The difficult changes that many older adults face-such as the death of a spouse, loss of independence, and health problems-can lead to depression, especially in those without a strong support system. But depression is NOT a normal or necessary part of aging.

Depression symptoms such as aches and pains and fatigue are often overlooked in the elderly. This is dangerous, because depression increases the risk of illness, death, and suicide. Learning how to spot and treat depression in older adults can help you and your loved ones remain happy and vibrant in the golden years.

What causes depression in the elderly?

The many possible causes for depression in the elderly come from many different sources. Examples include:

Psychological factors

• unresolved, repressed traumatic experiences from childhood or later life may surface when a senior slows down
• previous history of depression
• damage to body image (from amputation, cancer surgery, or heart attack)
• fear of death
• frustration with memory loss
• difficulty adjusting to stressful or changing conditions (i.e., housing and living conditions, loss of loved ones or friends, loss of capabilities, etc.)
• substance abuse

Environmental factors

• loneliness, isolation
• retirement (whether the individual has chosen to stop working, been laid off, or been forced to stop because of chronic health problems or a disability)
• being unmarried (especially if widowed)
• recent bereavement
• lack of a supportive social network
• decreased mobility due to illness or loss of driving privileges

Physical factors, including genetics

• inherited tendencies toward depression
• co-occurring illness (such as Parkinson's, Alzheimer's, cancer, diabetes or stroke)
• vascular changes in the brain
• a vitamin B-12 deficiency (as yet unclear if this is caused by poor eating habits or a result of depression)
• chronic or severe pain

Personality characteristics (may also be symptomatic of unresolved trauma)

• low self-esteem
• extreme dependency
• pessimism

Medications (all medications have side effects, but some can cause or worsen the symptoms of depression)

• some pain medicines (codeine, darvon)
• some drugs for high blood pressure (clonidine, reserpine)
• hormones (estrogen, progesterone, cortisol, prednisone, anabolic steroids)
• some heart medications (digitalis, propanalol)
• anticancer agents (cycloserine, tamoxifen, nolvadex, velban, oncovin)
• some drugs for Parkinson’s disease (levadopa, bromocriptine)
• some drugs for arthritis (indomethacin)
• some tranquilizers/antianxiety drugs (valium, halcion)
• alcohol.

When taken together, some drugs can interact in adverse ways. It is important that each doctor be aware of all the different types and dosages of medicine a patient takes and discuss possible interactions with him/her. This is another reason why elderly people should consider psychotherapy first in treating depression. If you are taking medication for a medical condition, you always run the risk of an unfavorable drug interaction with antidepressant medications unless you are closely supervised and monitored. In addition to increasing depression, some antidepressant drugs can create dependencies. Be sure to read warning labels and monitor drug use strictly and continuously.

Can anxiety lead to depression in seniors?

Some people worry themselves into a depression. This “what if” syndrome can emerge when a parent develops a degenerative or life-threatening illness, like Alzheimer’s disease, cancer, or a heart condition: “Is this going to happen to me?” they wonder. Or, after undergoing a coronary by-pass or dealing with other major illness themselves, they may fear for their own lives. Though normal, these concerns are not productive and can be damaging.

What is the difference between senior depression and dementia?

It takes a medical evaluation to distinguish between depression and dementia, but in brief you can think of the difference this way: a depressed person may have poor concentration and forget where s/he left the house keys, while a person with dementia does not know what they are called or perhaps cannot remember their purpose and tries to use them for something else.

What are the signs and symptoms of depression in the elderly?

It is not unusual for elderly people to experience sadness, social isolation and loneliness when faced with any of the causes mentioned above. Real depression is characterized by a persistent mood that does not lift, interferes significantly with ordinary life functions or activities, and ultimately may lead to suicide. Because some of these symptoms are similar to those caused by other conditions, including dementia, it is important to see a geriatric specialist for an evaluation. It is also helpful to be aware of the range of symptoms described below and not rely on "sadness" as a measure. Research has shown that many elderly do not think of themselves as sad, even when numerous other indicators point to a diagnosis of depression.

The following symptoms of depression are common in many older people:

• agitation
• anxiety
• persistent, vague or unexplained physical complaints
• memory problems; difficulty concentrating
• social withdrawal
• decreased appetite and weight loss or weight gain
• sleep disturbances: daytime sleepiness, difficulty falling asleep, multiple mid-night awakenings, early morning awakening
• irritability or demanding behavior
• lack of attention to personal care
• confusion, delusions or hallucinations
• feelings of discouragement or hopelessness
• sadness, lack of playfulness, inability to laugh
• loss of interest in normally pleasurable activities; in ability to feel pleasure
• prolonged grief after a loss
• loss of self worth
• reduced energy, fatigue
• abnormal thoughts, excessive or inappropriate guilt
• suicidal thoughts or attempts.

If these symptoms persist every day for more than two weeks, depression well may be present.

Why is it so difficult to diagnose depression in seniors with dementias and other diseases?

Even when a patient goes to a physician, depression may be overlooked for several reasons:

• symptoms may be ignored or confused with Parkinson’s, Alzheimer’s, dementia, thyroid disorders, strokes, heart disease, side effects of medication (any of which they may be)
• alcohol dependence as self-medication can mask signs of depression
• most doctors don’t have time to sit and talk with their patients to find out if they are depressed
• a patient’s usual aches and pains may draw the physician’s time and attention
• elderly patients may be conditioned by the stigma of an earlier era and hide depression from others, including their doctors

The following tests will be helpful in making an accurate diagnosis:

• a physical examination to determine if a medical illness is causing the depression
• a psychological evaluation
• blood tests such as CBC or blood differential, thyroid function tests, liver or kidney functions, etc.

Why is it important to treat depression in elderly people?

First and foremost, proper treatment can prevent suicide. Deteriorating health, a sense of isolation and hopelessness, and difficulty adjusting to new life circumstances can combine to push a person suffering from depression over the edge. For example, when depression is not treated in elderly white males, the suicide rate is six times the national average. Amazingly, 75% of such men have been seen by a doctor within several months of their deaths.

The National Institute of Mental Health considers depression in people age 65 and older to be

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