Teenage depression

Teenage depression isn’t just bad moods and occasional melancholy—it’s a serious problem that impacts every aspect of a teen’s life. Teen depression can lead to problems at home and school, drug abuse, self-loathing—even violence or suicide. But as a concerned parent, teacher, or friend, there are many ways you can help. Talking about the problem and offering support can go a long way toward getting your teenager back on track.

Understanding teen depression

There are as many misconceptions about teen depression as there are about teenagers in general. Yes, the teen years are tough, but most teens balance the requisite angst with good friendships, success in school or outside activities, and the development of a strong sense of self.

Occasional bad moods or acting out is to be expected, but depression is something different. Depression can destroy the very essence of a teenager’s personality, causing an overwhelming sense of sadness, despair, or anger.

Whether the incidence of teen depression is actually increasing, or we’re just becoming more aware of it, the fact remains that depression strikes teenagers far more often than most people think. And although depression is highly treatable, experts say only 1 in 5 depressed teens receive help.
Unlike adults, who have the ability to seek assistance on their own, teenagers usually must rely on parents, teachers, or other caregivers to recognize their suffering and get them the treatment they need. So if you have an adolescent in your life, it’s important to learn what teen depression looks like and what to do if you spot the warning signs.

Signs and symptoms of teen depression

Teenagers face a host of pressures, from the changes of puberty to questions about who they are and where they fit in. The natural transition from child to adult can also bring parental conflict as teens start to assert their independence. With all this drama, it isn’t always easy to differentiate between depression and normal teenage moodiness. Making things even more complicated, teens with depression do not necessarily appear sad, nor do they always withdraw from others. For some depressed teens, symptoms of irritability, aggression, and rage are more prominent.

Signs and symptoms of depression in teens

Sadness or hopelessness Irritability, anger, or hostility Tearfulness or frequent crying Withdrawal from friends and family Loss of interest in activities Changes in eating and sleeping habits

Restlessness and agitation Feelings of worthlessness and guilt Lack of enthusiasm and motivation Fatigue or lack of energy Difficulty concentrating Thoughts of death or suicide

If you’re unsure if an adolescent in your life is depressed or just “being a teenager,” consider how long the symptoms have been present, how severe they are, and how different the teen is acting from his or her usual self. While some “growing pains” are to be expected as teenagers grapple with the challenges of growing up, dramatic, long-lasting changes in personality, mood, or behavior are red flags of a deeper problem.

The difference between teenage and adult depression

Depression in teens can look very different from depression in adults. The following symptoms of depression are more common in teenagers than in their adult counterparts:

• Irritable or angry mood – As noted above, irritability, rather than sadness, is often the predominant mood in depressed teens. A depressed teenager may be grumpy, hostile, easily frustrated, or prone to angry outbursts.
• Unexplained aches and pains – Depressed teens frequently complain about physical ailments such as headaches or stomachaches. If a thorough physical exam does not reveal a medical cause, these aches and pains may indicate depression.
• Extreme sensitivity to criticism – Depressed teens are plagued by feelings of worthlessness, making them extremely vulnerable to criticism, rejection, and failure. This is a particular problem for “over-achievers.”
• Withdrawing from some, but not all people – While adults tend to isolate themselves when depressed, teenagers usually keep up at least some friendships. However, teens with depression may socialize less than before, pull away from their parents, or start hanging out with a different crowd.

Effects of teen depression

The negative effects of teenage depression go far beyond a melancholy mood. Many rebellious and unhealthy behaviors or attitudes in teenagers are actually indications of depression. The following are some the ways in which teens “act out” or “act in” in an attempt to cope with their emotional pain:

• Problems at school. Depression can cause low energy and concentration difficulties. At school, this may lead to poor attendance, a drop in grades, or frustration with schoolwork in a formerly good student.
• Running away. Many depressed teens run away from home or talk about running away. Such attempts are usually a cry for help.
• Drug and alcohol abuse. Teens may use alcohol or drugs in an attempt to “self-medicate” their depression. Unfortunately, substance abuse only makes things worse.
• Low self-esteem. Depression can trigger and intensify feelings of ugliness, shame, failure, and unworthiness.
• Internet addiction. Teens may go online to escape from their problems. But excessive computer use only increases their isolation and makes them more depressed.
• Reckless behavior. Depressed teens may engage in dangerous or high-risk behaviors, such as reckless driving, out-of-control drinking, and unsafe sex.
• Violence. Some depressed teens (usually boys who are the victims of bullying) become violent. As in the case of the Columbine school massacre, self-hatred and a wish to die can erupt into violence and homicidal rage.

Encouraging a depressed teen to open up

If you suspect that a teenager in your life is suffering from depression, speak up right away. Even if you’re unsure that depression is the issue, the troublesome behaviors and emotions you’re seeing in your teenager are signs of a problem.

Whether or not that problem turns out to be depression, it still needs to be addressed—the sooner the better. In a loving and non-judgmental way, share your concerns with your teenager. Let him or her know what specific signs of depression you’ve noticed and why they worry you. Then encourage your child to share what he or she is going through.

