Depression often goes overlooked, under-diagnosed and untreated in adults 65 years old and older. Symptoms tend to get dismissed as a standard part of aging. But they’re anything but. Depression is a serious illness that disrupts lives and increases the risk for suicide. Thankfully, however, it is treatable. Very treatable.
In her excellent, eye-opening book Depression in Later Life: An Essential Guide psychologist Deborah Serani, Psy.D, sheds light on this prevalent disorder. She shares a slew of vital facts, research and case studies about what depression looks like in seniors and what helps to treat it. Below are five important insights from Serani’s book that everyone should know.
Depression is all-too common in seniors.
Depression affects about 7 percent of seniors worldwide. It affects about 15 percent of seniors in America. Yet 90 percent don’t get diagnosed or properly treated. Part of the problem is that depression gets mistaken for other age-related issues, such as memory loss, muscle or joint weakness and medication side effects, Serani writes.
Depression may manifest differently in seniors.
Like younger individuals, seniors may experience sleep problems and loss of interest in activities they previously enjoyed. However, according to Serani, “Studies suggest seniors experience more structural changes in the brain and vascular issues, and aren’t aware that they’re feeling depressed.”
Seniors with depression tend to feel more irritated than depressed. They report more somatic complaints. They experience anxiety, unrest or feelings of fear or insecurity. Seniors might forget to eat or eat less. “Neurological changes from depression disrupt brain structures that often blunt the sense of smell and taste, which can leave the elderly with a decreased enjoyment of food,” Serani writes.
Seniors with depression more frequently have impairments in thinking, reasoning, memory and sustained effort. (Which explains why depression gets confused with memory loss.) They also often feel empty, numb and hopeless. Some are unable to cry.
Subclinical depression is more common in seniors than major depression.
That means that seniors experience some but not all the symptoms needed to receive a diagnosis of depression. It also means that they still suffer. The symptoms are still disruptive and troublesome. About 25 percent of seniors have subclinical depression. Sometimes, symptoms improve on their own. Other times they lead to major depression. Which is why it’s important to share how you’re feeling—and to seek a second opinion if your concerns are brushed aside.
Seniors are actually at greatest risk for suicide.
In particular, men 85 years and older have the highest rate of suicide. According to histories of people who died by suicide and interviews with seniors who’ve attempted suicide, five main risk factors have been identified. One risk factor is psychiatric illness. About 80 percent struggle with depression. A second risk factor is the inability to cope with stressors. Seniors at risk may have poor problem solving, anxiety and obsessive traits.
A third factor is chronic illness and pain. Seniors who were recently discharged from the hospital or nursing home have an increased risk for suicide. According to Serani, pain is “intrusive, demands attention, interrupts a sense of peace, slams to a stop any activity you’re doing, is physically unbearable, and is mentally inescapable. Pain leaves a senior feeling defeated, helpless and overwhelmed by seeking relief, which can often lead to the decision to die by suicide.”
A fourth factor is social disconnection. Seniors who lack social support or feel like they don’t have any support and experience rocky relationships are especially vulnerable. A final risk factor is functional impairment. That is, seniors who are unable to care for themselves the way they used to or have to rely on others for basic tasks feel inadequate. Their self-esteem may plummet. Risk also significantly goes up for seniors who have depression and are losing their physical or cognitive abilities.
Suicide frequently comes with warning signs—but they’re often overlooked.
Seventy-five percent of people who die by suicide exhibit warning signs. The problem is that loved ones and even professionals may miss, misunderstand or minimize these signs in seniors. They may feel helpless and unsure of what to do. They may understand their desire to die and respond with silence.
However, Serani stressed the importance that any warning sign should be seen as an emergency and treated as such. She features this list of warning signs for late-life suicide:
- Avoidant, secretive
- Breaking medical regimens or halting treatments
- Buying items that if used are lethal: rope, poison, gasoline, plastic bags, aspirin
- Distancing oneself from religious or faith-based activities
- Giving things away; money, possessions
- Increasing the use of alcohol or drugs
- Making arrangements for issues to be taken care of by others
- Making changes in wills
- No longer engaging in self-care and grooming
- Purchasing a firearm
- Preoccupation with death
- Remarks or statements that reflect a lack of concern about personal safety: It’s no big deal if I don’t wear a seatbelt. I think people live too long these days.
- Remarks or statements that reflect a time limit on being alive: I don’t think I’ll be around this Christmas. This is the last time you’ll see me.
- Researching ways to die by searching online
- Showing rage or talking about seeking revenge
- Stock-pilling medication
- Suddenly happier, calmer
- Suddenly wanting to visit or call people
- Talking about being a burden to others
- Talking about feeling hopeless or having no reason to live
- Talking about feeling trapped or in unbearable pain
- Talking about where to find paperwork, wills, bank statements, etc.
- Talking about wanting to die
Depression is a difficult and devastating illness. But, again, it’s also highly treatable. The key is to see a therapist and/or primary care physician for a comprehensive evaluation. If you’re struggling with the above symptoms, please seek help. If your loved one is struggling, please help them to seek help.
There is always hope. Always. Please, don’t throw away your shot.