Depression in Older Adults - How is it Different?

"Doesn't everyone get depressed as they get older?" It's a common misconception that becoming depressed is a natural part of the aging process. This and other age-specific beliefs often result in depression going under-diagnosed and untreated in this population.

I encountered this in my own life when I asked my mother if she was depressed awhile after my father died. I was concerned that she might need medication. Her response was, "I'm not depressed, I'm just unhappy." Although I found her answer confusing, it underscored to me that there are profound differences in her generation's concept of depression. We of the Dr. Phil/talk show/self-help book generation just assume everyone understands and shares our belief system about mental illness. Because depression is so common in older adults and their high risk of suicide, it's important for us to understand the signs and symptoms. According to NAMI (National Alliance on Mental Illness), depression affects as many as 6.5 million of the 35 million adults 65 and older and that older white males have the highest suicide rate in the U.S.

How do symptoms differ in older adults?

In addition to the usual depressive symptoms of lethargy, sadness, feelings of hopelessness, older people often have memory deficits, confusion and social withdrawal and they may even experience hallucinations or delusions. Often, these symptoms are misdiagnosed as dementia. It is also very difficult to gauge things like social withdrawal as many older adults live alone and may have mobility difficulties that restrict socializing.

Social/Cultural differences

It's important to also factor in that this generation grew up in a culture that doesn't support sharing "personal" things with strangers, may view depression as a "weakness" or believe that focusing too much on oneself is "selfish." This makes recognizing depression in older adults more challenging as they may not share their symptoms with you. Often older people will complain about physical ailments repeatedly. Recognize that this may be their way of seeking attention for depressive symptoms that they can't articulate.

Treatment options

Fortunately, depression in older adults is very treatable. Unfortunately, suggesting therapy may not be the best way to engage these patients in treatment. Starting with a family physician is what I call a "back door" approach. If the doctor has a trusting relationship with the patient, they may be more likely to see therapy as a way to get better if the doctor recommends it.

Antidepressants are often affective for treating older adult depression. But there are risks not evident in younger populations. WebMD discusses some of these concerns, such as the risk of side effects and other reactions with other medications the older patient may be taking. Also, some of the older types of antidepressants, such as imipramine and amitriptyline can be dangerously over-sedating or cause a drastic drop in blood pressure. It is often a good idea to have the patient referred to a psychiatrist who is skilled in medicating geriatric patients.

Older adults can also benefit from psychotherapy, support groups and informal peer-social groups.

What can you do to help a family member or friend who has been diagnosed with depression?

Make an extra effort to visit, call and spend time with them. If you are a family member, ask if they will sign a release so you can have contact with their doctor if needed. Assure them that this is simply to offer all the support you can, not to "pry" into their business.

Check out local resources like a local hospital, mental health facility or senior center to educate yourself on what is available in their community. Encourage them to participate in therapy or support groups, etc. and help facilitate getting them transportation if needed.

Nancy L