Your teen may be reluctant to open up. He or she may be ashamed, afraid of being misunderstood. Alternatively, depressed teens may simply have a hard time expressing what they’re feeling.

If your teen claims nothing is wrong, but has no explanation for what is causing the depressed behavior, you should trust your instincts. Remember that denial is a strong emotion. Furthermore, teenagers may not believe that what they’re experiencing is the result of depression.

Tips for Talking to a Depressed Teen
Offer support	Let depressed teenagers know that you’re there for them, fully and unconditionally. Hold back from asking a lot of questions (teenagers don’t like to feel patronized or crowded), but make it clear that you’re ready and willing to provide whatever support they need.
Be gentle but persistent	Don’t give up if your adolescent shuts you out at first. Talking about depression can be very tough for teens. Be respectful of your child’s comfort level while still emphasizing your concern and willingness to listen.
Listen without lecturing	Resist any urge to criticize or pass judgment once your teenager begins to talk. The important thing is that your child is communicating. Avoid offering unsolicited advice or ultimatums as well.
Validate feelings	Don’t try to talk teens out of their depression, even if their feelings or concerns appear silly or irrational to you. Simply acknowledge the pain and sadness they are feeling. If you don’t, they will feel like you don’t take their emotions seriously.

Getting treatment for teen depression

Depression is very damaging when left untreated, so don’t wait and hope that the symptoms will go away. If you see depression’s warning signs, seek professional help.

Make an immediate appointment for your teen to see the family physician for a depression screening. Be prepared to give your doctor specific information about your teen’s depression symptoms, including how long they’ve been present, how much they’re affecting your child’s daily life, and any patterns you’ve noticed. The doctor should also be told about any close relatives who have ever been diagnosed with depression or another mental health disorder. As part of the depression screening, the doctor will give your teenager a complete physical exam and take blood samples to check for medical causes of your child’s symptoms.

Seek out a depression specialist

If there are no health problems that are causing your teenager’s depression, ask your doctor to refer you to a psychologist or psychiatrist who specializes in children and adolescents. Depression in teens can be tricky, particularly when it comes to treatment options such as medication. A mental health professional with advanced training and a strong background treating adolescents is the best bet for your teenager’s best care.

When choosing a specialist, always get your child’s input. Teenagers are dependent on you for making many of their health decisions, so listen to what they’re telling you. No one therapist is a miracle worker and no one treatment works for everyone. If your child feels uncomfortable or is just not ’connecting’ with the psychologist or psychiatrist, ask for a referral to another provider that may be better suited to your teenager.

Don’t rely on medication alone

Expect a discussion with the specialist you’ve chosen about treatment possibilities for your son or daughter. There are a number of treatment options for depression in teenagers, including one-on-one talk therapy, group or family therapy, and medication.

Talk therapy is often a good initial treatment for mild to moderate cases of depression. Over the course of therapy, your teen’s depression may resolve. If it doesn’t, medication may be warranted. However, antidepressants should only be used as part of a broader treatment plan.

Unfortunately, some parents feel pushed into choosing antidepressant medication over other treatments that may be cost-prohibitive or time-intensive. However, unless your child is considered to be high risk for suicide (in which case medication and/or constant observation may be necessary), you have time to carefully weigh your options before committing to any one treatment.

Risks of teenage antidepressant use

In severe cases of depression, medication may help ease symptoms. However, antidepressants aren’t always the best treatment option. They come with risks and side effects of their own, including a number of safety concerns specific to children and young adults. It’s important to weigh the benefits against the risks before starting your teen on medication.

Antidepressants and the teenage brain

Antidepressants were designed and tested on adults, so their impact on the youthful, developing brain is not yet completely understood. Some researchers are concerned that the use of drugs such as Prozac in children and teens might interfere with normal brain development. The human brain is developing rapidly in young adults, and exposure to antidepressants may impact that development—particularly the way the brain manages stress and regulates emotions.

Antidepressant suicide warning for teens

Antidepressant medications may increase the risk of suicidal thinking and behavior in some teenagers. All antidepressants are required by the U.S. Food and Drug Administration (FDA) to carry a “black box” warning label about this risk in children, adolescents, and young adults up to the age of 24. The risk of suicide is highest during the first two months of antidepressant treatment.

Certain young adults are at an even greater risk for suicide when taking antidepressants, including teens with bipolar disorder, a family history of bipolar disorder, or a history of previous suicide attempts.

Teenagers on antidepressants should be closely monitored for any sign that the depression is getting worse. Warning signs include new or worsening symptoms of agitation, irritability, or anger. Unusual changes in behavior are also red flags.

According to FDA guidelines, after starting an antidepressant or changing the dose, your teenager should see their doctor:

• Once a week for four weeks
• Every 2 weeks for the next month
• At the end of their 12th week taking the drug
• More often if problems or questions arise

Supporting a teen through depression treatment

As the depressed teenager in your life goes through treatment, the most important thing you can do is to let him or her know that you’re there to listen and offer support. Now more than ever, your teenager needs to know that he or she is valued, accepted, and cared for.

