Depression in Older Persons

By the National Alliance on Mental Illness

How common is depression in later life? Depression affects more than 6.5 million of the 35 million Americans aged 65 years or older. Most people in this stage of life with depression have been experiencing episodes of the illness during much of their lives. For others, depression has a first onset in late life—even persons in their 80s and 90s. Depression in older persons is closely associated with dependency and disability and causes great suffering for the individual and the family.

Why does depression in the older population often go untreated? Depression in elderly people often goes untreated because many people think that depression is a normal part of aging and a natural reaction to chronic illness, loss and social transition. Elderly people do face noteworthy challenges to their connections through loss and also face medical vulnerability and mortality. For the elderly population depression can come in different sizes and shapes. Many elderly people and their families don’t recognize the symptoms of depression, aren’t aware that it is a medical illness and don’t know how it is treated. Others may mistake the symptoms of depression as signs of:

  • Dementia
  • Alzheimer’s Disease
  • Arthritis
  • Cancer
  • Heart Disease
  • Parkinson’s
  • Stroke
  • Thyroid Disorders

Also, many older persons think that depression is a character flaw and are worried about being made fun of or of being humiliated. They may blame themselves for their illness and are too ashamed to get help. Others worry that treatment would be too costly. Yet research has also shown that treatment is effective and in fact changes the brain when it works.

What are the consequences of untreated depression in older persons?

Late-life depression increases risk for medical illness and cognitive decline. Unrecognized and untreated depression has fatal consequences in terms of both suicide and nonsuicide mortality. The highest rate of suicide in the U.S. is among older white men. Depression is the single most significant risk factor for suicide in the elderly population. Tragically, many of those people who go on to die by suicide have reached out for help—20 percent see a doctor the day they die, 40 percent the week they die and 70 percent in the month they die. Yet depression is frequently missed. Elderly persons are more likely to seek treatment for other physical aliments than they are to seek treatment for depression.

Are symptoms of depression different in older persons than in younger persons?

Symptoms in older persons may differ somewhat from symptoms in other populations. Depression in older persons is at times characterized by:

  • Memory Problems
  • Confusion
  • Social Withdrawal
  • Loss of Appetite
  • Weight Loss
  • Vague Complaints of Pain
  • Inability to Sleep
  • Irritability
  • Delusions (Fixed False Beliefs)
  • Hallucinations

Older individuals who are depressed often have severe feelings of sadness but these feelings frequently are not acknowledged or openly shown; sometimes, when asked if they are “depressed,” the answer is “no.” Some general clues that someone may be experiencing depression are:

  • Persistent and Vague Complaints
  • Help-Seeking
  • Moving in a More Slow Manner
  • Demanding Behavior

How can clinical depression be distinguished from normal sadness and grief?

It’s natural to feel grief in the face of major life changes that many elderly people experience, such as leaving a home of many years or losing a loved one. Sadness and grief are normal, temporary reactions to the inevitable losses and hardships of life. Unlike normal sadness, however, clinical depression doesn’t go away by itself and lasts for months. Clinical depression needs professional treatment to reduce duration and intensity of symptoms. Any unresolved depression can affect the body. For example, depression, if left untreated, is a risk for heart disease and can suppress the immune system raising the risk of infection.

Like diabetes or arthritis, depression is a chronic disease. Getting well is only the beginning of the challenge—staying well is the real goal. For people experiencing their first episode of depression later in life, most experts would recommend treatment for six months to one year after acute treatment that achieves remission. For those that have had two or three episodes during their lifetimes, treatment should extend up to two years after remission. For peopled with more than three recurrences of depression, treatment may be life-long. The treatment that gets someone well is the treatment that will keep that person well.

Reviewed by Ken Duckworth, M.D., October 2009 Submitted by Sarah Swartz, Director of Business Development, The Carolina Center for Behavioral Health.

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