The implications of depression on seniors are especially profound, because depression can hasten cognitive decline, hinder self-care, and exacerbate illness.

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Depression affects more than 6.5 million people ages 65 and older in the U.S., according to the National Alliance on Mental Illness. That number rises dramatically among elderly people who are hospitalized—demonstrating the effect significant illness can have on mental health.

Causes | Symptoms | Diagnosis | Treatment

Causes of Depression in the Elderly

In our youth-obsessed culture, it is no surprise that growing old is difficult for many. It can introduce several new stresses in life, such as watching children grow independent and move away, watching a spouse or close friend become sick and die, or losing independence.

More often than in younger people, depression may be caused by an underlying biological disease process (or its treatment) in the elderly. With age comes an increased risk of medical conditions that affect brain functioning, such as stroke and cognitive decline.

In fact, cognitive decline, or dementia, and depression are intimately intertwined in older people. The symptoms of each can be difficult to tease apart, and one condition frequently aggravates the other. Recent research reveals that depression experienced in mid-and late-life is linked with an increased risk of developing dementia in older age, and depression in older age is associated with the presence of both mild cognitive impairment and dementia.

Symptoms of Depression in the Elderly

As with children, depression may not reveal itself in the elderly the same way it does with younger adults. Among the elderly, depression often manifests as:

• confusion
• difficulty sleeping
• hallucinations or delusions
• loss of appetite and weight loss
• memory problems
• social isolation
• vague physical complaints.

The notion that low mood is a normal part of aging is a misperception that leads to many missed opportunities for diagnosis and effective treatment.

Diagnosing Depression in the Elderly

Elderly people are more likely to suffer from neurological and other health changes that occur with age, such as stroke, that can act as biological causes of depression. As a result, an evaluation of depression in older people may be more likely to focus on tests of physical health, particularly neurological health. Tests of memory and other types of cognitive functioning are a common practice, for instance.

Another important component of diagnosing depression in the elderly is to look at what medications they are taking. Some elderly people take a dozen or more different drugs, and any one of them may have depression or some of its symptoms as a side effect. Often, a simple medication adjustment is all that is needed to get someone back to their old selves.

Treating Depression in the Elderly

The implications of depression on seniors are especially profound because depression can hasten cognitive decline, hinder self-care, and exacerbate illness. It also can increase the risk for suicide among the elderly. Older white men face the highest suicide rate of any group in the U.S. As a result, it is important to get treatment right.

The first step to treating depression in the elderly is to make sure there is no underlying condition producing the symptoms that has been overlooked, such as a mini-stroke (a stroke that produces symptoms so mild that it may not be diagnosed immediately). The next step is to make sure medication adjustments are made, as needed, if it is thought that drugs being taken for other conditions are contributing to depressive symptoms.

Elderly people can be treated for depression in a similar manner as younger adults, but one must be careful with medication. “Start low and go slow” is the typical mantra in this sensitive population. Older people often do not metabolize drugs as well as they once did, so they often require lower doses. They are more susceptible to side effects, and they may be taking other medications that can interact with drugs for depression. The presence of a potential drug-drug interaction does not always mean that a particular drug cannot be taken at all; it means one must be careful with it and look closely for undesirable effects.

For more information about depression, purchase the report, Overcoming Depression by the editors of Mind, Mood, and Memory.