Depression in older adults is common, but should not be considered a normal part of aging. Seniors with depression often feel sad or lose interest in things that they would typically enjoy. Other symptoms may include physical pain, fatigue, memory issues, and refusal of care. Ways to start feeling better include counseling, medication or a combination of the two.
Depression is one of the most common mental health disorders in the United States. An estimated 17.3 million adults in the United States had at least one major depressive episode—that is 7.1% of all adults in the United States.1 If you or a loved one is exhibiting some of the signs and symptoms of depression, it may be helpful to talk to a therapist.
Signs & Symptoms of Depression in Older Adults
Depression is a mood disorder which affects how you feel, think and behave. Signs of depression include hopelessness, irritability, and losing interest in previously-enjoyable activities. The symptoms of depression are serious and can be debilitating. Depression can occur one time or multiple times, and it can be chronic and persistent.
Common signs and symptoms of depression include:2
- Sad, anxious or empty mood
- Hopelessness, Helplessness or Worthlessness
- Irritability or restlessness
- Loss of interest in things you would typically enjoy
- Difficulty concentrating
- Changes in eating – overeating or not eating enough
- Changes in sleeping – sleeping too little, too much or having difficulty staying asleep
- Headaches, digestive issues, aches and pains without a physical cause
- Thoughts of death or suicide
Signs & Symptoms of Depression Specific to Older Adults
Depression in older adults is common and there are several signs and symptoms which are more prevalent in older adults:3,4
- Weight loss/Geriatric Anorexia
- Memory impairment
- Insomnia
- Slowed reaction times/psychomotor retardation
- Difficulty paying attention and focusing
- Preoccupation with somatic symptoms
- Change in functioning
- Refusal of care
Types of Depression Older Adults May Experience
There are a number of different types of depression, including Major Depressive Disorder and Persistent Depressive Disorder. The common feature of all depressive disorders is a sad, irritable or empty mood which affects a person’s ability to function. What differs between the types of depression is the duration, timing, or cause of symptoms.5 Duration is the amount of time a person has been experiencing symptoms, timing refers to when the symptoms occur, and cause of symptoms describes whether there is a particular stressor that occurred which triggered the symptoms.
Types of depression older adults may experience include:5
- Major Depressive Disorder: This is characterized by a low mood or loss of interest or pleasure which lasts most of the day for nearly every day in a two week period. Major depressive disorder can be diagnosed after a single episode, but it is often recurrent.
- Persistent Depressive Disorder: Is a chronic depressed mood, lasting most of the day, more days than not for a period of at least two years.
- Substance/Medication-Induced Depressive Disorder: This is a depressed mood, similar in symptoms to Major Depressive Disorder, however the onset of symptoms occurs within one month after use of a substance/medication which is capable of producing these symptoms.
- Depressive Disorder Due to Another Medical Condition:Is a persistent depressed mood or loss of interest in pleasure which is directly related to the physiological effects of another medical condition, e.g. cerebrovascular accident (CVA), Huntington’s Disease, Parkinson’s disease, or multiple sclerosis.
Why Does Depression in Seniors Often Go Undiagnosed?
Depression in older adults is often undiagnosed or misdiagnosed. Depression in older adults may not present in the same way that it does in younger adults. When people think of depression, they think of feeling sad. Sometimes, in older adults, there are other symptoms that occur, such as refusing care, pain or weight loss, that suggest depression but may be thought to be a result of other ailments or life events.4 Many people, even physicians, can mistake symptoms of depression for symptoms of other illnesses.
Another reason depression often goes undiagnosed in older adults is because there is the false belief that the symptoms of depression are a normal part of the aging process. For example, a depressed older adult may feel aches and pains and have difficulty remembering things. These symptoms may seem like they are a normal part of aging, but they are not.
What Are the Consequences of Untreated Depression in Older Adults?
There can be serious consequences for untreated depression in older adults. Untreated depression may lead to cognitive decline and physical illness.7 Depressed older adults may have changes in eating habits, overeating or not eating enough, which can lead to other health issues, and they may experience higher rates of insomnia and memory impairment.3 Untreated depression can affect behavior and may put an older adult at a greater risk of self-neglect.
