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.