• Be understanding. Living with a depressed teenager can be difficult and draining. At times, you may experience exhaustion, rejection, despair, aggravation, or any other number of negative emotions. During this trying time, it’s important to remember that your child is not being difficult on purpose. Your teen is suffering, so do your best to be patient and understanding.
• Encourage physical activity. Encourage your teenager to stay active. Exercise can go a long way toward relieving the symptoms of depression, so find ways to incorporate it into your teenager’s day. Something as simple as walking the dog or going on a bike ride can be beneficial.
• Encourage social activity. Isolation only makes depression worse, so encourage your teenager to see friends and praise efforts to socialize. Offer to take your teen out with friends or suggest social activities that might be of interest, such as sports, after-school clubs, or an art class.
• Stay involved in treatment. Make sure your teenager is following all treatment instructions and going to therapy. It’s especially important that your child takes any prescribed medication as instructed. Track changes in your teen’s condition, and call the doctor if depression symptoms seem to be getting worse.
• Learn about depression. Just like you would if your child had a disease you knew very little about, read up on depression so that you can be your own “expert.” The more you know, the better equipped you’ll be to help your depressed teen. Encourage your teenager to learn more about depression as well. Reading up on their condition can help depressed teens realize that they’re not alone and give them a better understanding of what they’re going through.

The road to your depressed teenager’s recovery may be bumpy, so be patient. Rejoice in small victories and prepare for the occasional setback. Most importantly, don’t judge yourself or compare your family to others. As long as you’re doing your best to get your teen the necessary help, you’re doing your job.

Taking care of the whole family when one child is depressed

As a parent dealing with teen depression, you may find yourself focusing all your energy and attention on your depressed child. Meanwhile, you may be neglecting your own needs and the needs of other family members. While helping your depressed child should be a top priority, it’s important to keep your whole family strong and healthy during this difficult time.

• Take care of yourself– In order to help a depressed teen, you need to stay healthy and positive yourself, so don’t ignore your own needs. The stress of the situation can affect your own moods and emotions, so cultivate your well–being by eating right, getting enough sleep, and making time for things you enjoy.
• Reach out for support – Get the emotional support you need. Reach out to friends, join a support group, or see a therapist of your own. It’s okay to feel overwhelmed, frustrated, helpless, or angry. The important thing is to talk about how your teen’s depression is affecting you, rather than bottling up your emotions.
• Be open with the family – Don’t tiptoe around the issue of teen depression in an attempt to “protect” the other children. Kids know when something is wrong. When left in the dark, their imaginations will often jump to far worse conclusions. Be open about what is going on and invite your children to ask questions and share their feelings.
• Remember the siblings – Depression in one child can cause stress or anxiety in other family members, so make sure “healthy” children are not ignored. Siblings may need special individual attention or professional help of their own to handle their feelings about the situation.
• Avoid the blame game – It can be easy to blame yourself or another family member for your teen’s depression, but it only adds to an already stressful situation. Furthermore, depression is normally caused by a number of factors, so it’s unlikely—except in the case of abuse or neglect—that any loved one is “responsible.”

See  more : http://www.helpguide.org/mental/depression_teen_teenagers.htm

Depression in Men

As men, we often believe we have to be strong and in control of our emotions at all times. When we feel hopeless, helpless, or overwhelmed by despair we tend to deny it or cover it up by drinking too much, behaving recklessly, or exploding with anger. But depression in men is a common condition. The first step to recovery is to understand there’s no reason to feel ashamed. Then you can face the challenge head on and start working to feel better.

Understanding depression in men

Depression is not a sign of emotional weakness or failing of masculinity. It is a treatable health condition that affects millions of men of all ages and backgrounds, as well as those who care about them—spouses, partners, friends, and family. It can also lead to heart disease and other serious medical problems. Of course, it’s normal for anyone to feel down from time to time—dips in mood are an ordinary reaction to losses, setbacks, and disappointments in life. However, if intense feelings of despair and hopelessness take hold of you, and interfere with work, family, and your ability to enjoy life, you may be suffering from depression.

Unfortunately, depression in men can often be overlooked as many of us find it difficult to talk about our feelings. Instead, we tend to focus on the physical symptoms that often accompany depression, such as back pain, headaches, difficulty sleeping, or sexual problems. This can result in the underlying depression going untreated, which can have serious consequences. In fact, men suffering from depression are four times more likely to commit suicide than women. It’s important for any man to seek help with depression before feelings of despair become feelings of suicide. You need to talk honestly with a friend, loved one, or doctor about what’s going on in your mind as well as your body. Once correctly diagnosed, there is plenty you can do to successfully treat and manage depression.

If you're feeling suicidal...

When you’re feeling depressed or suicidal, problems don’t seem temporary—they seem overwhelming and permanent. But with time, you will feel better, especially if you reach out for help.

Read Helpguide’s Suicide Prevention articles or call the National Suicide Prevention Lifeline at 1-800-273-8255.

For help outside the U.S., visit Befrienders Worldwide.

Signs and symptoms of depression in men

Men can experience depression in different ways to women. You may develop the standard symptoms of depression and become sad and withdrawn, losing interest in friends and activities you used to enjoy. Or you may become irritable and aggressive, compulsively working, drinking more than normal, and engaging in high risk activities.

