By Heather Coakley, Psy.D., M.S.W.
There are many difficult changes that older people face—such as stressful life events, the death of a spouse, living alone or major medical problems—these situations can lead to depression, especially in those without a strong support system or ability to cope. However depression is not a normal or necessary part of aging. In fact, most seniors are satisfied with their lives despite the challenges that can come along with growing old.
Left untreated, depression not only prevents older adults from enjoying their lives, it may also take a serious toll on a person’s health. But if you learn how to recognize the signs of depression and find effective ways to help, you and/ or your loved ones can remain happy and vibrant throughout the golden years.
Although depression in the elderly is a common problem, only a small percentage gets the help they need. There are many reasons depression in older adults is so often overlooked: Some assume seniors have good reason to be down or that depression is just part of aging. Elderly adults are often isolated, with few around to notice their distress. Physicians are more likely to ignore depression in older patients, concentrating instead on physical complaints. Finally, many depressed seniors are reluctant to talk about their feelings or ask for help.
Recognizing depression in the elderly starts with knowing the signs and symptoms. Depression red flags also include:
- Agitation or Frustration
- Anhedonia (losing interest in hobbies or other pleasurable activities)
- Social withdrawal and isolation (reluctance to be with friends, engage in activities, or leave home)
- Significant weight loss, gain or loss of appetite
- Sleep disturbances (difficulty falling asleep or staying asleep or oversleeping)
- Loss of self-worth (worries about being a burden, feelings of worthlessness, self-loathing)
- Increased use of alcohol or other illicit or prescription drugs
- Suicidal thoughts or attempts
People who suffer from depression often have difficulty seeking help because they struggle with low motivation and fatigue. For depressed seniors, raised in a time when mental illness was highly stigmatized and misunderstood, it can be even more difficult—especially if they don’t believe depression is a real illness or are too proud or ashamed to ask for assistance.
Things you can do to help:
You can make a difference by offering emotional support. Listen to your loved one with patience and compassion. Don’t criticize feelings expressed, but point out realities and offer hope. You can also help by seeing that the person gets and accurate diagnosis and appropriate treatment. Help him or her find a good doctor, accompany the person to appointments, and offer moral support. You can also invite your loved one out. Depression is less likely when people’s bodies and minds remain active. Suggest activities to do together that used to be enjoyable: walks, an art class, a trip to the museum or the movies—anything that provides mental or physical stimulation. Schedule regular social activities. Group outings, visits from friends and family members or trips to the local senior or community center can help combat isolation and loneliness. Be gently insistent if your plans are refused: depressed people often feel better when they’re around others. Plan and prepare healthy meals. A poor diet can make depression worse, so make sure your loved one is eating right. Encourage follow through with treatment. Depression usually recurs when treatment is stopped too soon, so help them keep up with the agreed upon treatment plan. If none of these steps seem to be helping, look into other medications and therapies. Make sure all medications are taken as instructed. Remind your loved one to obey doctor's orders about the use of alcohol while on medication. Help them remember when to take their dose. Watch for suicide warning signs. Seek immediate professional help if you suspect that your loved one is thinking about suicide.
One last important point, before being diagnosed with depression, elderly adults should be screened for common health issues that can affect mood. These include:
- Hormonal imbalances
- Electrolyte imbalances or dehydration
- Thyroid problems
- Vitamin B12 deficiency
When undergoing evaluation for depression, long-term or severe health issues should also be taken into account. Chronic medical conditions, particularly those that are painful, disabling, or life-threatening, can understandably lead to depression. Illnesses that affect the brain can also cause depression through the disease process itself.
Medical conditions that commonly trigger depression include:
- Alzheimer’s or other Dementia
- Heart attack or disease
- Multiple sclerosis
All medications have side effects, but some can actually cause symptoms of depression or make a pre-existing depression worse. It’s not uncommon for seniors to hoard medications over time and then take them as they fell they’re needed and after they expire. This is very dangerous as medications change their chemical make-up as they break down after expiration. Multiple drug interactions or a failure to take a medication as prescribed can also contribute to depression. For elderly individuals with multiple prescriptions, the risk of medication-induced depression is particularly high.
Make a list of all medications being taken and bring it to the doctor. He or she can help you determine if any of the prescriptions are causing depression symptoms.
Depression treatment is just as effective for elderly adults as it is for younger people. Therapy, support groups and medication can all help relieve symptoms. However, health issues should always be considered in an older adult’s treatment plan.
Related links for depression in older adults
General resources for depression in the elderly
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Depression – Guide to depression in seniors from the National Institute of Mental Health and the National Institute on Aging. Provides information about the risk factors, symptoms, and treatment. (National Institutes of Health)
Depression in the Elderly – Overview of depression in older adults, including contributing factors, signs and symptoms, and how to find help and support. (Palo Alto Medical Foundation)
Depression in Older Adults – Pamphlet for seniors with depression describes what it feels like, what the risk factors are, and how you can help yourself. (Royal College of Psychiatrists)
Understanding Geriatric Depression – Provides a good overview and information on the signs and symptoms that distinguish dementia from depression, discusses treatment and side effects of medications, and suggests ways to help a depressed elderly person. (ElderCare Online)
Adapted from Depression in Older Adults and the Elderly: www.Helpguide.org
Dr. Heather Coakley has a private psychotherapy practice in Long Beach, CA.