Over 2 million Americans over the age of 65 experience depression. This doesn’t mean it’s inevitable in older age, however — far from it!

As an older adult, you may be experiencing new health concerns, adjusting to retirement, or even processing the loss of a loved one. Or, you may be thriving, but still coming to terms with your own mortality.

At any stage of life, it’s natural to feel sad as you accept losses along with time’s passage.

Sometimes though, sadness turns to hopelessness. It seems harder to reach out to people or to eat or sleep as you typically do. If symptoms persist daily for two or more weeks, you — or an older loved one in your life — may have depression.

Depression looks and feels different depending on the age group. In children, it may present as irritability or fatigue, while adults may have difficulties concentrating or lose interest in things they once enjoyed.

For seniors, symptoms of depression may be overlooked or simply considered a natural part of aging.

Also, other health concerns may mimic, cause, coexist with, or get mistaken for depression. A mental health professional can help determine this.

Here’s the good news: Depression is very treatable and you have options.

The National Institute on Aging outlines these different types of depression in older adults:

  • Major depressive disorder. If you’re unable to do daily chores or you experience disruptive symptoms for two or more weeks, it’s possible you may have major depressive disorder.
  • Persistent depressive disorder (dysthymia). You may have persistent depressive disorder, aka dysthymia, if you feel depressed (joyless, lethargic) for more than two years, but still accomplish your daily activities.
  • Substance/medication-induced depressive disorder. This type of depression may result from the prolonged use of alcohol or pain medication.
  • Depressive disorder due to a medical condition. Another health condition, such as dementia or heart disease, may be causing you to feel depressed.

Symptoms of depression

Depression in older adults may look similar to depression in younger adults. Only a mental health professional can diagnose depression, but it’s helpful to know what to look for.

It could be beneficial to consider changes in how you feel.

Are you:

  • fatigued?
  • disinterested in things you love?
  • overwhelmed by the thought of socializing?
  • feeling hopeless or worthless?

It’s also helpful to look at changes in how and what you’re thinking.

Do you:

  • believe there’s no point in doing anything?
  • rehash your mistakes?
  • contemplate death or even suicide?

Unexplained changes in behavior can also signal possible depression. If you have depression, you may be experiencing these symptoms:

  • sleeping too much or too little
  • eating too much or too little
  • decreased interest in getting dressed or bathing
  • communicating less with others
  • forgetting appointments
  • feeling pains that can’t be linked by doctors to a medical cause

The American Psychological Association (APA) suggests that compared to younger adults, older adults experience some symptoms of depression more intensely, including:

  • higher rates of insomnia
  • higher rates of memory loss
  • slower than typical reaction times
  • difficulty making decisions or sustaining attention

You may wish to seek help if you notice that your symptoms start to interfere with tasks that require a little more concentration, such as:

  • cooking
  • driving
  • taking medications

Is it dementia or is it depression?

Apathy, forgetfulness, and confusion are hallmarks of dementia and depression. Sometimes dementia can trigger depression, and in some cases, the two can coexist.

It’s important to rule out depression before jumping to a diagnosis of dementia. The treatments for each will be different.

If you’re an older adult living with depression, you may notice — and feel distressed by — any new signs of forgetfulness.

A person with dementia, though, may be less likely to notice the changes. Only a mental health professional can diagnose depression and recommend medication and treatment, if necessary.

Cultural background

Cultural background can also impact how depression is expressed.

Older adults from some backgrounds may talk about their feelings of unhappiness. Others will express depression through physical symptoms, such as stomach issues or headaches.

According to the World Health Organization (WHO), depression affects about 5% of the world’s older adult population.

  • A literature review suggests that 2% of adults aged 55 and over experience major depression, and 10% to 15% of older adults have symptoms of clinical depression, even without experiencing major depression.
  • The rate of depression goes up with increasing age.
  • Although adults aged 65 and older account for only 13% of the U.S. population, they account for 20% of all deaths by suicide.

The majority of older adults living in the community are not depressed, according to the Centers for Disease Control and Prevention (CDC). The picture changes somewhat for older adults in living situations to accommodate advanced age or health concerns.

  • Only 1% to 5% of adults living in the community experience major depression.
  • Of adults who need home healthcare, 13.5% are depressed.
  • About 11.5% of hospitalized older patients have major depression.

What stops some depressed seniors from getting help?

In the 65 and older age bracket, only 38% of adults believe that depression is a medical problem, and only 42% say they would seek help from a medical professional, according to Mental Health America.

