Depression is a mental health disorder of serious concern in older adults. According to the National Institute of Mental Health (NIMH), an estimated two million of the nearly 35 million Americans over the age of 65 years have some form of diagnosable depression. An additional five million of these individuals have significant symptoms that do not meet the full diagnostic criteria for the disorder.
Depression comes in many forms, from mild sadness to a mood disorders such as major depression.Depression is frequently undiagnosed and untreated because it is often overlooked or considered normal or inevitable. This is especially true in the face of other medical conditions and life events (e.g., death of loved ones) that frequently affect older adults. However, depression is never a normal part of the aging process.
Many older adults may be particularly susceptible to the numerous complications and other risks of depression. For example, depression appears to be more likely to lead to suicide in older adults than in younger patients. Adults over the age of 65 years make up only 13 percent of the U.S. population, according to NIMH, but they make up 18 percent of all suicide deaths.
The causes of depression are still not fully understood, but a number of advances have been made in identifying potential factors. Most likely, a combination of genetic and environmental factors is involved. Depression tends to run in families and may be triggered by stress (e.g., death of a loved one). Depression is more common in women and people with chronic medical conditions.
The signs and symptoms of depression in older adults may differ from those in younger patients. Among the most common changes of mood in older adults with depression are feelings of nervousness, emptiness, restlessness, irritability or being unloved. Reduced appetite and weight loss, insomnia (not sleeping enough), fatigue, memory problems and confusion are also common in these patients. Older adults may be more likely than younger patients to display vague physical symptoms (e.g., aches and pains).
Depression in older adults is poorly recognized even among physicians. Many individuals, including many physicians, view depression as normal or expected for older adults. This belief is not true and often deters or delays proper diagnosis and treatment. When it is properly recognized, the diagnosis of depression involves a complete medical history, including information about the onset, duration and severity of symptoms.
Older patients with mild depression may respond well with psychotherapy alone, whereas those with moderate to severe depression may require antidepressant medication. However, the outcome of treatment is generally best with a combination of psychotherapy and medication. Older adults are often more sensitive than younger patients to medication side effects and are more likely to have other medical conditions. Because of this, selective serotonin reuptake inhibitors (SSRIs) are prescribed more frequently than older antidepressants.
