Depression in Older Adults
Recognizing the Signs and Getting the Right Treatment
Have you lost interest in the activities you used to enjoy? Do you struggle with feelings of helplessness and hopelessness? Are you finding it harder and harder to get through the day? If so, you’re not alone. The good news: depression is not a normal or necessary part of aging. Senior depression can be treated, and with the right support, treatment, and self-help strategies you can feel better and live a happy and vibrant life.
Depression: A problem for many older adults and the elderly
Depression is a common problem in older adults. And its symptoms affect every aspect of your life, including your energy, appetite, sleep, and interest in work, hobbies, and relationships.
Unfortunately, all too many depressed seniors fail to recognize the symptoms of depression, or don’t take the steps to get the help they need. There are many reasons depression in older adults and the elderly is so often overlooked:
- You may assume you have good reason to be down or that depression is just part of aging.
- You may be isolated—which in itself can lead to depression—with few around to notice your distress.
- You may not realize that your physical complaints are signs of depression.
- You may be reluctant to talk about your feelings or ask for help.
You can feel good at any age
Depression isn’t a sign of weakness or a character flaw. It can happen to anyone, at any age, no matter your background or your previous accomplishments in life. Similarly, physical illness, loss, and the challenges of aging don’t have to keep you down. You can feel better and enjoy your golden years once again, no matter what challenges you face.
Signs and symptoms of depression in older adults and the elderly
Recognizing depression in the elderly starts with knowing the signs and symptoms. Depression red flags include:
- Sadness or feelings of despair
- Unexplained or aggravated aches and pains
- Loss of interest in socializing or hobbies
- Weight loss or loss of appetite
- Feelings of hopelessness or helplessness
- Lack of motivation and energy
- Sleep disturbances (difficulty falling asleep or staying asleep, oversleeping, or daytime sleepiness)
- Loss of self-worth (worries about being a burden, feelings of worthlessness or self-loathing
- Slowed movement or speech
- Increased use of alcohol or other drugs
- Fixation on death; thoughts of suicide
- Memory problems, slowed movement and speech
- Neglecting personal care (skipping meals, forgetting meds, neglecting personal hygiene)
Depressed seniors may not feel “sad”
While depression and sadness might seem to go hand and hand, many depressed seniors claim not to feel sad at all. They may complain, instead, of low motivation, a lack of energy, or physical problems. In fact, physical complaints, such as arthritis pain or worsening headaches, are often the predominant symptom of depression in the elderly.
Is it grief or depression?
As you age, you experience many losses. Loss is painful—whether it’s a loss of independence, mobility, health, your long-time career, or someone you love. Grieving over these losses is normal and healthy, even if the feelings of sadness last for a long time.
Distinguishing between grief and clinical depression isn’t always easy, since they share many symptoms. However, there are ways to tell the difference. Grief is a roller coaster involving a wide variety of emotions and a mix of good and bad days. Even when you’re in the middle of the grieving process, you will have moments of pleasure or happiness. With depression, on the other hand, the feelings of emptiness and despair are constant.
While there’s no set timetable for grieving, if it doesn’t let up over time or extinguishes all signs of joy—laughing at a good joke, brightening in response to a hug, appreciating a beautiful sunset—it may be depression.
Medical conditions can cause depression in older adults
It’s important to be aware that medical problems can cause depression in older adults and the elderly, either directly or as a psychological reaction to the illness. Any chronic medical condition, particularly if it is painful, disabling, or life-threatening, can lead to depression or make depression symptoms worse.
- Parkinson's disease
- heart disease
Depression as a side effect of medication
Symptoms of depression can also occur as a side effect of many commonly prescribed drugs. You’re particularly at risk if you’re taking multiple medications. While the mood-related side effects of prescription medication can affect anyone, older adults are more sensitive because, as we age, our bodies become less efficient at metabolizing and processing drugs.
Medications that can cause or worsen depression include:
- Blood pressure medication (clonidine)
- Beta-blockers (e.g. Lopressor, Inderal)
- High-cholesterol drugs (e.g. Lipitor, Mevacor, Zocor)
- Tranquilizers (e.g. Valium, Xanax, Halcion)
- Calcium-channel blockers
- Medication for Parkinson's disease
- Sleeping pills
- Ulcer medication (e.g. Zantac, Tagamet)
- Heart drugs containing reserpine
- Steroids (e.g. cortisone and prednisone)
- Painkillers and arthritis drugs
- Estrogens (e.g. Premarin, Prempro)
If you feel depressed after starting a new medication, talk to your doctor. You may be able to lower your dose or switch to another medication that doesn’t impact your mood.
