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Though it is not necessarily a normal part of the aging process, depression in the elderly is a widespread public health concern. More than 15% of healthy elderly people who live independently suffer depression at some time.
Depression in the elderly is quite different from depression among younger adults. It is often triggered by chronic conditions such as arthritis, diabetes, high blood pressure or heart disease. Symptoms of depression may overlap with symptoms of other illnesses such as Alzheimer's Disease, or Parkinson's Disease. According to a study published in the Journal of Clinical Psychiatry (1994), 50% of people with Alzheimer's and 35% of those with Parkinson's become clinically depressed. Many drugs can cause side effects that mimic or aggravate depressive symptoms. The cognitive deterioration typical to these diseases may make depression more difficult to diagnose.
Elderly people may not exhibit the usual symptoms of depression, complaining only that they are fatigued, or suffering from a loss of appetite.
Personal losses, an inevitable part of aging, can be distressing, and can lead to depression. Some 800,000 Americans lose their spouse each year. Within 2 months of becoming widowed, about 20% of them will meet the criteria for major depression. For about 1/3 of these people, the depression will last for up to a year.
Many doctors are reluctant to prescribe antidepressants to elderly people without a definite diagnosis of depression because many antidepressants cause side effects that are worse than depression. However, neglecting depression in the elderly is potentially life threatening. Those who are depressed are less likely to survive heart attack, cancer and stroke, or, if they do survive, their recovery takes longer.
Untreated, the depressed elderly person is at serious risk for suicide. The elderly commit suicide at a rate twice that of the rest of the population. Elderly men account for 81% of all suicides over the age of 65. Sadly, 70% of elderly people who commit suicide see their family doctors within a month before their death, and 39% have a medical encounter within a week of committing suicide.
If you are concerned that an elderly person seems depressed, suggest a complete medical exam and treatment. Reassure them, if necessary, that depression is a serious, real illness, and that it can be treated. If they are reluctant to seek help, perhaps because they believe that a mental illness is a personal failing or a show of weak character, ask their physician for help. Don't wait until the person mentions suicide. In general, the elderly talk less about suicide than younger people, but they are more likely to do it.
While antidepressants are effective in treating depression in 60 to 80% of users, there are some special considerations when prescribing them for older people:
- Depression and the Elderly from the National Institutes of Health
- Recognizing and Treating Depression: A Guide for the Elderly and Their Caregivers by Richard O'Boyle
- Understanding Geriatric Depression from RSI and ElderCare Online
- Depression and Anxiety After Surgery by Jan Allen
- Depression in the Caregiver by Dorothy Womack