Depression - older adults
Depression in the elderly
Depression is a mental health condition. It is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with daily life for weeks or longer.
Depression in older adults is a widespread problem, and it is not a normal part of aging. It is often not recognized or treated.
The elderly are at high risk for depression because they are more likely than younger people to have experienced illness, death of loved ones, impaired function and loss of independence. The cumulative effect of negative life experiences may be overwhelming to an older person.
Causes
In older adults, life changes can increase the risk for depression or make existing depression worse. Some of these changes are:
- A move from home, such as to a retirement facility
- Chronic illness or pain
- Children moving away
- Spouse or close friends passing away
- Loss of independence (for example, problems getting around or caring for oneself, or loss of driving privileges)
Depression can also be related to a physical illness, such as:
- Thyroid disorders
- Parkinson disease
- Heart disease
- Cancer
- Stroke
- Dementia (such as Alzheimer disease)
Overuse of alcohol or certain medicines (such as sleep aids) can make depression worse.
If you often feel sad, blue, unhappy, miserable, or down in the dumps, you may have depression. Let's talk about depression, and what you can do to get out of your funk. Depression often runs in families. This may be due to your genes, passed down by your parents and grandparents, the behaviors you learn at home, or both. Even if your genetic makeup makes you more likely to develop depression, a stressful or unhappy life event may triggers the depression. Depression can have many causes, including internal factors like genetics, or negative personality. External factors, substance misuse, or trauma and loss. Common triggers include alcohol or drug use, and medical problems long-term pain, cancer or even sleeping problems. Stressful life events, like getting laid off, abuse at home or on the job, neglect, family problems, death of a loved one, or divorce, can send someone spiraling into depression. There are three main types of depression; major depression, atypical depression and dysthymia. To be diagnosed with major depression, you must demonstrate 5 or more of the primary symptoms for at least two weeks. Atypical depression occurs in about a third of patients with depression, with symptoms including overeating, oversleeping, and feeling like you are weighed down. Dysthymia is a milder form of depression that can last for years if not treated. Other forms include the depression that is part of bipolar disorder, postpartum depression, occurring after a woman gives birth, premenstrual dysphoric disorder, occurring 1 week before a woman's menstrual period and seasonal affective disorder, occurring in both males and females during the fall and winter seasons. No matter what type of depression you have and how severe it is, some self-care steps can help. Get enough sleep if you can, exercise regularly, and follow a healthy, nutritious diet. Avoid alcohol and recreational drugs. Get involved in activities that make you happy and spend time with family and friends. If you are religious, talk to a clergy member. Consider meditation, tai chi, or other relaxation methods. If you are depressed for 2 weeks or longer, contact your doctor or other health professional before your symptoms get worse. Treatment will depend on your symptoms. For mild depression, counseling and self-care may be enough. Either psychotherapy or antidepressant medicines may help, but they are often more effective when combined. Vigorous exercise and light therapy could offer significant benefit alone or in combination. Healthy lifestyle habits can help prevent and treat depression, and reduce the chances of it coming back. Talk therapy and antidepressant medication can also make you less likely to become depressed again. In fact, talk therapy may help you through times of grief, stress, or low mood. In general, staying active, making a difference in the life of others, getting outside and keeping in close contact with other people is important for preventing depression.
Symptoms
Many of the usual symptoms of depression may be seen. However, depression in older adults may be hard to detect. Common symptoms such as fatigue, appetite loss, and trouble sleeping can be part of the aging process or a physical illness. As a result, symptoms of early depression may be ignored, or confused with other conditions that are common in older adults.
Exams and Tests
The health care provider will perform a physical exam. Questions will be asked about medical history and symptoms.
Blood and urine tests may be done to look for a physical illness.
A mental health specialist may be needed to help with diagnosis and treatment.
Treatment
The first steps of treatment are to:
- Treat any illness that may be causing the symptoms.
- Stop taking any medicines that may be making symptoms worse.
- Avoid alcohol and sleep aids.
If these steps do not help, medicines to treat depression and talk therapy often help.
Doctors often prescribe lower doses of antidepressants to older people, and increase the dose more slowly than in younger adults.
To better manage depression at home:
- Exercise regularly, if the provider says it is OK.
- Surround yourself with caring, positive people and do fun activities.
- Learn good sleep habits.
- Learn to watch for the early signs of depression, and know how to react if these occur.
- Drink less alcohol and do not use illegal drugs.
- Talk about your feelings with someone you trust.
- Take medicines correctly and discuss any side effects with the provider.
Outlook (Prognosis)
Depression often responds to treatment. The outcome is usually better for people who have access to social services, family, and friends who can help them stay active and engaged.
The most worrisome complication of depression is suicide. Men make up most suicides among older adults. Divorced or widowed men are at the highest risk.
Families should pay close attention to older relatives who are depressed and who live alone.
When to Contact a Medical Professional
Contact your provider if you keep feeling sad, worthless, or hopeless, or if you cry often. Also call if you're having trouble coping with stresses in your life and want to be referred for talk therapy.
If you are caring for an aging family member and think they may have depression, contact their provider.
If you or someone you know is thinking about suicide, call or text 988 or chat
You can also call 911 or the local emergency number or go to the hospital emergency room. DO NOT delay.
If someone you know has attempted suicide, call 911 or the local emergency number right away. DO NOT leave the person alone, even after you have called for help.
References
Fox C, Hameed Y, Maidment I, Laidlaw K, Hilton A, Kishita N. Mental illness in older adults. In: Fillit HM, Rockwood K, Young J, eds. Brocklehurst's Textbook of Geriatric Medicine and Gerontology. 8th ed. Philadelphia, PA: Elsevier; 2017:chap 56.
National Institute on Aging website. Depression and older adults.
Siu AL; US Preventive Services Task Force (USPSTF), Bibbins-Domingo K, et al. Screening for depression in adults: US Preventive Services Task Force recommendation statement. JAMA. 2016;315(4):380-387. PMID: 26813211
Version Info
Last reviewed on: 7/28/2022
Reviewed by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