Unfortunately, men are far less adept at recognizing their symptoms than women. A man is more likely to deny his feelings, hide them from himself and others, or try to mask them with other behaviors. The three most common signs of depression in men are:

• Physical pain. Sometimes depression in men shows up as physical symptoms—such as backache, frequent headaches, sleep problems, sexual dysfunction, or digestive disorders—that don’t respond to normal treatment.
• Anger. This could range from irritability, sensitivity to criticism, or a loss of your sense of humor to road rage, a short temper, or even violence. Some men become abusive, controlling, verbally or physically abusive to wives, children, or other loved ones.  
• Reckless behavior. A man suffering from depression may start exhibiting escapist or risky behavior. This could mean pursuing dangerous sports, driving recklessly, or engaging in unsafe sex. You might drink too much, abuse drugs, or gamble compulsively.

Differences between male and female depression
Women tend to:	Men tend to:
Blame themselves	Blame others
Feel sad, apathetic, and worthless	Feel angry, irritable, and ego inflated
Feel anxious and scared	Feel suspicious and guarded
Avoid conflicts at all costs	Create conflicts
Feel slowed down and nervous	Feel restless and agitated
Have trouble setting boundaries	Need to feel in control at all costs
Find it easy to talk about self-doubt and despair	Find it “weak” to admit self-doubt or despair
Use food, friends, and "love" to self-medicate	Use alcohol, TV, sports, and sex to self-medicate
Adapted from: Male Menopause by Jed Diamond

Triggers for depression in men

There’s no single cause of depression in men. Biological, psychological, and social factors all play a part, as do lifestyle choices, relationships, and coping skills. Stressful life events or anything that makes you feel useless, helpless, alone, profoundly sad, or overwhelmed by stress can also trigger depression in men. These could include:

• Overwhelming stress at work, school, or home
• Marital or relationship problems
• Not reaching important goals
• Losing or changing a job; embarking on military service
• Constant money problems
• Health problems such as chronic illness, injury, disability
• Recently quitting smoking
• Death of a loved one
• Family responsibilities such as caring for children, spouse, or aging parents
• Retirement; loss of independence

Depression in men and erectile dysfunction

Impotence or erectile dysfunction is not only a cause of depression in men, it can also be a side effect of many antidepressant medications.

• Men with sexual function problems are almost twice as likely to be depressed as those without.
• Depression increases the risk of erectile dysfunction.
• Many men are reluctant to acknowledge sexual problems, thinking it’s a reflection on their manhood rather than a treatable problem caused by depression.

Risk factors for depression in men

While any man can suffer from depression, there are some risk factors that make a man more vulnerable to the illness, such us:

• Loneliness and lack of social support
• Inability to effectively deal with stress
• A history of alcohol or drug abuse
• Early childhood trauma or abuse
• Aging in isolation, with few social outlets

Treating depression in men

Don't try to tough out depression on your own. It takes courage to seek help, but most men with depression respond well to treatments such as lifestyle changes, social support, therapy, or medication—or a combination of treatments.

The first step is to talk to your doctor. Be open about how you’re feeling as well as the physical symptoms you’re experiencing so your mental health specialist can make an accurate diagnosis.

• Therapy. You may feel that talking to a stranger about your problems is ‘unmanly,’ or that therapy carries with it a victim status. However, if therapy is available to you, it can be an extremely effective treatment for depression in men. Opening up to a therapist can often bring a swift sense of relief, even to the most skeptical male.
• Medication. Antidepressant medication may help relieve some symptoms of depression, but doesn’t cure the underlying problem, and is rarely a long-term solution. Medication also comes with side effects. Don't rely on a doctor who is not trained in mental health for guidance on medication, and always pursue healthy lifestyle changes and social support as well.

Lifestyle changes to treat depression in men

Lifestyle changes are extremely effective tools at treating depression in men. Even if you need other treatments as well, lifestyle changes can help lift depression and keep it from coming back.

• Exercise regularly. Regular exercise is a powerful way to fight depression in men. Not only does it boost serotonin, endorphins, and other feel-good brain chemicals, it triggers the growth of new brain cells and connections, just as antidepressants do. It also boosts self-esteem and helps to improve sleep. For maximum results, aim for 30 to 60 minutes of activity on most days.
• Eat well. Eating small, well-balanced meals throughout the day will help you keep your energy up and minimize mood swings. While you may be drawn to sugary foods for the quick boost they provide, complex carbohydrates are a better choice. They'll get you going without the sugar crash. Deficiencies in B vitamins can trigger depression so take a B-complex vitamin supplement or eat more citrus fruit, leafy greens, beans, chicken, and eggs. Foods rich in certain omega-3 fats—such as salmon, walnuts, soybeans, and flaxseeds—can also give your mood a boost.
• Get enough sleep. When you don't get enough sleep, your depression symptoms can be worse. Sleep deprivation exacerbates anger, irritability, and moodiness. Aim for somewhere between 7 to 9 hours of sleep each night.
• Reduce stress. Make changes in your life to help manage and reduce stress. Too much stress exacerbates depression and puts you at risk for future depression. Set realistic goals and break them down into manageable tasks rather than burden yourself with huge objectives all at once. Figure out the things in your life that stress you out, such as work overload or unsupportive relationships, and make a plan to avoid them or minimize their impact.

