intentionally triggered in a patient by passing small electrical currents through his or her brain. The result is frequently a positive change in brain chemistry.
Despite a lot of misconceptions among the general public and some health care providers, ECT has been used for several decades and has an excellent track record when it comes to elderly patients. It's been shown to be especially beneficial for people with depressive disorders who also have a family history of depression, wake up too early each morning, have delusions, or have slowed psychomotor abilities. The most common side effects are short-term memory loss and confusion.
How to Help an Elderly Loved One Who Has Depression
First, keep in mind that your loved one may put up some resistance, mostly out of fear or resentment. (We are often afraid of the actions we'll have to take in order to get better. And nobody likes to be seen as having a mental illness. Personal pride sometimes gets in the way of our better judgment.) Your loved one's depression may also make him or her feel hopeless, ashamed, or like a burden to you. All of those feelings can make it very difficult for your loved one to find the motivation to accept help and follow through with appropriate actions.
As you move forward, consider the following tips:
Depression in the elderly doesn't have to be a long-term problem. With help and persistence, almost anyone can get better, regardless of their age. Don't give up. Always remember that there are plenty of reasons to remain hopeful. Move forward gently, but with real purpose. With time, the light will probably return.
- 1 National Institutes of Health, U.S. National Library of Medicine, Annals of Saudi Medicine, "Prevalence of depressive disorders in the elderly," website last visited on July 26, 2017.
- 2 American Academy of Family Physicians, American Family Physician, "Depression in Later Life: A Diagnostic and Therapeutic Challenge," website last visited on July 26, 2017.
- 3 Centers for Disease Control and Prevention, "Depression is Not a Normal Part of Growing Older," website last visited on July 26, 2017.
- 4 Geriatric Mental Health Foundation, "Depression in Late Life: Not A Natural Part Of Aging," website last visited on January 23, 2020.
- American Psychological Association, "Aging and depression," website last visited on July 26, 2017.
- Current Psychiatry Reports, "Electroconvulsive Therapy in the Elderly: New Findings in Geriatric Depression," website last visited on July 26, 2017.
- ModernMedicine Network, Formulary Journal, "Depression in the elderly: A pharmacist's perspective," website last visited on July 26, 2017.
- National Institute of Mental Health, Older Adults and Depression, website last visited on July 8, 2019.