Depression in Late Life: Not A Natural Part Of
Initiative on Depression in Late Life
EVERYONE FEELS SAD OR BLUE SOMETIMES.
It is a natural part of life. But when the sadness
persists and interferes with everyday life, it may
be depression. Depression is not a normal part of growing
older. It is a treatable medical illness, much like
heart disease or diabetes.
Depression is a serious illness affecting approximately 15 out of every 100
adults over age 65 in the United States. The disorder affects a much higher
percentage of people in hospitals and nursing homes. When depression occurs
in late life, it sometimes can be a relapse of an earlier depression. But when
it occurs for the first time in older adults, it usually is brought on by another
medical illness. When someone is already ill, depression can be both more difficult
to recognize and more difficult to endure.
DEPRESSION IS NOT A PASSING MOOD.
Sadness associated with normal grief or everyday "blues" is
different from depression. A sad or grieving person
can continue to carry on with regular activities. The
depressed person suffers from symptoms that interfere
with his or her ability to function normally for a
prolonged period of time.
Recognizing depression in the elderly is not always easy. It often is difficult
for the depressed elder to describe how he or she is feeling. In addition,
the current population of older Americans came of age at a time when depression
was not understood to be a biological disorder and medical illness. Therefore,
some elderly fear being labeled "crazy," or worry that their illness
will be seen as a character weakness.
The depressed person or their family members may think that a change in mood
or behavior is simply "a passing mood," and the person should just "snap
out of it." But someone suffering from depression can not just "get
over it." Depression is a medical illness that must be diagnosed and treated
by trained professionals. Untreated, depression may last months or even years.
UNTREATED DEPRESSION CAN:
- lead to disability
- worsen symptoms of other illnesses
- lead to premature death
- result in suicide.
When it is properly diagnosed and treated, more than
80 percent of those suffering from depression recover
and return to their normal lives.
The most common symptoms
of late-life depression include:
- persistent sadness (lasting two weeks or more)
- feeling slowed down
- excessive worries about finances and health problems
- frequent tearfulness
- feeling worthless or helpless
- weight changes
- pacing and fidgeting
- difficulty sleeping
- difficulty concentrating
- physical symptoms such as pain or gastrointestinal
One important sign of depression is when people withdraw
from their regular social activities. Rather than explaining
their symptoms as a medical illness, often depressed
persons will give different explanations such as:
It's too much trouble,"
" I don't feel well enough," or
" I don't have the energy."
For the same reasons, they often neglect their personal appearance, or may
begin cooking and eating less. Like many illnesses, there are varying levels
and types of depression. A person may not feel "sad" about anything,
but may exhibit symptoms such as difficulty sleeping, weight loss, or physical
pain with no apparent explanation. This person still may be clinically depressed.
Those same symptoms also may be a sign of another problem -- only a doctor
can make the correct diagnosis.
IT CAN HAPPEN TO ANYONE.
Sometimes depression will occur for no apparent reason.
In other words, nothing necessarily needs to "happen" in
one's life for depression to occur. This can be because
the disease often is caused by biological changes in
the brain. However, in older adults, there usually
are understandable reasons for the depression. As the
brain and body age, a number of natural bio-chemical
changes begin to take place. Changes as the result
of aging, medical illnesses or genetics may
put the older adult at a greater risk for developing depression.
Chronic or serious illness is the most common cause
of depression in the elderly. But even when someone
is struggling with a chronic illness such as arthritis,
it is not natural to be depressed. Depression is defined
as an illness if it lasts two weeks or more and if
it affects one's ability to lead a normal life.
Many factors can contribute to the development of
depression. Often people describe one specific event
that triggered their depression, such as the death
of a partner or loved one, or the loss of a job through
layoff or retirement. What seems like a normal period
of sadness or grief may lead to a prolonged, intense
grief that requires medical attention.
The loss of a life-long partner or a friend is a frequent
occurrence in later life. It is normal to grieve after
such a loss. But it may be depression rather than bereavement
if the grief persists, or is accompanied by any of
the following symptoms:
- guilt unconnected with the loved one's death
- thoughts of one's own death
- persistent feelings of worthlessness
- inability to function at one's usual level
- difficulty sleeping
- weight loss.
If any of these symptoms are triggered by a loss,
a physician should be consulted.
Changes in the older adult's sensory abilities or
environment may contribute to the development of depression.
Examples of such changes include:
- changes in vision and hearing
- changes in mobility
- moving from the family home
- neighborhood changes
In the older population, medical illnesses are a common
trigger for depression, and often depression will worsen
the symptoms of other illnesses. The following illnesses
are common causes of late-life depression:
- Parkinson's disease
- heart disease
- Alzheimer's disease.
In addition, certain medical illnesses may hide the
symptoms of depression. When a depressed person is
preoccupied with physical symptoms resulting from a
stroke, gastrointestinal problems, heart disease or
arthritis, he or she may attribute the depressive symptoms
to an existing physical illness, or may ignore the
symptoms entirely. For this reason, he or she may not
report the depressive symptoms to his or her doctor,
creating a barrier to becoming well.