Dementia vs. depression in older adults
Never assume that a loss of mental sharpness is just a normal sign of old age. It could be a sign of either depression or dementia, both of which are common in older adults and the elderly. Depression and dementia share many similar symptoms, including memory problems, sluggish speech and movements, and low motivation, so it can be difficult to tell the two apart.
|Is it Depression or Dementia?|
|Symptoms of Depression||Symptoms of Dementia|
Mental decline is relatively rapid
Mental decline happens slowly
Knows the correct time, date, and where he or she is
Confused and disoriented; becomes lost in familiar locations
Difficulty with short-term memory
Language and motor skills are slow, but normal
Writing, speaking, and motor skills are impaired
Notices or worries about memory problems
Doesn’t notice memory problems or seem to care
Whether cognitive decline is caused by dementia or depression, it’s important to see a doctor right away. If it’s depression, memory, concentration, and energy will bounce back with treatment. Treatment for dementia will also improve you or your loved one’s quality of life. And in some types of dementia, symptoms can be reversed, halted, or slowed.
Help for depressed seniors tip 1: Find ways to stay engaged
If you’re depressed, you may not want to do anything or see anybody. But isolation and disconnection only make depression worse. The more engaged you are—socially, mentally, and physically—the better you’ll feel.
The importance of face-to-face connection
On your own, it can be difficult to maintain perspective and sustain the effort required to beat depression. That’s why support matters—so make an effort to connect to others and limit the time you’re alone. If you can’t get out to socialize, invite loved ones to visit you, or keep in touch over the phone or email.
But digital communication isn’t a replacement for face-to-face contact. Do your best to see people in person on a daily basis. Your mood will thank you! And remember, it’s never too late to build new friendships. Start by joining a senior center, a book club, or another group of people with similar interests.
Ways to help you feel connected and engaged in life again
- Get out in to the world. Try not to stay cooped up at home all day. Go to the park, take a trip to the hairdresser, or have lunch with a friend.
- Volunteer your time. Helping others is one of the best ways to feel better about yourself and expand your social network.
- Take care of a pet. A pet can keep you company, and walking a dog, for example, can be good exercise for you and a great way to meet people.
- Learn a new skill. Pick something that you’ve always wanted to learn, or that sparks your imagination and creativity.
- Create opportunities to laugh. Laughter provides a mood boost, so swap humorous stories and jokes with your loved ones, watch a comedy, or read a funny book.
Tip 2: Healthy habits matter
When you’re depressed, it’s hard to find the motivation to do anything—let alone look after your health. But your health habits have an impact on depression symptoms. The better care you take of your body, the better you’ll feel.
Move your body
Exercise is a powerful depression treatment. In fact, research suggests it can be just as effective as antidepressants. And you don’t have to suffer through a rigorous workout to reap the benefits. Anything that gets you up and moving helps. Look for small ways to add more movement to your day: park farther from the store, take the stairs, do light housework, or enjoy a short walk. It all adds up.
Even if you’re ill, frail, or disabled, there are many safe exercises you can do to build your strength and boost your mood—even from a chair or wheelchair. Just listen to your body and back off if you’re in pain.
Eat to support your mood
Your dietary habits make a difference with depression. Start by minimizing sugar and refined carbs. Sugary and starchy comfort foods can give you a quick boost, but you pay for it later when your blood sugar crashes. Instead, focus on quality protein, complex carbs, and healthy fats, which will leave you satisfied and on an emotional even keel. Going too long without eating can also worsen your mood, making you tired and irritable, so do your best to eat something at least every 3-4 hours.
Support quality sleep
Many older adults struggle with sleep problems, particularly insomnia. But lack of sleep makes depression worse. Aim for somewhere between 7 to 9 hours of sleep each night. You can help yourself get better quality sleep by avoiding alcohol and caffeine, keeping a regular sleep-wake schedule, and making sure your bedroom is dark, quiet, and cool.