Exercise as an Antidepressant for Men

Exercise can treat mild to moderate depression as effectively as antidepressant medication. Check with your doctor before starting a new exercise program, then follow these exercise tips:

• Exercise regularly and often. A 10-minute walk can improve your mood for two hours. The key to sustaining mood benefits is to exercise regularly. That may mean exercising vigorously for 30 minutes once a day as well as taking one or two short walks to keep your mood elevated throughout the whole day.
• Find activities that are at least moderately intense. Aerobic exercise undoubtedly has mental health benefits, but you don't always have to sweat strenuously to see results. Remember, even a few minutes of gentle activity are better than none at all.
• Choose exercises that are continuous and rhythmic. Walking, swimming, running, biking, rowing, and yoga are all good choices.
• Add a mind-body element to increase relaxation. If walking or running, for example, focus on each step—the sensation of your feet touching the ground, the rhythm of your breath, and the feeling of the wind against your face. If resistance training, focus on coordinating your breathing with your movements and note how your body feels as you raise and lower the weights.
• Make exercise social. Joining a class or exercising in a group can help keep you motivated and make exercise an enjoyable social activity. Try joining a running club or taking stationary bike classes at a gym or YMCA. If you like healthy competition, seek out tennis partners, join a soccer league, volleyball team, or pickup basketball game. Or find a workout buddy, and afterwards have a drink or watch a game together.

Social support to treat depression in men

Strong social networks reduce isolation, which can trigger or intensify bouts of depression.

• Let your family and friends help you. Accepting help and support is not a sign of weakness. Close relationships are vital to helping you get through this tough time.
• Participate in social activities, even if you don’t feel like it. When you’re depressed, it feels more comfortable to retreat into your shell. But being around other people will make you feel less depressed.

Building a social network to beat depression in men

More than just avoiding solitude, men need to find people they can really connect with, face-to-face. That doesn’t mean simply trading jokes with a coworker or chatting about sports with the guy sitting next to you in a bar. It means finding someone you feel comfortable sharing your feelings with, someone who’ll listen to you without judging you, or telling you how you should think or feel.

For many men—especially when they’re suffering from depression—reaching out to others can seem overwhelming. Close relationships don’t happen overnight, but there are steps you can take to help you connect with others and build a solid support network.

• Join a support group for depression. Being with others who are facing the same problems can help reduce your sense of isolation and remove the stigma you may feel. It can also be inspiring to share experiences.
• Volunteering can be a great way to help others while also expanding your social network.
• Meet new people with a common interest by taking a class, joining a club, or enrolling in a special interest group that meets on a regular basis.
• Walk a dog. It’s good exercise for you and a great way to meet people. If you can’t adopt your own, ask a friend or neighbor to borrow their dog.
• Invite someone to a ballgame, movie, or concert. There are plenty of other people who feel just as awkward about reaching out and making new friends as you do. Be the one to break the ice.
• Call or email an old buddy. Even if you’ve retreated from relationships that were once important to you, make the effort to reconnect.
• Confide in a counselor, coach, or clergy member.
• Be a good listener. To develop a solid friendship with someone, be prepared to listen and support them just as you want them to listen and support you.

More tips for fighting depression in men

• Challenge negative thoughts. Make a note of every negative thought you have and what triggered it. For each negative, write down something positive. For example, “My boss hates me. He gave me this difficult report to complete” could be replaced with, “My boss must have a lot of faith in me to give me so much responsibility.”
• Postpone making important decisions. If possible, avoid making life-changing decisions before your depressed mood has lifted. It’s hard for a man to be objective when suffering from depression. Discuss potential changes with someone whose opinion you trust before changing careers, moving home, or getting divorced, for example.
• Don’t expect your mood to improve instantly. Feeling better takes time. You’ll likely begin to feel a little better each day. Many men recovering from depression notice improvements in sleep patterns and appetite before improvements in mood.

Helping a male relative or loved one with depression

It often takes a wife, partner, or other family member to recognize a man’s symptoms of depression. Even if a man suspects he’s depressed, he may be ashamed that he’s unable to cope on his own and only seek help when pressured to do so by a loved one.

Talking to a man about depression

The first step is to let him know that depression is common among men and is no way a negative reflection on his manhood. Many men don’t exhibit typical depressive symptoms—but rather anger and reckless behavior—so you may want to avoid using the word “depression” and try describing his behavior as "stressed" or "overly tired”. It could help him to open up.

