By. Dr. Hannah Stewart
Depression is NOT a normal part of aging but is common among older adults.
Why do we care?
Depressive illness in older adults is associated with impaired functioning, increased risk of suicide, and increased risk of death with other common conditions such as stroke, and heart attack. Up to 10% of older adults suffer from depression. Up to 1 in 3 older adults can experience depression in the hospital. Nearly 1 in 4 depressed older adults commit suicide.
Untreated depression decreases overall quality of life.
So what is depression?
Doctors use specific criteria to diagnose Major Depressive Disorder. Some notable elements may include:
Decreased interest or pleasure in activities
Trouble sleeping or staying awake
Loss of energy
Feelings of worthlessness
Loss of appetite
Thoughts of suicide or harming others
These symptoms can often cause distress or difficulty with daily functioning. Patients who do not have symptoms for major depression can still be diagnosed with minor depression or other similar conditions. Up to 40% of older adults have been found to have minor depression.
Who gets depression?
Anyone can become depressed, which is why screening is important. For older adults, risk factors include:
Lower socioeconomic status
Having multiple medical conditions
Cognitive issues like dementia
Family history of depression
How do doctors diagnose depression?
Some older adults have multiple medical problems and take multiple medications which can impact their mood. In this population the diagnosis of depression may be difficult to make and often unrecognized.
Your doctor will consider your medical problems and medications to narrow down the cause of your depressed mood.
Most doctors will start with a short screening tool using just two questions. “During the past month, have you been bothered by feeling down, depressed, or hopeless?”, “During the past month, have you been bothered by little interest or pleasure in doing things.” If answers are concerning for depression or depressed mood, then your doctor will likely perform further testing by using other screening tools. Additionally, family members may recognize signs of depression that can be helpful for your diagnosis.
How is depression treated?
When someone is diagnosed with depression, the next step is to create a treatment plan. The most common first-line treatment for depression is cognitive-behavioral therapy, which helps patients to change negative thinking. This type of therapy improves depressed mood, self-care, communication and functioning. Unfortunately, many older adults do not have access or take advantage of therapy due to a lack of services, insurance, or social and cultural beliefs.
Many patients may need the addition of medications for better treatment results. There are several types of medicines used to treat depression. Some medicines are safer than others for older adults. It is important to talk to your doctor to determine which medicine is the right one for you. Geriatricians pay particular attention to medication safety and how medications may interact with each other and diseases. See the GeriAcademy blog post Am I Taking Too Much Medicine.
The most common side effects experienced by depression medications include nausea, dizziness, sexual dysfunction, weight loss, or weight gain. You must discuss any side effects with your doctor as soon as you experience them.
It may take 6 weeks or longer for medications to be steadily effective. But do not lose hope; continue routine follow ups and open communication with your doctor. Just like other diseases you will need continued monitoring and treatment.
Lastly, exercise has been found to have significant improvement in all age groups with depression. Recommendations for older adults are 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise a week. Always consult with your doctor before starting any exercise program.
For older adults there is still a stigma associated with depression, some find seeking help to be a sign of weakness. However, anyone experiencing symptoms of depression should get help from a health care professional. Just like any other disease, depression can be treated. The journey to recovery is always easier with a doctor that you trust.
The national suicide prevention lifeline is available 24 hours a day. Please reach out if you have thoughts of harming yourself because you are loved and important!
I hope you found this post to be helpful. Recognizing signs of Depression is the first step. Talk to your health care provider, or consider a consultation with a geriatrician.
check out other posts from www.Geriacademy.com
This post was written by Dr. Hannah Stewart DO. Board Certified in Internal Medicine, a current geriatric fellow at Vanderbilt University Medical Center.
Blazer DG. Depression in late life: review and commentary. J Gerontol A Biol Sci Med Sci. 2003 Mar;58(3):249-65. doi: 10.1093/gerona/58.3.m249. PMID: 12634292
Centers for Disease Control and Prevention and National Association of Chronic Disease Directors. The State of Mental Health and Aging in America Issue Brief 2: Addressing Depression in Older Adults: Selected Evidence-Based Programs. Atlanta, GA: National Association of Chronic Disease Directors; 2009 (accessed 2/1/2024)
Conner, Kyaien O., et al. "Mental health treatment seeking among older adults with depression: the impact of stigma and race." The American Journal of Geriatric Psychiatry 18.6 (2010): 531-543.
Fiske, Amy, Julie Loebach Wetherell, and Margaret Gatz. "Depression in older adults." Annual review of clinical psychology 5 (2009): 363-389.
Löwe, Bernd, Kurt Kroenke, and Kerstin Gräfe. "Detecting and monitoring depression with a two-item questionnaire (PHQ-2)." Journal of psychosomatic research 58.2 (2005): 163-171.
Rodda, Joanne, Zuzana Walker, and Janet Carter. "Depression in older adults." Bmj 343 (2011).