Depressive Disorders in Older Patients

Do the Elderly Face Depression?

Depression over the age of 65 can be difficult; patients may have difficulty functioning and feel distressed. Later-life depression can be caused by medical illnesses. About 15 percent of people over 65 have symptoms of depression, and these symptoms can make them feel physically ill and increase mortality.

Depression can make it harder for people to enjoy the things that they normally enjoy. Memory and concentration can be affected as well. Families of those who are depressed may also suffer, so it’s important that everyone involved is educated about how to handle this condition.

What Is Depression in Older Adults?

Late-life depression affects older people in many aspects of their lives. Depression can affect factors such as the level of energy a person has, relationships, and sleep patterns. Depression lasts for several weeks; it isn’t just a passing feeling. Depression may be triggered by a loss of the ability to function at normal levels or by emotional stress, although it can also present for no noticeable reason.

People who have depression need medical treatment to correct the imbalances in their brains’ chemicals. Without treatment, depression can last for weeks, months, or even years, and it may worsen over time.

What Mood Disorders Should I Look For?

Major depressive disorder is one of the most serious mood disorders. About 1 to 2 percent of people over the age of 65 face this condition. These people may have had depression in their younger years, but for some, this will be the first episode.

Depression has two main symptoms:

• A depressed mood that lasts for two weeks or longer and persists throughout the day
• A loss of interest in hobbies or activities that are normally fun or enjoyable
• A person with depression might also have a few of these symptoms:
• Significant weight loss or weight gain
• Changes in appetite
• Restlessness
• Fatigue
• Feelings of guilt, worthlessness, or hopelessness
• Difficulty concentrating or remembering
• Thoughts of suicide or attempts at suicide

Delusions and hallucinations can also accompany a severe major depressive disorder episode. When these two symptoms are present, the depression is categorized as psychotic depression, which is most common in later life.

If you notice these symptoms in a family member it is important to seek help. Untreated depression is the number one cause of suicide in the United States, and older people have almost double the suicide risk of the general population. Early treatment is the best way to prevent these situations.

What Other Types of Depression Are There?

Older people might also have disorders such as dysthymic disorder and minor depressive disorder. The symptoms of these types of depression are not normally as severe as those of major depression, but they can still make it hard for a person to function. Treatment is still important, and it will help the patient feel better over time.

What Causes Depression?

Depression is caused by a chemical imbalance in the brain. This imbalance can be caused or worsened by certain types of medications that older patients may need to take, including blood pressure medications, muscle relaxants, or steroids. If you or a family member feels more depressed after switching medications, tell your doctor. The new medication may be causing symptoms that could be eliminated by the use of a different drug.

Is Depression Normal After the Death of a Loved One?

Some depression is normal after major life changes such as retirement, moving to a nursing home, having financial issues, or being lonely. Older people often face the death of loved ones and friends, and this can also be a trigger for depression. While sadness and some depression are expected in these situations, a physician should evaluate depressive episodes lasting for longer than two months after a loss.

How Is Late-Life Depression Different from General Depression?

Younger people who have depression might have problems sleeping, feel fatigued, or have trouble with eating too much or too little. However, for older adults, these symptoms can be part of the natural aging cycle, so it is important for doctors and family members to be aware of the person’s emotional state. Feelings of worthlessness, avoiding interactions with other people, problems with memory and concentration, and other psychological symptoms need to be evaluated for proper diagnosis.

How Is Depression Evaluated?

A complete medical and psychiatric evaluation is completed to diagnose depression for any age. A doctor will want to know when the patient started feeling symptoms of depression and if it has ever happened before. The severity of symptoms and how long they last is also important. Older individuals will have their mental statuses assessed, and laboratory tests may be completed. This will help rule out any medical conditions that could be causing or influencing the severity of the depression.
How Is Depression Treated?

If a medical illness is the reason for depression or is making depression worse, it will need to be treated separately. Depression is treated with medication and/or psychotherapy. One or the other might work better for an individual patient, but they can be combined in various proportions to help most patients work through difficult times. For very severe depression that isn’t responding to medication, electroconvulsive therapy may be considered. Most late-life cases of depression are treated with antidepressants that affect the brain’s chemistry to control moods. Selective serotonin reuptake inhibitors (SSRIs) are the most widely prescribed type of antidepressant.

These antidepressants include medications such as:

• Citalopram
• Fluoxetine
• Paroxetine
• Sertraline
• Fluvoxamine

These medications are often well tolerated by older patients, but citalopram and sertraline are considered the most effective of the SSRIs. Psychotic depression is usually treated with antipsychotic medications like risperidone or quetiapine.

• Editors, experts, and contents pages from the guidelines
• Depression in Older Adults: A Guide for Patients and Families

View Resources

• Mentalhealth.va.gov – Depression
• MedlinePlus – Depression – elderly
• Ncbi.nlm.nih.gov – Development and validation of a geriatric depression screening scale: a preliminary report.
• Nihseniorhealth.gov – About Depression