Depression in Older Adults

Overcoming the Stigma and Getting Treatment

/ Author:  / Reviewed by: Joseph V. Madia, MD

Among older adults, depression is stigmatized. Depression may be perceived as a sign of weakness, not a disease. Yet, clinical depression affects millions of Americans over 65.

Late in life, most people are dealing with the hardships of chronic illness, loss of loved ones, and loss of independence. But depression is not a normal part of the aging process. Many seniors with depression have struggled with it throughout their lives, but for others, it might be the first time they're affected by the disease.

About 10 percent of the senior population suffers from depression, according to Dr. Helen Lavretsky, a geriatric psychiatrist and Professor In-Residence in the Department of Psychiatry at UCLA. In nursing homes and assisted living facilities, the rates are much higher – 50 percent of residents have some form of depression.

However, depression often goes undiagnosed and untreated in seniors. Doctors frequently neglect to ask about mental health, and seniors don't like to talk about it. Even when depression is diagnosed, only 40 percent receive treatment. That is to say, the majority of older adults with depression suffer in silence.

What causes depression in older adults?

Clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for weeks or longer, according to the A.D.A.M. Medical Encyclopedia. Depression is more commonly diagnosed in the younger population than the older population.

The elderly are at a point in their lives where they're dealing with major life changes, possibly many changes at once. They're facing their own mortality, and the mortality of those they love. General health and cognitive abilities are in decline, making them more dependent on others. They may be in a caregiving position for a spouse, or face a move to an assisted living facility. These are among many triggers for depression.

A family history of depression can make seniors more prone to developing the condition. But illnesses can also bring depression as a symptom. Stroke, Parkinson's, diabetes, and cancer all increase risk of depression.

Additionally, the medications that seniors take to treat their illnesses may have depression as a side effect, Dr. Lavretsky told dailyRX. That's why it's important to evaluate an individual's health fully before treating for depression.

How to recognize and talk about depression

For most people, the late stage of life is punctuated by periods of loss and grief. But persistent sadness that lasts for months is not normal.

Symptoms of depression include social withdrawl, moving slower, and persistent but vague complaints. But if you decide to talk to a loved one about what you believe might be depression, proceed carefully.

Among seniors, depression is a touchy subject. “There's a lot of stigma attached to depression,” said Dr. Lavretsky. “In some cultural ethnicities, people never say, 'I'm depressed.' They complain of pain instead of depression.”

Some seniors might view a mental health diagnosis or therapy with skepticism. They may hold the belief that a person with depression should just “snap out of it,” and not want to recognize their own feelings as depression.

“If they are not saying what's bothering them, it's a good time to bring up what's going on in their lives,” Dr. Lavretsky advises. She recommends having an honest conversation. “First of all you have to discuss everything. What's painful, why aren't you doing anything? Do you feel sad? Do you feel like crying?”

“It has to be put in medical terms, that it's an illness,” she said. “It's not their fault, it's a chemical imbalance. It's treatable.”

Diagnosing depression

When seniors visit their primary care physicians, they may never be asked about their mental state. That's why depression is so rarely diagnosed or treated in this population.

However, if depression is recognized, Dr. Lavretsky believes it's essential to assess the individual's overall health. “If this is the first time they have depression, in their late life, refer to the primary care physician to make sure they don't have another illness.” Alzheimer's, dementia, cancer, heart disease and low thyroid are among the illnesses associated with symptoms of depression.

Doctors should look at the drugs that seniors may be taking for other conditions, and find out if any have depression as a side effect. Because seniors are sensitive to side effects, a lower dose may be more appropriate.

Dr. Lavretsky noted that this process may be complicated by the fact that seniors are prescribed medications from many different doctors. Often, there's no one to check all the drugs they're taking, and how they interact with each other. In this case, family involvement is very important to monitor their medications over time, and make sure that depression is addressed.

Treating depression

Fortunately, treating depression has good success rates. “Sixty to seventy percent [of those with depression] do well over time,” said Dr. Lavretsky. She says that it might take multiple approaches to properly treat the disorder.

Dr. Lavretsky favors a holistic approach to treating depression. “Mind-body approaches like yoga, tai-chi, and meditation can be helpful in reducing stress and reducing the number of medications one takes,” she said.

In April 2011, she published a study showing that seniors who did Tai Chi, along with standard depression treatment, helped elderly people lower their level of depression and improved their memory and cognition. Compared to a group who took only medication, the Tai Chi practicers experienced greater reductions in depression.

The goal, she said, is to treat depression while adding as few complicating medicines as possible to the individual's regimen. But in cases of severe depression, more aggressive treatment may be necessary.

The most important thing is to try and overcome the stigma of depression, and get help. Depression is an illness that is treatable.

Review Date: 
October 27, 2011