• Point out how his behavior has changed, without being critical. For example, “You always seem get stomach pains before work,” or "You haven't played racquetball for months."
• Suggest a general check-up with a physician. He may be less resistant to seeing a family doctor than a mental health professional at first. A regular doctor can rule out medical causes of depression and then make a referral to someone trained in mental health for therapy or medication. Sometimes, this “professional” opinion makes all the difference for a man.
• Offer to help him find a mental health provider and go with him on the first visit. Some men are resistant to talking to a stranger about their feelings, so try to remove roadblocks to him seeking help.
• Encourage him to make a list of symptoms to discuss. Help him focus on his feelings as well as physical ailments, and to be honest about his use of alcohol and drugs.

How to offer support to a man with depression

Supporting a man with depression requires understanding, patience, affection, and encouragement.

• Engage him in conversation and listen carefully. Do not disparage the feelings he expresses, but do point out realities and offer hope.
• Do not ignore remarks about suicide. Call the National Suicide Prevention Lifeline at 1-800-273-8255 or find a suicide helpline outside the U.S. at Befrienders Worldwide.
• Invite him for walks, outings, to the movies, and other activities. Be gently insistent if your invitation is refused.
• Encourage participation in activities that once gave pleasure, such as hobbies, sports, or cultural activities, but do not push him to undertake too much too soon. He needs diversion and company, but too many demands can increase his feelings of failure.
• Do not accuse him of faking his feelings, or expect him ‘to snap out of it.’ Instead, keep reassuring him that, with time and help, he will feel better.
• You may need to monitor whether he is taking prescribed medication or attending therapy sessions. Encourage him to follow orders about the use of alcohol if he’s prescribed antidepressants.
• Remember, you can’t “fix” someone else’s depression. You’re not to blame for your loved one’s depression or responsible for his happiness. Ultimately, recovery is in his hands.

Adapted from: National Institute of Mental Health

Depression in Older Adults

Depression affects more than 19 million Americans every year, regardless of age, race, or gender.  While depression is not a normal part of the aging process, there is a strong likelihood of it occurring when other physical health conditions are present.  For example, nearly a quarter of the 600,000 people who experience a stroke in a given year will experience clinical depression.

The changes that often come in later life—retirement, the death of loved ones, increased isolation, medical problems—can lead to depression. Depression prevents you from enjoying life like you used to. But its effects go far beyond mood. It also impacts your energy, sleep, appetite, and physical health. However, depression is not an inevitable part of aging, and there are many steps you can take to overcome the symptoms, no matter the challenges you face.

Depression: a problem for many older adults and the elderly

Have you lost interest in the activities you used to enjoy? Do you struggle with feelings of helplessness and hopelessness? Are you finding it harder and harder to get through the day? If so, you’re not alone.

Depression is a common problem in older adults. The symptoms of depression affect every aspect of your life, including your energy, appetite, sleep, and interest in work, hobbies, and relationships.

Unfortunately, all too many depressed seniors fail to recognize the symptoms of depression, or don’t take the steps to get the help they need. There are many reasons depression in older adults and the elderly is so often overlooked:

• You may assume you have good reason to be down or that depression is just part of aging.
• You may be isolated—which in itself can lead to depression—with few around to notice your distress.
• You may not realize that your physical complaints are signs of depression.
• You may be reluctant to talk about your feelings or ask for help.

Feeling good as you age

Depression isn’t a sign of weakness or a character flaw. It can happen to anyone, at any age, no matter your background or your previous accomplishments in life. Similarly, physical illness, loss, and the challenges of aging don’t have to keep you down. Whether you’re 18 or 80, you don’t have to live with depression. Senior depression can be treated, and with the right support, treatment, and self-help strategies you can feel better and live a happy and vibrant life.

Causes of depression in older adults and the elderly

As you grow older, you face significant life changes that can put you at risk for depression. Causes and risk factors that contribute to depression in older adults and the elderly include:

• Health problems – Illness and disability; chronic or severe pain; cognitive decline; damage to body image due to surgery or disease.
• Loneliness and isolation – Living alone; a dwindling social circle due to deaths or relocation; decreased mobility due to illness or loss of driving privileges.
• Reduced sense of purpose – Feelings of purposelessness or loss of identity due to retirement or physical limitations on activities.
• Fears – Fear of death or dying; anxiety over financial problems or health issues.
• Recent bereavement – The death of friends, family members, and pets; the loss of a spouse or partner.

Bereavement, loss, and depression in the elderly

As you age, you experience many losses. Loss is painful—whether it’s a loss of independence, mobility, health, your long-time career, or someone you love. Grieving over these losses is normal and healthy, even if the feelings of sadness last for a long time. Losing all hope and joy, however, is not common.

Is it grief or depression?

Distinguishing between grief and clinical depression isn’t always easy, since they share many symptoms. However, there are ways to tell the difference. Remember, grief is a roller coaster. It involves a wide variety of emotions and a mix of good and bad days. Even when you’re in the middle of the grieving process, you will have moments of pleasure or happiness. With depression, on the other hand, the feelings of emptiness and despair are constant.

While there’s no set timetable for grieving, if it doesn’t let up over time or extinguishes all signs of joy—laughing at a good joke, brightening in response to a hug, appreciating a beautiful sunset—it may be depression.

Other symptoms that suggest depression, not just grief:

Intense, pervasive sense of guilt. Thoughts of suicide or a preoccupation with dying. Feelings of hopelessness or worthlessness.

