Depression

Depression is a serious and common disorder of mood that involves mind, body and behavior. It affects the way you feel about yourself and others and the way you participate in life. Most likely, depression is caused by a combination of genetic, biological, environmental, and psychological factors. Many people experience their first depressive episode after the age of 65 and a majority of those people go untreated due, in part, to the myth that depression is a normal part of aging.

While depression is not a normal part of aging, older adults may be more at risk because of common late- life stressors including: loss of a loved one, changes in health, lifestyle or living arrangements, difficulty hearing or seeing, changes in physical independence, loss of friends and social roles, challenges to self-esteem, use of medications, physical pain, and cognitive impairment. People are at an even higher risk for depression if they have had depression in earlier years, have a family history of depression or other mental disorder, have experienced recent significant or multiple losses, or have serious health problems. Older adults and their care partners need to be aware of depression symptoms so that they intervene before the problem becomes more serious or dangerous. In older adults, depression often presents as physical pain or irritability, leading to doctor visits. Older patients with symptoms of depression have roughly 50 percent higher health care costs than non-depressed seniors.

As with anxiety, depression may occur with some common physical illnesses (diabetes, cancer, heart disease, arthritis) and/or the medications (prescription or over-the-counter) used for treatment. There are different types and degrees of depressive disorders. A trained professional needs to conduct the assessment, make the diagnosis and advise on a treatment process. If medication is recommended, it needs to be understood that it can take medication more than six weeks to reach a therapeutic level. If people can have patience with depression treatment, they will likely have the opportunity to recover.

Risk Factors

Important risk factors linked to later life depression include:

• Conditions associated with disability or decline
• Illness – especially heart disease, stroke, cancer, vascular disease, and diabetes
• Perceived (self-reported) poor health
• Pain
• Stressful life events, (e.g., financial difficulties, new illness, change of living situation, retirement, job loss, relationship problems)
• Progressive/disabling sensory loss (e.g., macular degeneration)
• Sleep disturbances
• Cognitive impairment or dementia
• Medication side effects
• Alcohol or drug (prescription and over-the-counter medication) misuse or abuse
• Prior depressive episode or family history of depression or other mental illness
• Extended or complicated bereavement
• Multiple or significant losses
• Dissatisfaction with social network, disconnection from community
• Isolation
• History of recurrent falls

Symptoms

When several of the following symptoms occur nearly every day for two or more weeks, it could mean that a person has depression and help should be sought:

• Difficulty concentrating, focusing and making decisions
• An ongoing sad, empty or anxious mood
• Decreased energy, fatigue, feeling slowed down
• Increased agitation and restlessness
• Withdrawal/isolation
• Loss of interest in ordinary or pleasurable activities
• Change in appetite and/or sleep patterns
• Increased physical complaints and/or pain for which there is no physical explanation
• Feelings of worthlessness, guilt, hopelessness, or strong negativity

A large number of older adults experience “mild” (also called subsyndromal) depression that has the same symptoms to a lesser degree – low energy, lack of desire, lack of motivation, negativity, and a low mood. Though these symptoms may be labeled “mild,” in later life, the consequences can be very dangerous. Imagine, for example, that if an already frail person feels fatigued and has no motivation or desire, she/he may not go to the store for food for several days. For a frail person, several days without adequate nutrition could result in serious health consequences and hospitalization. At its worst, untreated depression can lead to suicide.