“Diagnosis is complicated because medical conditions or medications can cause symptoms of depression, such as weight loss or appetite change, psychomotor retardation, loss of energy or fatigue, insomnia or hypersomnia, and difficulty concentrating,” according to the authors of this review.
While symptoms tend to be similar across the life span, Dr. Marchand noted that there are differences in how depression manifests in younger versus older populations.
For instance, compared with younger individuals, the elderly are more likely to experience weight loss, anhedonia (“lack of response to pleasurable stimuli”), cognitive impairment and psychosis. But they’re less likely to report feelings of guilt and worthlessness, he said.
What Triggers Depression in Seniors
Many biological and psychological factors may contribute to late-life depression. This includes dysregulation of the hypothalamic-pituitary-adrenal axis and disruption of a person’s sleep cycle and circadian rhythms, Marchand said.
Elderly individuals also may struggle with significant stressors, such as the death of a spouse or close friends. They may struggle with loss of independence and living with a chronic medical illness, Marchand said.
Depression tends to affect individuals with unremitting health conditions. And, according to the Centers for Disease Control and Prevention, 80 percent of older adults have at least one chronic health condition, and 50 percent have two or more.
Depression also is associated with dementia and other medical conditions, such as hypothyroidism, Marchand said.
Treatment for Depression in Seniors
The first step in treating depression in the elderly, Marchand said, is to rule out medical causes. A doctor should review the medications an individual is taking, since “some can cause depressive symptoms, and, in most cases, some basic laboratory tests should be done.” This includes “blood count, urinalysis, thyroid function tests, vitamin B12 and folate levels and chemistry panel.”
It also might be necessary to perform a physical exam and electrocardiogram, he said. If medication or a medical illness is causing the depression, then the physician will treat the underlying condition, he said.
In general, effective treatment for depression in the elderly is the same for younger patients: “medication, psychotherapy or both.” (A combination typically is most helpful.) The dose of antidepressant medication, however, might be lower.
“For those with severe depression who do not respond to medication, electroconvulsive therapy (ECT) is often recommended.”
Preventing Suicide in Seniors
Whether a person has suicidal thoughts or not, it’s important that the treating physician or therapist creates a safety plan, Marchand said. “The plan should include specific steps to take if suicidal thoughts develop.”
He also emphasized that suicidal thinking is an emergency that requires immediate help. “Readers should call the National Suicide Prevention Lifeline, call their medical or mental health provider, go to a local emergency room or call 911.”
The National Suicide Prevention Lifeline — 1-800-273-TALK (8255) – is available 24 hours a day. There’s also a special crisis line – which you can reach by calling the Lifeline and pressing 1 – and website for veterans and their families.
“Starting with one’s primary care provider is an approach that works for many,” Marchand said. Be sure to clearly state that you’re concerned about depression, he said.
Another option is to schedule an appointment with a psychiatrist or other mental health practitioner, such as a psychologist.
Marchand also suggested visiting the Geriatric Mental Health Foundation, which includes referrals to geriatric psychiatrists in the U.S. and Canada.
If you’re a loved one of a senior with depression, providing emotional support and helping the person find and stay in treatment are critical, he said. “It can be very helpful to go with the depressed person to his first appointment.”
Depression is a serious illness. Fortunately, it’s also treatable. If you think you have depression, please see a mental health professional for an evaluation and treatment. If you’re a loved one of someone who’s struggling, help them find effective professional help right away.