Slow speech and body movements. Inability to function at work, home, and/or school. Seeing or hearing things that aren’t there.

Depression and illness in older adults and the elderly

Depression in older adults and the elderly is often linked to physical illness, which can increase the risk for depression. Chronic pain and physical disability can understandably get you down. Symptoms of depression can also occur as part of medical problems such as dementia or as a side effect of prescription drugs.

Medical conditions can cause depression in the elderly

It’s important to be aware that medical problems can cause depression in older adults and the elderly, either directly or as a psychological reaction to the illness. Any chronic medical condition, particularly if it is painful, disabling, or life-threatening, can lead to depression or make depression symptoms worse.
These include:

Parkinson’s disease stroke heart disease cancer diabetes

thyroid disorders Vitamin B12 deficiency dementia and Alzheimer’s disease lupus multiple sclerosis

Prescription medications and depression in the elderly

Symptoms of depression are a side effect of many commonly prescribed drugs. You’re particularly at risk if you’re taking multiple medications. While the mood-related side effects of prescription medication can affect anyone, older adults are more sensitive because, as we age, our bodies become less efficient at metabolizing and processing drugs.

Medications that can cause or worsen depression include:

Blood pressure medication (clonidine) Beta-blockers (e.g. Lopressor, Inderal) Sleeping pills Tranquilizers (e.g. Valium, Xanax, Halcion) Calcium-channel blockers Medication for Parkinson’s disease

Ulcer medication (e.g. Zantac, Tagamet) Heart drugs containing reserpine Steroids (e.g. cortisone and prednisone) High-cholesterol drugs (e.g. Lipitor, Mevacor, Zocor) Painkillers and arthritis drugs Estrogens (e.g. Premarin, Prempro)

If you feel depressed after starting a new medication, talk to your doctor. You may be able to lower your dose or switch to another medication that doesn’t impact your mood.

Alcohol and depression in the elderly

It can be tempting to use alcohol to deal with physical and emotional pain as you get older. It may help you take your mind off an illness or make you feel less lonely. Or maybe you drink at night to help you get to sleep.

While alcohol may make you feel better in the short term, it can cause problems over time. Alcohol makes symptoms of depression, irritability, and anxiety worse and impairs your brain function. Alcohol also interacts in negative ways with numerous medications, including antidepressants. And while drinking may help you nod off, it can impair the quality of your sleep.

Signs and symptoms of depression in the elderly

Recognizing depression in the elderly starts with knowing the signs and symptoms. Depression red flags include:

Sadness Fatigue Abandoning or losing interest in hobbies or other pleasurable pastimes Social withdrawal and isolation (reluctance to be with friends, engage in activities, or leave home) Weight loss or loss of appetite

Sleep disturbances (difficulty falling asleep or staying asleep, oversleeping, or daytime sleepiness) Loss of self-worth (worries about being a burden, feelings of worthlessness, self-loathing) Increased use of alcohol or other drugs Fixation on death; suicidal thoughts or attempts

Depression in the elderly without sadness

While depression and sadness might seem to go hand and hand, many depressed seniors claim not to feel sad at all. They may complain, instead, of low motivation, a lack of energy, or physical problems. In fact, physical complaints, such as arthritis pain or worsening headaches, are often the predominant symptom of depression in the elderly.

Depression clues in older adults

Older adults who deny feeling sad or depressed may still have major depression. Here are the clues to look for:

Unexplained or aggravated aches and pains Feelings of hopelessness or helplessness Anxiety and worries Memory problems Lack of motivation and energy

Slowed movement and speech Irritability Loss of interest in socializing and hobbies Neglecting personal care (skipping meals, forgetting meds, neglecting personal hygiene)

Dementia vs. depression in the elderly

Never assume that a loss of mental sharpness is just a normal sign of old age. It could be a sign of either depression or dementia, both of which are common in older adults and the elderly.

Since depression and dementia share many similar symptoms, including memory problems, sluggish speech and movements, and low motivation, it can be difficult to tell the two apart. There are, however, some differences that can help you distinguish between the two.

Is it Depression or Dementia?
Symptoms of Depression	Symptoms of Dementia
Mental decline is relatively rapid	Mental decline happens slowly
Knows the correct time, date, and where he or she is	Confused and disoriented; becomes lost in familiar locations
Difficulty concentrating	Difficulty with short-term memory
Language and motor skills are slow, but normal	Writing, speaking, and motor skills are impaired
Notices or worries about memory problems	Doesn’t notice memory problems or seem to care

Whether cognitive decline is caused by dementia or depression, it’s important to see a doctor right away. If it’s depression, memory, concentration, and energy will bounce back with treatment. Treatment for dementia will also improve you or your loved one’s quality of life. And in some types of dementia, symptoms can be reversed, halted, or slowed.

Depression self-help for older adults and the elderly

It’s a myth to think that after a certain age you can’t learn new skills, try new activities, or make fresh lifestyle changes. The truth is that the human brain never stops changing, so older adults are just as capable as younger people of learning new things and adapting to new ideas. Overcoming depression often involves finding new things you enjoy, learning to adapt to change, staying physically and socially active, and feeling connected to your community and loved ones.

