Depression is More Common Among Older Individuals

Considering the many adverse factors that accompany older age, it’s not surprising that the likelihood of depression increases as people grow older. Some of the risk factors for depression in late life include:

• Widowed, divorced or separated marital status
• Social isolation
• Female sex
• Functional or cognitive impairment
• Physical illness, especially when severe, recent in onset, added onto other chronic disorders, and associated with limited mobility or uncontrolled pain.

Age itself is not a cause of depression

All too often, symptoms of depression in the elderly are attributed to older age, which itself does not cause depression, and so depression is unrecognized and untreated. In fact, estimates are that only 65 percent of the 16.5 million Americans who had an episode of major depression in 2007 received treatment. With awareness of the above risk factors and the common manifestations of depression, family members and friends can help to steer a depression sufferer to appropriate treatment. 

Symptoms of depression

A reference guide established by the American Psychiatric Association lists the following symptoms of a major depression:

• Depressed mood with overwhelming feelings of sadness and grief
• Loss of interest and pleasure in activities formerly enjoyed
• Insomnia, early morning awakening, or oversleeping almost daily
• Feelings of guilt, worthlessness, and helplessness
• Changes in appetite that cause significant weight gain or loss
• Fatigue or decreased energy
• Inability to concentrate or think
• Restlessness or feeling physically slowed down
• Recurrent thought of death or suicide, or a suicide attempt

These symptoms are not only useful in suspecting or diagnosing major depression, but also illustrate the deterioration in quality of life that accompanies depression. Depressed individuals have a higher use of illicit drugs and excessive alcohol intake; the increased risk of suicide is particularly high among men. In addition, evidence accumulating over the past 20 years has demonstrated that major depressive episodes are associated with an increased risk of developing coronary heart disease, having unstable angina or a heart attack, strokes and overall mortality. The risk of a heart attack is especially great in those with a major depression after an initial heart attack. 

Treatment of depression in older people

Psychotherapy, talking with a psychiatrist, psychologist, or other mental health professional, and antidepressant drugs are both effective treatments for depression. (Exercise is often mentioned as a way to treat mild to moderate depression, but a recent review of multiple studies found no statistically significant benefit from exercise.)  Both psychotherapy and medications can diminish symptoms of depression and improve quality of life--benefits of antidepressants are often not evident for 4 to 6 weeks and psychotherapy may require even more time to show effectiveness.  

Because of their greater sensitivity to antidepressants and possible interactions with other medications that are so commonly taken by the elderly, side effects are more common even though treatment is initiated with smaller doses than used in younger patients. The two most frequently used drugs are tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs); the latter are prescribed more often because they tend to have milder side effects. However, a study published in a recent issue of the British Medical Journal found that falls and low blood sodium levels were more common in those taking SSRIs than tricyclics. It is disappointing that neither this study nor others has shown that successful treatment of depression lessens the incidence of heart attacks or strokes.