There are some myths that may inhibit older adults and their care providers from seeking help for depression. They include:

  • Prolonged sadness is inevitable because aging is hard.
  • Symptoms must be due to some other health problem, like dementia.
  • “I should be able to snap out of it.”

Cultural background can also be a driving force in whether older adults will seek help for mental health issues.

Mental Health America suggests Black Americans may not report symptoms if they view mental illness as weakness and treatment as a luxury.

Meanwhile, the suicide rate among white men 85 years old and older is the highest of any other demographic — nearly four times larger than that of the broader population. Some think this might be because older white males believe that reaching out for help is a sign of weakness.

Older adults who are religious may see depression as a lack of faith. This can prevent them from seeking mental health help for symptoms of depression.

Depression is not connected to a lack of willpower. Life situations, medical conditions, and medications can all contribute to depression in older adults.

Situational causes

  • bereavement
  • elder abuse
  • isolation
  • changes in housing
  • changes in mobility
  • retirement
  • living with a lower household income

Medical causes

  • substance use
  • a family history or personal history of depression
  • low serotonin and norepinephrine levels
  • other medical conditions, such as Parkinson’s disease, stroke, dementia, heart disease, cancer, and arthritis
  • decreased folate levels

Medications contributing to depression

There are some medications that may also increase an older adult’s chance of depression, including:

  • beta-blockers for blood pressure
  • ACE inhibitors for blood pressure
  • protein pump inhibitors (PPIs) for acid reflux

If you’re an older adult and you’re experiencing symptoms of depression, consider reaching out to your medical doctor. They may be able to refer you to a mental health professional who can help.

You may be given a screening test — such as the Geriatric Depression Scale or the Mini-Mental State Examination — to help determine if you may have depression.

Treatment for depression in older adults is similar to that for any adult living with depression: medication, therapy, or a combination of both. However, there may be some special considerations.

Medication

  • Medications used to treat depression are called antidepressants.
  • Antidepressants don’t work overnight. You may notice a lightening of symptoms after two weeks.
  • Possible side effects can include intestinal distress, weight changes, and drowsiness.
  • If side effects worsen, you and your doctor can discuss changing your dose or medication.
  • Call your doctor immediately if you have dramatic mood changes or thoughts of suicide.

As an older adult, there are a few extra factors about medication you may want to consider:

  • If you take multiple medications, you may be at risk for more interactions.
  • If your medication can make you less alert, you may need a plan to reduce the risk of falls.
  • If your medication can cause forgetfulness, consider a plan so that you don’t miss doses.
  • It’s not safe to cut doses or stop medication without a doctor’s guidance.
  • A recent study suggests that antidepressants may increase the risk of Alzheimer’s in older adults.
  • Some research supports selective serotonin reuptake inhibitors (SSRIs) as the first pharmacological choice in treating both Alzheimer’s and depression, however.

Psychotherapy

Psychotherapy (or “talk therapy”) can help treat depression without medication. It encourages healthy ways to cope with stresses, including new:

  • thought and behavioral patterns
  • relational patterns
  • habits
  • problem-solving strategies

If your depression is severe, you may wish to consider both psychotherapy and medication.

Therapies focused on emotions, behaviors, and structured activities may help older adults with both Alzheimer’s and depression.

Depression cannot necessarily be prevented. However, some lifestyle changes can improve mental health, and complementary therapies may help aid medical and psychological treatments in easing depression.

Helpful actions to consider if you have depression include:

  • connecting with friends
  • joining a church, community center, or library program
  • adding exercising — such as dancing, swimming, yoga, or walking — into your daily routine
  • cutting back on alcohol
  • eating balanced, nutritious meals
  • maintaining a consistent sleep schedule

If you know an older adult who is living with depression, or you’re a caregiver for an older adult having symptoms of depression, there are some ways you can help support and care for them.

  • Encourage conversations with healthcare professionals.
  • Be gentle when introducing new ideas.
  • Help research resources for recreation and socializing.
  • Offer assistance tracking medicines and appointments.
  • Assist with social media and virtual connections.
  • Offer rides and healthy meal preparation.
  • Help find low-cost healthcare. The National Institute for Mental Health suggests a nationwide directory of clinics.

If you have symptoms of depression and they just don’t seem to go away, consider reaching out to a healthcare professional.

They can help determine if your symptoms are caused by another medical condition or if you may benefit from seeing a mental health professional.

They also may be able to recommend one that specializes in older adults. Our Find a Therapist tool may help, as well.

Here are some other resources specific to older adults that you may find helpful.

No matter what your age, help is available for depression and treatment is effective.