Depression is not a normal part of aging, but it’s often treated that way by primary care doctors and even seniors themselves. The problem can be missed or ignored, and even when it’s recognized, you—or a loved one—may not get the appropriate treatment.

IS IT DEPRESSION?

Contrary to the stereotype, depression is actually not more common in healthy seniors compared with younger adults. Unfortunately, many doctors assume that depression is a normal and difficult to treat response to aging, and either miss or neglect the many reversible factors that can be addressed.

Older people are less likely to recognize depression in themselves and, when they do, are more likely to try to tough it out rather than ask for help. There are still many misconceptions about depression—58% of adults over age 65 think depression comes with aging. Even among those who recognize it as a disease, many think it’s something they can manage on their own, without professional help.

What does change later in life are some of the risk factors for depression, such as struggling with a debilitating disease like dementia and Parkinson’s, heart disease, cancer, arthritis or the after-effects of having a stroke. Losses are another common trigger—losing a spouse or adjusting to retirement can both be stressful.  About 17% of seniors who become widowed meet the criteria for depression after one year.

Depression can also be a side effect of a medication you’re taking. A study that looked at medication use in more than 26,000 adults found that more than one-third were using a prescription medication that could cause depression. Two of the riskier drug classes are narcotic pain medications and benzodiazepines—these are tranquilizers often taken for anxiety (itself a possible symptom of depression) or sleep.

If you’re concerned about depression in yourself or a loved one, know that sadness might not be the only or even the most obvious symptom of depression in later years. Depression does not just affect the mood and the mind. It’s a disease of the whole body.

In fact, older people who are depressed are more likely to report physical symptoms than emotional ones, such as:

  • A lack of energy and/or increase in fatigue
  • Confusion, memory loss and difficulty making decisions
  • Slowed movement or speech
  • Either a loss of or increase in appetite and corresponding weight changes
  • Sleeping more or less than usual
  • Aches and pains, such as headaches, cramps, an upset stomach or other digestive issues
  • Acting agitated

OVERCOMING TREATMENT CHALLENGES

Complicating the picture, seniors with depression do not respond to treatment as well as younger people. Research that followed over 1,000 patients with depression for two years found that patients age 70 or older were more likely to still have depression after that time, more likely to have frequent symptoms, and less likely to show improvement than younger people.

There are specific reasons for this. The longer a patient has depression before getting a diagnosis, the more challenging it is to treat. Seniors may also be less likely than younger people to use psychotherapy (talk therapy), an important part of a comprehensive treatment plan. Antidepressants may not work as well in people who have some cognitive impairment—changes in an aging brain may make brain chemicals that should respond to antidepressants less responsive, making psychotherapy even more essential.

The biggest reason of all is that seniors aren’t typically treated by a geriatric psychiatrist, one who specializes in seniors. A primary care doctor or even a psychiatrist without this special training may not be skilled enough for your needs. Indeed, most seniors treated for depression are treated by their primary care doctors—less than 3% of people over age 65 with depression ever see a mental health specialist. If their only treatment is a prescription for an antidepressant, it stands to reason that depression will be worse for them. No antidepressants are better in terms of effectiveness, but their side effect profiles are important to consider. So, while some of the older antidepressants are actually some of the best in terms of effect, their side effects pose too many risks in later life. A geriatric psychiatrist will not only better understand a drug’s effect on each individual, but will also be able to tease out symptoms of depression from symptoms of separate medical conditions and help patients overcome resistance to working with a psychotherapist. With this combination of medication and psychotherapy, treatment can be just as effective as for younger people.

Complementary therapies can augment the positive effects of talk therapy and medication. Exercise, such as walking, and a healthy diet,can go a long way to improving mood.

Important: Know that unrecognized or undertreated depression in seniors can be extremely dangerous. Suicide is a real risk among the elderly. About 20% of suicides occur in people age 65 and older. Men over age 85 have a six-times higher suicide rate than the average American. Any thoughts or talk of suicide should prompt a loved one to reach out urgently to a mental health specialist or even a suicide hotline.

Still, there’s good reason to be positive about managing depression in later life. With age comes better control of emotions, less impulsivity and more resiliency. Combined with the right care, these traits can help conquer depression.