If you’re depressed, you may not want to do anything or see anybody. But isolation and inactivity only make depression worse. The more active you are—physically, mentally, and socially—the better you’ll feel.

• Exercise. Physical activity has powerful mood-boosting effects. In fact, research suggests it may be just as effective as antidepressants in relieving depression. The best part is that the benefits come without side effects. You don’t have to hit the gym to reap the rewards. Look for small ways you can add more movement to your day: park farther from the store, take the stairs, do light housework, or enjoy a short walk. Even if you’re ill, frail, or disabled, there are many safe exercisesyou can do to build your strength and boost your mood—even from a chair or wheelchair.
• Connect with others. Getting the support you need plays a big role in lifting the fog of depression and keeping it away. On your own, it can be difficult to maintain perspective and sustain the effort required to beat depression. You may not feel like reaching out, but make an effort to connect to others and limit the time you’re alone. If you can’t get out to socialize, invite loved ones to visit you, or keep in touch over the phone or email.
• Bring your life into balance. If you’re feeling overwhelmed by stress and the pressures of daily life, it may be time to learn new emotional management and emotional intelligence skills. Watch the short video clip and consider following Helpguide’s free Bring Your Life Into Balance toolkit.

Depression treatment options for older adults and the elderly

Depression treatment is just as effective for elderly adults as it is for younger people.

However, since depression in older adults and the elderly is often the result of a difficult life situation or challenge, any treatment plan should address that issue. If loneliness is at the root of your depression, for example, medication alone is not going to cure the problem.

Also, any medical issues complicating the depression must be also be addressed.

Antidepressant treatment for older adults and the elderly

Older adults are more sensitive to drug side effects and vulnerable to interactions with other medicines they’re taking.

Recent studies have also found that SSRIs such as Prozac can cause rapid bone loss and a higher risk for fractures and falls. Because of these safety concerns, elderly adults on antidepressants should be carefully monitored.

In many cases, therapy and/or healthy lifestyle changes, such as exercise, can be as effective as antidepressants in relieving depression, but without the dangerous side effects.

Alternative medicine for depression in older adults and the elderly

Herbal remedies and natural supplements can also be effective in treating depression, and in most cases, are much safer for older adults than antidepressants. However, some herbal supplements may cause interactions with certain medications or occasionally carry side effects, so always check with your doctor before taking them.

• Omega-3 fatty acids may boost the effectiveness of antidepressants or work as a standalone treatment for depression.
• St. John’s wort can help with mild or moderate symptoms of depression but should not be taken with antidepressants.
• Folic acid can help relieve symptoms of depression when combined with other treatments.
• SAMe may be used in place of antideppresants to help regulate mood, but in rare cases can cause severe side effects.

Counseling and therapy for older adults and the elderly

Therapy works well on depression because it addresses the underlying causes of the depression, rather than just the symptoms.

• Supportive counseling includes religious and peer counseling. It can ease loneliness and the hopelessness of depression, and help you find new meaning and purpose.
• Therapy helps you work through stressful life changes, heal from losses, and process difficult emotions. It can also help you change negative thinking patterns and develop better coping skills.
• Support groups for depression, illness, or bereavement connect you with others who are going through the same challenges. They are a safe place to share experiences, advice, and encouragement.

Helping a depressed senior

The very nature of depression interferes with a person's ability to seek help, draining energy and self-esteem. For depressed seniors, raised in a time when mental illness was highly stigmatized and misunderstood, it can be even more difficult—especially if they don’t believe depression is a real illness, are too proud or ashamed to ask for assistance, or fear becoming a burden to their families.

If an elderly person you care about is depressed, you can make a difference by offering emotional support. Listen to your loved one with patience and compassion. Don’t criticize feelings expressed, but point out realities and offer hope. You can also help by seeing that your friend or family member gets an accurate diagnosis and appropriate treatment. Help your loved one find a good doctor, accompany him or her to appointments, and offer moral support.

Other tips for helping a depressed elderly friend or relative:

• Invite your loved one out. Depression is less likely when people’s bodies and minds remain active. Suggest activities to do together that your loved one used to enjoy: walks, an art class, a trip to the museum or the movies—anything that provides mental or physical stimulation.
• Schedule regular social activities. Group outings, visits from friends and family members, or trips to the local senior or community center can help combat isolation and loneliness. Be gently insistent if your plans are refused: depressed people often feel better when they’re around others.
• Plan and prepare healthy meals. A poor diet can make depression worse, so make sure your loved one is eating right, with plenty of fruit, vegetables, whole grains, and some protein at every meal.
• Encourage the person to follow through with treatment. Depression usually recurs when treatment is stopped too soon, so help your loved one keep up with his or her treatment plan. If it isn’t helping, look into other medications and therapies.
• Make sure all medications are taken as instructed. Remind the person to obey doctor's orders about the use of alcohol while on medication. Help them remember when to take their dose.
• Watch for suicide warning signs. Seek immediate professional help if you suspect that your loved one is thinking about suicide.