When Elders Get Depressed: It's Not Just "Old Age"
by Mary Mihaly and Jacquelyn Rudis
We look forward to our later years as a time for plenty of traveling, reflecting, playing with grandkids, volunteering, not to mention spending our hard-earned retirement savings!
Sadly, some older people develop depression during their "golden years." Since depression is more serious than simply feeling a little down once in a while, it is important that older adults are properly diagnosed and treated. The fact that depression can lead to suicide really highlights the importance of getting treatment for this common mood disorder.
Why Older People Become Depressed TOP
Hormonal Changes
One important reason older people experience depression is related to hormonal changes. Depression may be a symptom of low thyroid hormone levels, a common problem in the older population. Elderly depression occurs in both men and women.
In men, testosterone levels decline over time as a normal part of aging. Testosterone is a hormone involved in many bodily functions. Low testosterone can bring on fatigue and depressive symptoms.
In women, deficiencies in the hormones progesterone and estrogen, both of which decrease with menopause, can be linked to depression.
Some researchers believe that another problem in both elderly men and women is a reduction in DHEA, a steroid hormone that is an important building block for testosterone and estrogen. Levels of DHEA in the elderly are the lowest of any age group. Researchers continue to study the potential role that DHEA may play in the treatment of depression.
Other Factors
A number of other physical causes—medications, loss of function due to arthritis, heart disease, osteoporosis, lack of physical activity, even dietary deficiencies—can also cause or contribute to depression. In addition, depression can be situational, developing from isolation, financial worries, loss of a loved one, or retirement.
Why Depression Remains Undiagnosed and Untreated TOP
Many people assume that symptoms like sleep disturbances, mood changes, and loss (or increase) in appetite, are simply a part of growing old. Doctors may also dismiss these symptoms without realizing that depression may be the underlying condition. In addition, depression can sometimes be confused for dementia, so the correct treatment plan is not put in place.
There are other reasons why depression may go unrecognized in older people. Mental illness can carry a social stigma. This stigma may make some people feel ashamed to admit that they are struggling with depression and not seek the help that they need. In other cases, budget cuts may reduce the kinds of services that are available for the elderly so that there are not enough qualified professionals to diagnose and treat depression.
In fact, the United States Preventive Services Task Force (USPSTF) does recommend that all adults are screened for depression. The USPSTF emphasizes that there should be a professional on staff to assist with the diagnosis and treatment. This is important because if you do have depression your condition will need to be monitored to make sure that your symptoms are improving.
How to Tell If Someone Is Depressed TOP
Depression can be diagnosed with a combination of these common symptoms. If you have any of them for at least 2 weeks, see your doctor for a mental health evaluation:
- Depressed mood, irritability
- Decreased interest or pleasure in most activities
- Significant weight loss or weight gain
- Significant change in sleeping patterns
- Moving more slowly than normal
- Fatigue, loss of energy
- Indecision or inability to think clearly
- Feelings of worthlessness or guilt
Older adults with depression may also have:
- Memory problems
- Confusion
- Delusions or hallucinations
- Feeling pain without any medical cause
- Persistent and vague complaints
- Demanding behavior
If you have suicidal thoughts, which is another symptom of depression, call for emergency medical services right away.
Keep in mind that other conditions with similar symptoms would need to be ruled out before making a definite diagnosis.
How Treatment Can Help TOP
Discuss treatment options with your doctor. It may be recommended that you do one or more of the following:
Medication
People with major depression often respond well to antidepressants. Before taking an antidepressant drug, a doctor will consider all aspects of the the person's health and prescribe the drug least likely to cause any serious side effects. Low doses are initially prescribed to allow the body to adjust to the medication. In older adults, it may take many weeks for a drug to produce noticeable results.
Like many medications, antidepressants have side effects that sometimes restrict their use with older people. Side effects range from minor ones, such as a dry mouth, to the more serious, such as a drop in blood pressure. However, there are several drugs that are well-tolerated by older adults that may cause little or no side effects.
Therapy
There are many different approaches to therapy. Often therapy with older people is problem-oriented, focusing on helping people deal with immediate issues, such as the loss of a loved one, a change in residence, or retirement. Other approaches can focus on making behavioral changes, such as learning to adopt new views on life or restructuring daily activities. Family therapy may also be helpful in assisting older people and their children when dealing with unrealistic expectations, guilt, and unresolved issues. Other types of therapy that may be helpful in older adults include:
- Cognitive behavioral therapy—focuses on thoughts, feelings, and behaviors
- Interpersonal psychotherapy—short-term type of therapy that focuses on relationships
- Psychodynamic therapy—focuses on gaining self-awareness by facing unresolved issues
Lifestyle Changes TOP
In addition to medication and/or therapy, eating a balanced diet and getting regular exercise can help relieve depressive symptoms.
Take some time to look over medications you or a loved one may be taking. It is possible that some are counteracting one another. This may indicate that they can be changed or eliminated.
Depression Can Be Successfully Treated in the Elderly TOP
Older adults with depression can improve when they are treated with medication, therapy, or a combination of both. Coexisting medical conditions also tend to improve when depression is treated. Depression is an illness that can be successfully managed in people of all ages.
RESOURCES:
Depression and Bipolar Support Alliance
http://www.ndmda.org
Senior Health—National Institutes of Health
http://nihseniorhealth.gov
CANADIAN RESOURCES:
Canadian Mental Health Association
http://www.ontario.cmha.ca
Canadian Psychiatric Association
http://www.cpa-apc.org
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Last reviewed February 2017 by Michael Woods, MD, FAAP
Last Updated: 2/11/2015