Most people have feelings of sadness at some point in their lives, and feeling down every once in a while is a normal part of life. But, depression is not just having “the blues” or the emotions we feel when grieving the loss of a loved one. It is a true medical condition that is treatable, like diabetes or hypertension. The Centers for Disease Control and Prevention report that minor depression affects 15%–20% of community-dwelling older adults and is known to profoundly compromise health and quality of life. Fortunately, effective treatment options are available, and for most people, depression gets better with counseling, medicine, or other forms of help.
Risk factors
Older adults are at increased risk. We know that about 80% of older adults have at least one chronic health condition, and 50% have two or more. Depression is more common in people who also have other illnesses. In addition, older adults are often misdiagnosed and undertreated. Director of Social Services at Fairview Senior Living, Jill Favereau, BSW, LSW explains that “providers may mistake an older adult’s symptoms of depression as just a natural reaction to illness or the life changes that may occur as we age, and therefore not see the depression as something to be treated. Older adults themselves often share this belief and do not seek help because they don’t understand that they could feel better with appropriate treatment.”
According to the National Institute on Aging (NIA), there are many other things that may be risk factors for depression. For some people, changes in the brain can affect mood and result in depression. Others may experience depression after a major life event, like a medical diagnosis or a loved one’s death. Sometimes, those under a lot of stress, such as people who care for loved ones with a serious illness or disability, can feel depressed. Research on depression has shown that these factors, while not the cause of depression, can increase the risk:
- A medical condition, such as a stroke or cancer
- A family or personal history of depression
- Stress, including caregiver burnout
- Problems sleeping
- Isolation and loneliness
- Functional limitations that make engaging in activities of daily living difficult
- Addiction or substance abuse
Depression is common in people with Alzheimer’s and related dementias. Dementia can cause some of the same symptoms as depression, and depression can be an early warning sign of possible dementia. Suicide attempts may also increase in people recently diagnosed with dementia. It is important to have support systems in place to help cope with a dementia diagnosis and possible depression symptoms that follow. The CDC says, however, that core research is needed to determine effective depression treatment options for people with dementia.
Signs and symptoms
When we think of depression, we often think of sadness, but in some older adults with depression, sadness is not their primary symptom. Some seniors have described more of a feeling of numbness or a lack of interest in activities they used to enjoy. The following list from the NIA highlights common depression symptoms, but because people experience depression differently, keep in mind that there may be symptoms some people experience that are not listed here.
- Persistent sad, anxious, or empty feeling
- Feelings of hopelessness, guilt, worthlessness, or helplessness
- Irritability, restlessness, or having trouble sitting still
- Loss of interest in once pleasurable activities, including sex
- Decreased energy or feeling of fatigue
- Difficulty concentrating, remembering, or making decisions
- Sleeping issues, such as waking up too early in the morning, or sleeping more than usual
- Eating more or less than usual, usually with unplanned weight gain or loss
- Persistent aches or pains, headaches, cramps, or digestive problems
- Thoughts of death or suicide, or suicide attempts
If you or a loved one have several of these signs and symptoms and they last for more than two weeks, it is time to talk with a healthcare provider about treatment options. Fairview Senior Living’s Favereau suggests, “if you are a family member or friend of an older adult, it helps to watch for clues. Listen carefully if someone of any age says they feel depressed, sad, or empty for long periods of time. That person may really be asking for help.”
Treatment options
Treatment, particularly a combination of psychotherapy and medications, has been shown to be effective for older adults. However, not all medications or therapies will be right for everyone. Treatment choices differ for each person, and sometimes multiple treatments must be tried in order to find one that works.
Common forms of treatment for depression include:
- Psychotherapy, counseling, or “talk therapy” that can help a person identify and change troubling emotions, thoughts, and behavior. It may be done with a psychologist, licensed clinical social worker (LCSW), psychiatrist, or other licensed mental health care professional.
- Medications for depression that may balance hormones that affect mood, such as serotonin. There are many different types of commonly used antidepressant medications. Selective serotonin reuptake inhibitors (SSRIs) are antidepressants commonly prescribed to older adults. A psychiatrist, mental health nurse practitioner, or primary care physician can prescribe and help monitor medications and potential side effects.
- Electroconvulsive Therapy (ECT), during which electrodes are placed on a person’s head to enable a safe, mild electric current to pass through the brain. This type of therapy is usually considered only if a person’s illness has not improved with other treatments.
- Repetitive transcranial magnetic stimulation (rTMS), which uses magnets to activate the brain. rTMS does not require anesthesia and targets only specific regions of the brain to help reduce side effects such as fatigue, nausea, or memory loss that could happen with ECT.
- Complementary health approaches, like yoga, can improve well-being and help people cope with stress. However, there is little evidence to suggest that these approaches, on their own, can successfully treat depression. While they can be used in combination with other treatments, they should not replace medical treatment.
Don’t avoid getting help because you don’t know how much treatment will cost. Treatment for depression is usually covered by private insurance and Medicare. Also, some community mental health centers may offer treatment based on a person’s ability to pay.
Supporting someone with depression
As a friend or family member of a person with depression, here are a few things you can do:
- Encourage the person to seek medical treatment and stick with the treatment plan
- Help set up medical appointments or accompany the person to the provider’s office or a support group
- Participate with the person in activities they enjoy
- Know the warning signs of suicide, and what to do if you suspect someone is suicidal. Don’t shy away from asking if a family member or friend is feeling depressed or suicidal. Asking if someone is having thoughts of suicide will not make them more likely to act on those thoughts. Your questions may help the person open up about how they’ve been feeling and encourage them to seek treatment.
Resources for more information on depression:
- National Institute on Aging, Depression and Older Adults
- National Institute on Mental Health, Older Adults and Depression
- SAMHSA (Substance Abuse and Mental Health Services Administration), Toolkit for Treatment of Depression in Older Adults
- Find detailed descriptions of different types of depression from the National Institute of Mental Health.
If you are thinking about harming yourself, or know someone who is, tell someone who can help immediately.
- Do not isolate yourself
- Call a trusted family member or friend
- Call 911 or go to a hospital emergency room to get immediate help
- Make an appointment with a healthcare provider
- Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to talk to a trained counselor