Alcohol and depression in older adults
It can be tempting to use alcohol to deal with physical and emotional pain. It may help you take your mind off an illness, feel less lonely, or get to sleep. But alcohol makes symptoms of depression and anxiety worse over the long run. It also impairs brain function and interacts in negative ways with numerous medications, including antidepressants. And while drinking may help you nod off, it also keeps you from getting the refreshing deep sleep you need.
Tip 3: Know when to seek professional help
Depression treatment is just as effective for older adults as it is for younger people. However, since depression in older adults and the elderly is often triggered or compounded by a difficult life situation or challenge, any treatment plan should address that issue. If loneliness is at the root of your depression, for example, medication alone is not going to cure the problem. Also, any medical issues complicating the depression must be addressed.
Antidepressant risk factors for older adults and the elderly
Older adults are more sensitive to drug side effects and vulnerable to interactions with other medicines they’re taking. Studies have also found that SSRIs such as Prozac can cause rapid bone loss and a higher risk for fractures and falls. Because of these safety concerns, elderly adults on antidepressants should be carefully monitored.
In many cases, therapy and/or healthy lifestyle changes, such as exercise, can be as effective as antidepressants in relieving depression, without the dangerous side effects.
Alternative medicine for depression in older adults and the elderly
If you can’t tolerate antidepressants or are worried about the risks, there are a number of herbal remedies and supplements which have shown promise in treating depression. However, even natural supplements can cause interactions with certain medications you’re taking or lead to unpleasant side effects, so talk to your doctor and do your research on drug interactions.
- Omega-3 fatty acids may boost the effectiveness of antidepressants or work as a standalone treatment for depression.
- St. John’s wort can help with mild or moderate symptoms of depression but should not be taken with antidepressants.
- Folic acid can help relieve symptoms of depression when combined with other treatments.
- SAMe may be used in place of antidepressants to help regulate mood, but in rare cases can cause severe side effects.
Counseling and therapy for older adults and the elderly
Therapy works well on depression because it addresses the underlying causes of the depression, rather than just the symptoms.
- Supportive counseling includes religious and peer counseling. It can ease loneliness and the hopelessness of depression, and help you find new meaning and purpose.
- Therapy helps you work through stressful life changes, heal from losses, and process difficult emotions. It can also help you change negative thinking patterns and develop better coping skills.
- Support groups for depression, illness, or bereavement connect you with others who are going through the same challenges. They are a safe place to share experiences, advice, and encouragement.
Helping a depressed older adult or senior
The very nature of depression interferes with a person's ability to seek help, draining energy and self-esteem. 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, are too proud or ashamed to ask for assistance, or fear becoming a burden to their families.
If an elderly person you care about is depressed, you can make a difference by offering emotional support. Listen to your loved one with patience and compassion. You don’t need to try to “fix” someone’s depression; just being there to listen is enough. Don’t criticize feelings expressed, but point out realities and offer hope. You can also help by seeing that your friend or family member gets an accurate diagnosis and appropriate treatment. Help your loved one find a good doctor, accompany him or her to appointments, and offer moral support.
Other tips for helping a depressed elderly friend or relative:
Invite your loved one out. Depression is less likely when people’s bodies and minds remain active. Suggest activities to do together that your loved one used to enjoy: 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, with plenty of fruit, vegetables, whole grains, and some protein at every meal.
Encourage the person to follow through with treatment. Depression usually recurs when treatment is stopped too soon, so help your loved one keep up with his or her treatment plan. If it isn’t helping, look into other medications and therapies.
Make sure all medications are taken as instructed. Remind the person 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.
More help for depression
References and resources
General resources for depression in older adults and the elderly
Older Adults and Depression – Good overview of depression in older adults. (NIMH)
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)
Overcoming Geriatric Depression – Provides a discussion of the emotional needs of elders, and offers very useful suggestions for family members in dealing with a depressed elder. (ElderCare Online)
Antidepressant use in older adults and the elderly
Antidepressant Use Linked to Bone Loss – Covers two Archives of Internal Medicine studies on the connection between SSRI use in adults over 65 and abnormal bone loss. (National Institutes of Health)
Alternative medicine for depression in older adults and the elderly
Alternative Medicine – Alternative techniques for treating depression, including herbal remedies and supplements. (Mayo Clinic)
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