DEPRESSION IS TREATABLE
Most depressed elderly people can improve dramatically
from treatment. In fact, there are highly effective
treatments for depression in late life. Common treatments
prescribed by physicians include:
- antidepressant medications
- electroconvulsive therapy (ECT).
Psychotherapy can play an important role in the treatment
of depression with, or without, medication. This type
of treatment is most often used alone in mild to moderate
depression. There are many forms of short-term therapy
(10-20 weeks) that have proven to be effective. It
is important that the depressed person find a therapist
with whom he or she feels comfortable and who has experience
with older patients.
Antidepressants work by increasing the level of neurotransmitters
in the brain. Neurotransmitters are the brain's "messengers." Many
feelings, including pain and pleasure, are a result
of the neurotransmitters' function. When the supply
of neurotransmitters is imbalanced, depression may
A frequent reason some people do not respond to antidepressant
treatment is because they do not take the medication
properly. Missing doses or taking more than the prescribed
amount of the medication compromises the effect of
the antidepressant. Similarly, stopping the medication
too soon often results in a relapse of depression.
In fact, most patients who stop taking their medication
before four to six months after recovery will experience
a relapse of depression.
Usually, antidepressant medication is taken for at least six months to a year.
Typically, it takes four to 12 weeks to begin seeing results from antidepressant
medication. If after this period of time the depression does not subside, the
patient should consult his or her physician. Antidepressant drugs are not habit-forming
or addictive. And because depression is often a recurrent illness, it usually
is necessary to stay on the medication for six months after recovery to prevent
new episodes of depression.
Electroconvulsive therapy (ECT) is a treatment that
unnecessarily evokes fear in many people. In reality,
ECT is one of the most safe, fast-acting and
effective treatments for severe depression. It can be life saving. ECT often
is the best choice for the person who has a life-threatening depression that
is not responding to antidepressant medication or for the person who cannot
tolerate the medication.
After a thorough evaluation, a physician will determine
the treatment best suited for a person's depression.
The treatment of depression demands patience
and perseverance for the patient and the physician. Sometimes several different
treatments must be tried before full recovery. Each person has individual
biological and psychological characteristics that require individualized
Suicide is more common in older people than in any
other age group. The population over age 65 accounts
for more than 25 percent of the nation's suicides.
In fact, white men over age 80 are six times more likely
to commit suicide than the general population, constituting
the largest risk group. Suicide attempts or severe
thoughts or wishes by older adults must always be taken
It is appropriate and important to ask a depressed person:
- Do they feel as though life is no longer an option
- Have they had thoughts about harming themselves?
- Are they planning to do it?
- Is there a collection of pills or guns in the
- Are they often alone?
Most depressed people welcome care, concern and support,
but they are frightened and may resist help. In the
case of a potentially suicidal elder, caring friends
or family members must be more than understanding.
They must actively intervene by removing pills and
weapons from the home and calling the family physician,
mental health professional or, if necessary, the police.
CARING FOR A DEPRESSED PERSON
The first step in helping an elderly person who may
be depressed is to make sure he or she gets a complete
physical checkup. Depression may be a side effect of
a pre-existing medical condition or of a medication.
If the depressed older adult is confused or withdrawn,
it is helpful for a caring family member or friend
to accompany the person to the doctor and provide important
The physician may refer the older adult to a psychiatrist with geriatric training
or experience. If a person is reluctant to see a psychiatrist, he or she may
need assurance that an evaluation is necessary to determine if treatment is
needed to reduce symptoms, improve functioning and enhance well-being.
It is important to remember that depression is a highly treatable medical condition
and is not a normal part of growing older. Therefore, it is crucial to understand
and recognize the symptoms of the illness. As with any medical condition, the
primary care physician should be consulted if someone has symptoms that interfere
with everyday life. An older person who is diagnosed with depression also should
know that there are trained professionals who specialize in treating the elderly
(called "geriatric psychiatrists") who may be able to help.
The American Association for Geriatric Psychiatry
(AAGP) is a national professional organization of geriatric
psychiatrists. AAGP's 2,000 members are the leading
researchers, educators and clinical practitioners in
the areas of late-life depression, dementia, schizophrenia,
psychosis, anxiety and sleep disorders and other mental
health disorders affecting the elderly.
WHERE TO GO FOR HELP:
Geriatric Mental Health Foundation
7910 Woodmont Avenue
Bethesda, MD 20814
American Association for Geriatric Psychiatry
7910 Woodmont Avenue
Bethesda, MD 20814
American Association of Retired Persons
601 E Street, NW
Washington, DC 20049
National Mental Health Association
2001 N. Beauregard St., 12th Floor
Alexandria, VA 22311
National Alliance for the Mentally Ill
Colonial Place Three
2107 Wilson Blvd., Suite 300
Arlington, VA 22201-3042
Depression and Bipolar Support Alliance
730 N. Franklin, Suite 501
Chicago, II 60610
National Institute of Mental Health - Public Inquiries
6001 Executive Blvd.
Room 8184, MSC 9663
Bethesda, MD 20892-9663
(866) 615-6464 (toll-free)
American Geriatrics Society
The Empire State Building
350 Fifth Avenue, Suite 801
New York, NY 10118