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A Guide to Mental Wellness in Older Age: Recognizing and Overcoming Depression

Am I Depressed?

Everyone has experienced a period of sadness during his or her lifetime. Sometimes these feelings of sadness are in response to something that has happened such as the loss of a loved one or a difficult time at home. But, there is a difference between feeling sad in response to a life event and experiencing a clinical depression. Depression is not just “feeling blue” or feeling grief after a loss. Depression is a feeling of sadness that lasts for many weeks and does not go away. Depression interferes with your daily activities and often includes changes in sleep, changes in appetite, and a general loss of energy.

Depression is a common illness that affects millions of Americans each year, but it is a treatable illness. Depression is not a personal weakness. You cannot develop depression from reading sad stories or catch it from someone else. Depression is caused by an imbalance in brain chemicals called neurotransmitters. Men and women of all ages, genders, races, ethnic groups, and economic status can experience depression. Famous people including actors, successful business people, and politicians have spoken out about their experiences with late-life depression.

The symptoms of depression in older persons differ from those experienced by young persons or those in midlife. The signs that an older person may be suffering from depression include the inability to sleep, memory problems, confusion, withdrawal from social situations, and irritability. People in their later years are less likely to appear sad or talk about a depressed mood. This is partly because depression feels different to a person in late life and also partly because an older depressed person will often not talk about symptoms of sadness. Sometimes the most common symptom of depression in an older adult is persistent complaints about vague aches and pains along with frequent demanding behavior.

There is evidence that depression can run in families and that the risk of depression can be passed from parents to children. However, it is not known yet how genetic factors work or how important they are. Other risk factors for late-life depression include gender (women are more likely to suffer from late-life depression than men), being single (especially widowed), and lack of friends (living alone at home with few outside contacts with other people).

As we age, there are life events that can trigger a clinical depression. Physical health conditions such as heart attack, stroke, hip fracture, bypass surgery, and macular degeneration are often associated with the development of depression. Hormonal changes in women have been shown to trigger depression. Increased alcohol or drug use (including over-the-counter medications) may lead to a clinical depression. Certain medications prescribed by your physician or a combination of medications can cause a clinical depression. Medicines prescribed for pain, high blood pressure, and arthritis; hormonal treatments; and tranquilizers can result in a change in brain chemicals to trigger a clinical depression.

The loss of a loved one may lead to a depression. Most individuals grieve when a loved one dies, but if that grief becomes profound and lasts a long period of time, it can evolve into a clinical depression that requires treatment.

Symptoms of Depression

Symptoms of depression usually last over two weeks.

  • Disturbed sleep (sleeping too much or too little)
  • Changes in appetite (weight loss or gain)
  • Physical aches and pains
  • Lack of energy or motivation
  • Irritability and intolerance
  • Loss of interest or pleasure
  • Feelings of worthlessness or guilt
  • Difficulties with concentration or decision making
  • Noticeable restlessness or slow movement
  • Recurring thoughts of death or suicide
  • Changed sex drive

 

Risk Factors for Late-Life Depression

  • Changes in medications or newly prescribed medications for other illnesses
  • Recent loss of a loved one
  • Presence of another illness or after a stroke, bypass operation, or hip fracture
  • Severe and chronic pain
  • Living alone and feeling socially isolated
  • Hormonal changes
  • Family history of depression
  • Alcohol or drug abuse or misuse

 

If you have become worried that you feel “low” or your changes in sleep patterns are disrupting your normal activities, you should seek help. Some of your friends may have told you that your feelings are normal for someone your age, or that depression is expected as you experience physical limitations in life. This is not true. Depression is not a normal function of aging. When you feel depressed over a period of time, it is time to seek treatment.

You don’t have to experience all of the symptoms of depression to have depression—people experience depression differently. One person may lack energy or motivation, sleep excessively, and gain weight. Another person may become anxious and lose sleep. Older adults usually experience more problems with sleep and are less likely to have a depressed mood or guilty preoccupation (that is common in younger persons with depression).

If you have thoughts of suicide or death, contact someone immediately, whether it be a medical professional, a spiritual advisor or a loved one. The most important thing to remember about suicidal thoughts is that they are symptoms due to the chemistry of your brain—they are not signs of personal weakness nor will they go away by themselves. Don’t let embarrassment stand in the way of communicating how you feel.

Geriatric Depression Scale (Short Form)

The Geriatric Depression Scale (GDS) is a screening tool designed specifically for older adults who may need further evaluation for depression. It is a valuable and reliable measurement tool used in clinical practice and research programs. If you suspect you are suffering from depression, you can answer the questions yourself. If you have a score of five or more points, you should contact your health care provider for further evaluation.

Instructions: Choose the best answer for how you have felt over the past week.

    YES NO
1. Are you basically satisfied with your life?    
2 Have you dropped many of your activities and interests?    
3 Do you feel that your life is empty?    
4 Do you often get bored?    
5 Are you in good spirits most of the time?    
6 Are you afraid that something bad is going to happen to you?    
7 Do you feel happy most of the time?    
8 Do you often feel helpless?    
9 Do you prefer to stay at home, rather than going out and doing things?    
10 Do you feel that you have more problems with memory than most?    
11 Do you think it is wonderful to be alive now?    
12 Do you feel worthless the way you are now?    
13 Do you feel full of energy?    
14 Do you feel that your situation is hopeless?    
15 Do you think that most people are better off than you are?    
       
  Scoring: Score one point if you answered NO to Questions 1, 5 7, 11, 13. Score one point if you answered YES to Questions 2, 3, 4, 6, 8, 9, 10, 12, 14, 15. Total your points.    
  TOTAL    

 

Author: Jerry Yesavage, M.D., Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center. Reference: Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey MB, Leirer VO: Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research. 17: 37-49, 1983.

A Guide to Mental Wellness in Older Age: Recognizing and Overcoming Depression

© Geriatric Mental Health Foundation 2004
7910 Woodmont Avenue, Suite 1050
Bethesda, Maryland 20814
301.654.7850
info@GMHFonline.org
www.GMHFonline.org

Expert assistance was provided by Lissy F. Jarvik, M.D., Professor Emerita of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, School of Medicine; Susan Lieff, M.D., M.Ed., Assistant Professor, Department of Psychiatry, University of Toronto; and Stephen J. Bartels, M.D., M.S., Associate Professor of Psychiatry, Dartmouth Medical School.

The Geriatric Mental Health Foundation grants permission to print, photocopy, and distribute this material. Please cite the Foundation, including the address, phone and website.