Depression and older adults

Depression is the most common mood disorder for older adults. It may go undiagnosed if the symptoms are masked by another condition or misinterpreted as part of the aging process.


Risk factors
Risk factors for depression among older adults include:
chronic medical conditions
being divorced or widowed
caring for an ill spouse
social isolation
additional life stressors, such as an uncertain living situation or financial or legal concerns
repeated losses, such as the deaths of numerous friends or loved ones
a personal or family history of depression
a family history of depression
memory loss
dementia

Symptoms
Older adults often have more prominent symptoms of depression than younger adults. For example, they may experience more pronounced confusion, memory loss and physical complaints. A loss of self-esteem is also prominent.
For some older adults, symptoms of depression resemble those of dementia, such as disorientation, confusion, memory loss or distractibility. With dementia, there's a history of decline in cognitive abilities before the depressive symptoms appear. With depression, the cognitive decline occurs more abruptly. Depression also commonly accompanies dementia, especially in the early stages. At any stage, a medical evaluation can help differentiate between depression and dementia.

Depression is more common among older adults being treated for medical problems than among older adults in the general population. Other conditions may mask or contribute to the symptoms of depression. Sometimes it's the treatment rather than the disease that leads to depression.

Elderly adults who are depressed typically have poorer physical and social health, as well as higher rates of cardiovascular illness, stroke, hip fractures, diabetes, disabilities and cancer. Clinical depression is the most common psychiatric condition associated with suicide among older adults.


Treatment
Older adults often seek help for depression from a primary care doctor. Many older adults are more comfortable visiting the doctor for physical complaints -- which may be caused by the depression in the first place -- than psychological complaints.
Maintaining social connections and a regular pattern of daily activities (such as sleeping, eating and physical activity) may help ease depression. Because alcohol is a depressant, it's essential to limit any alcohol use.

Antidepressants are a common treatment for depression. The U.S. Food and Drug Administration has issued an advisory for doctors, patients, loved ones and caregivers to closely monitor anyone who's taking antidepressants, especially when treatment begins or dosages are adjusted. For older adults, doctors generally "start low and go slow" with antidepressants and adjust dosages frequently. This careful approach is important because:

Age-related changes in brain chemistry make elderly adults especially sensitive to antidepressants.
Other physical illnesses may interfere with antidepressants.
Some medications -- such as benzodiazepines, beta blockers, centrally acting antihypertensives and corticosteroids -- can precipitate or aggravate depression. At certain doses, they may counteract antidepressant medications.
It often takes up to six to 12 weeks for elderly adults to notice any effects from antidepressants.
Lack of money or difficulty reaching a pharmacy may make some older adults less likely to take the medication consistently.
Depending on the type of depression and the severity of the symptoms, various types of therapy or counseling may be recommended. Electroconvulsive therapy (ECT) may be used to treat severe depression, including depression with psychotic characteristics. Hospitalization may be needed in cases involving suicidal thoughts, psychotic episodes, physical debilitation or a severe medical illness.