When Elders Get Depressed: It's Not Just "Old Age"
We look forward to our later years as a time for plenty of traveling, reflecting, playing with grandkids, volunteering, not to mention spending our hard-earned retirement savings!
Sadly, some older people develop depression during their "golden years." Since depression is much more serious than simply feeling a little down once in a while, it is very important that older adults are properly diagnosed and treated. The fact that depression can lead to suicide really highlights the importance of getting treatment for this mood disorder.
Why Older People Become Depressed
One important reason older people experience depression is related to hormonal change. Depression also is a symptom of low thyroid hormone levels, a common problem in the older population. Elderly depression occurs in both men and women.
In men, testosterone levels decline over time as a normal part of aging. Low testosterone can bring on fatigue and depressive symptoms. Testosterone is a hormone involved in many bodily functions.
In women, deficiencies in the hormones progesterone and estrogen, both of which decrease with menopause, can be linked to depression.
Some researchers believe that another problem in both elderly men and women is a reduction in DHEA, a steroid hormone that is an important building block for testosterone and estrogen. Levels of DHEA in the elderly are the lowest of any age group. Researchers continue to study the potential role that DHEA may play in the treatment of depression.
A number of other physical causes—medicines, loss of function due to arthritis, heart disease, osteoporosis, lack of physical activity, even dietary deficiencies—can also cause or contribute to depression. In addition, depression can be situational, developing from isolation, financial worries, loss of a loved one, or retirement.
Why Depression Remains Undiagnosed and Untreated
Older patients tend to assume that symptoms, like sleep disturbances, mood changes, and loss (or increase) in appetite, are simply a part of growing old. Doctors may also dismiss these symptoms without realizing that depression may be the underlying condition. In addition, depression can sometimes be confused for dementia, so the correct treatment plan is not put in place.
There are other reasons why depression may go unrecognized in older people. Mental illness can carry a social stigma. This stigma may make some people feel ashamed to admit that they are struggling with depression and not seek the help that they need. In other cases, budget cuts may reduce the kinds of services that are available for the elderly so that there are not enough qualified professionals to diagnose and treat depression.
In fact, the United States Preventive Services Task Force (USPSTF) does recommend that all adults are screened for depression. But USPSTF emphasizes that there should be a professional on staff to assist with the diagnosis and treatment. This is important because if you do have depression your condition will need to be monitored to make sure that your symptoms are improving.
How to Tell If Someone Is Depressed
Depression can be diagnosed with a combination of these common symptoms. If you any of them for at least two weeks, see your doctor for a mental health evaluation:
Older adults with depression may also exhibit:
If you have suicidal thoughts, which is another symptom of depression, call for medical help right away.
Keep in mind that other conditions with similar symptoms would need to be ruled out before making a definite diagnosis.
How Treatment Can Help
Discuss treatment options with your doctor. It may be recommended that you do one or more of the following:
People with major depression often respond well to antidepressants. Before taking an antidepressant drug, a doctor will consider all aspects of the patient's health and prescribe the drug least likely to cause any serious side effects. Low doses are initially prescribed to allow the body to adjust to the medicine. In older adults, it may take many weeks for a drug to produce noticeable results.
Like many medicines, antidepressants have side effects that sometimes restrict their use with older people. Side effects range from minor ones, such as a dry mouth, to the more serious, such as a drop in blood pressure. However, there are several drugs that are well-tolerated by older adults that may cause little or no side effects.
There are many different approaches to therapy. Often therapy with older people is problem-oriented, focusing on helping people deal with immediate issues, such as the loss of a loved one, a change in residence, or retirement. Other approaches can focus on making behavioral changes, such as learning to adopt new views on life or restructuring daily activities. Family therapy may also be helpful in assisting older people and their children when dealing with unrealistic expectations, guilt, and unresolved issues. Other types of therapy that may be beneficial in older adults include:
Take some time to look over medications you or a loved one may be taking. It is possible that some are counteracting one another. This may indicate that they can be changed or eliminated.
Depression Can Be Successfully Treated in Elderly Patients
Older adults with depression can improve when they are treated with medicine, therapy, or a combination of the two. Coexisting medical conditions also tend to improve when depression is treated. Depression is an illness that can be successfully managed in people of all ages.
Depression and Bipolar Support Alliance
Canadian Mental Health Association
Canadian Psychiatric Association
Bain J. Testosterone and the aging male: to treat or not to treat? Maturitas. 2010;66(1):16-22.
Depression. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated March 13, 2013. Accessed March 15, 2013.
Depression. National Institutes of Health Senior Health website. Available at: http://nihseniorhealth.gov/depression/aboutdepression/01.html. Updated April 2011. Accessed March 13, 2013.
Depression in older adults. American Academy of Family Physicians website. Available at: http://familydocto.... Updated August 2012. Accessed March 15, 2013.
Depression in older adults. Mental Health America website. Available at: http://www.mentalh.... Accessed March 15, 2013.
Depression in older adults and the elderly. Helpguide website. Available at: http://www.helpguide.org/mental/depression_elderly.htm. Updated November 2012. Accessed March 10, 2011.
Depression in older persons. National Alliance on Mental Illness website. Available at: http://www.nami.or.... Updated October 2009. Accessed March 18, 2013.
McHenry MC. Testosterone deficiency in older men: a problem worth treating. Consult Pharm. 2012;27(3):152-163.
Older adults: depression and suicide facts. National Institute of Mental Health website. Available at: http://www.nimh.ni.... Updated April 2007. Accessed March 15, 2013.
Schmidt PJ, Daly RC, Block M, et al. Dehydroepiandrosterone monotherapy in midlife-onset major and minor depression. Arch Gen Psychiatry. 2005;62(2):154-162.
Last reviewed March 2013 by Brian Randall, MD