Depression is more than just a passing mood. It is a condition presenting persistent withdrawal from previously enjoyed activities, difficulty sleeping, physical discomforts and feelings of “slowing down.” Depression is most often associated with sad feelings but it may occur without sadness.
Prevalence of Late-Onset Depression
Depression is the most common mental health problem among seniors, according to the Centers for Disease Control and Prevention (CDC), but the majority of older adults are not depressed. In fact, only 7.7 percent of people over the age of 50 report current depression and 15.7 percent report a lifetime diagnosis of the mood disorder. Hispanic and female adults over 50 reported the highest incidence of depression.
While the rate of depression increases with age, depression is not part of the normal aging process nor is it a normal response to life changes. Clinical depression is a serious medical condition that requires treatment for patients of any age.
Symptoms of Depression for Older Adults
Common signs and symptoms of depression include:
- Feelings of sadness or ‘emptiness’
- Fatigue
- Losing interest in once-pleasurable pastimes
- Social withdrawal and isolation
- Sleep disturbances, such as difficulty falling asleep or staying asleep, oversleeping, or sleepiness during the daytime
Sadness is one sign of depression, and depression and sadness often go hand-in-hand, but it is possible to suffer depression without feeling sad. Many seniors with depression do not express feelings of sadness at all and, instead, complain more about low energy, lack of motivation or physical ailments.
- Weight gain or weight loss
- Loss of appetite
- Aches and pains
- Headaches
- Loss of self-worth, self-loathing
- Worrying about being a burden
- Increased use of alcohol or other drugs
- Fixation on death
- Suicidal thoughts or attempts
- Abdominal cramps
The symptoms of depression are like those for younger people but depressive disorders are often under-recognized and untreated in older adults. Older adults and their families can sometimes try to “reason away” the signs of depression. They may assume that they have a good reason to be down or that aging is simply part of the aging process. Many are unaware of the symptoms of depression, especially those symptoms unrelated to sadness.
Signs of depression are sometimes easy to overlook. Older adults often live alone, with no one around to notice their distress. Seniors can sometimes feel reluctant to talk about their feelings or to seek help.
Causes and Risk Factors for Late-Onset Depression
The National Institutes of Health say that genetics, brain chemistry and stress can contribute to late-onset depression. Those with a family history of depression may be at higher risk for developing the mood disorder. In fact, researchers in one study found that people with specific variant in a serotonin-transporter gene (5-HTT) were more likely to become depressed in response to stress, according to Harvard Health Publications.
Many cases of depression are the result of neurotransmitter or stress hormone imbalances. A significant number of people with depression have low levels of serotonin or norepinephrine, but low levels of neurotransmitters alone will not cause depression.
Stress, such as loss of a loved one or facing a serious illness, causes the brain to work in an “all or nothing” mode that leads to catastrophizing and difficulty solving complex problems. This can ratchet up stress levels even further. In turn, the body responds to stress by shutting down nonessential functions, increasing the stress hormones adrenaline and cortisol, suppresses appetite and diverts all available fuel to the main muscles. Maintaining this heightened state of stress is exhausting and depletes the body of its resources, rendering the senior unable to deal effectively with the stressful situation at hand. The sense of being overwhelmed and incapable increases the risk for depression.
People who had depression when they were younger are more likely to experience it again later in life. Changes that come late in life, such as medical problems that cause pain and disability, loss of loved ones, retirement and social isolation, can lead to depression.
Loss of a spouse is a major risk factor for clinical depression. In fact, one-third of all widows and widowers meet the criteria for depression during the first month after the death of their spouse, according to Mental Health America. Half of these individuals remain clinically depressed a year later.
Chronic illnesses that occur later in life, such as Alzheimer’s disease, Parkinson’s, heart disease, arthritis and cancer, can trigger symptoms of depression.
Risk factors for depression later in life include:
- Widowhood
- Physical illness
- Limited education, typically less than high school
- Impaired functional status
- Heavy alcohol consumption
Complications of Depression
Many older adults with depression do not receive treatment, which can have serious effects on quality of life and mortality. Untreated depression can also lead to a higher risk for suicide. People over the age of 85 have the highest suicide rates of any age group. The suicide rate for older white males is six times higher than that of the public.
Associated with distress and suffering, depression can impair physical and mental health and interfere with social functioning. Depression can adversely affect the course of treatment of other chronic illnesses. Older adults with depression go to the doctor and emergency room more often, use more medication and stay in the hospital longer. In fact, older patients with symptoms of depression pay 50 percent higher healthcare costs.
Left untreated, depression and other mental health disorders are associated with poor health outcomes, increased disability, caregiver stress and diminished quality of life. This mood disorder can also increase mortality. Fortunately, treatment works.
Treatment for Depression in Older Adults
Depression is treatable in 80 percent of cases. Recovery from depression takes time but treatment helps to improve quality of life for even older adults with serious medical conditions. Cognitive behavioral therapy and antidepressant medications help.
Cognitive behavioral therapy (CBT), also known as “talk therapy,” helps people change negative thinking styles and behaviors that contribute to depression. CBT works well alone or in conjunction with antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs).
Depression is a serious issue for seniors but growing older does not condemn older adults to a life of sadness. Late-onset depression is common, identifiable and treatable for nearly all who suffer from this mood disorder.