Depression in seniors is common, and it is associated with negative health outcomes, disability and costs.6 It may complicate or exacerbate existing mental or physical health problems, or create new issues.3
The Stigma of Depression Among Seniors
Older adults are more likely to seek help for other medical issues than they are for depression.7 This may be due to a perceived stigma associated with mental health issues. Older generations may still perpetuate incorrect stereotypes and discriminate against people with mental health issues. They may believe people with mental health issues are “crazy,” “dangerous,” or “insane,” and older people with mental health issues as “incompetent” or “weak.”
The stigma associated with mental health continues to negatively influence older adults’ willingness to seek treatment. Some research indicates this is the number one reason why older adults do not seek help for mental health issues, including depression.8
Treatment of Depression in Older Adults
Even in severe cases, depression can be highly treatable. There is no one-size-fits-all method of treatment for depression because people are affected by depression differently. Medication, talk therapy, or a combination of the two are the most common treatments for depression.
Psychotherapy, also called talk therapy or counseling, is an effective way to treat depression. There are many evidence-based approaches that can be used, including Cognitive Behavioral Therapy (CBT), Solution Focused treatment, or Acceptance and Commitment Therapy (ACT). Psychotherapy is performed by a clinician who specializes in mental health treatment, such as a Psychiatrist, Psychologist, Licensed Clinical Social Worker (LCSW) or Licensed Practical Counselor (LPC).
It is important to seek professional assistance if you or your loved one are experiencing some of the signs and symptoms of depression and functioning is impaired. A professional, such as a primary care physician or mental health provider can help by assessing, providing formal diagnosis, and providing recommendations for treatment.
4 Ways Get Help for Depression in Older Adults
Getting help for depression is often difficult because a person who is depressed may lack the energy or motivation to be able to seek support. It is also possible that the person does not recognize they are depressed. There may be fear of judgement or stigma associated with having a mental health issue and it may be perceived as a sign of weakness. There might be worry about being a burden on loved ones.
Here are four ways to reach out and get help if you think that you or your loved one may be depressed:
1. Consult a Trusted Physician
A medical professional can assess symptoms and provide recommendations for treatment. You may also receive information about possible medications that can help, and/or a referral to a mental health professional, e.g. Psychologist, Psychiatrist, Licensed Professional Counselor or Licensed Clinical Social Worker.
2. Talk to Someone Who Is Supportive About How You Are Feeling
It can be incredibly helpful to know that you have someone who will listen to you about how you are feeling. This person may also be able to help you in other ways, for example, they could make calls on your behalf to schedule an appointment, or accompany you to an appointment.
3. Learn More About Depression
Understanding the causes, symptoms and treatment of depression can help to eliminate any stigma and misunderstanding, which are common barriers to receiving treatment.
4. Talk to a Mental Health Professional
Psychologists, Psychiatrists, Licensed Professional Counselors and Licensed Clinical Social Workers are all trained to assess and treat depression. Typically, therapy has been done in an office setting. However, there is now the option to meet virtually, and online therapy may be a great option if you are not sure about counseling or have difficulty leaving your home.
Senior Depression Statistics
Depression is not a normal part of the aging process, and the good news is that the majority of older adults are not depressed. Estimates of the prevalence of depression in the older adult population range from 1%-5% overall, but are higher in homebound older adults (13.5%) and in hospitalized older adults (11.5%).9 Older adult women are at higher risk for depression, and this may be due to biological factors, such as hormonal changes which occur, or psychosocial factors, such as maintaining social relationships, caregiving. Widowed and unmarried older adults are also at a higher risk for depression.7
Older adults are at increased risk for depression because depression is more common in people who have other illnesses, such as cancer or heart disease. Approximately 80% of older adults have at least one chronic health condition, and it is estimated that 50% are affected by two or more.9
4 Tips for Coping With Senior Depression
If you’re struggling with depression as an older adult, these four tips can help:
1. Stay Connected
Continue to engage socially with friends, family, or others in the community. Maintaining social ties, even when you’re feeling sad, can be helpful to elevate mood.
2. Exercise & Eat Well
Physical activity and eating nourishing foods can help with mild and moderate depression.
3. Give It Time
It may take time for medication, talk therapy and lifestyle changes to begin to work and for you to feel better. Improvement in your mood may be gradual. Keeping your expectations realistic and acknowledging that it may take some time to feel better.
4. Don’t Give Up
There is no one-size-fits-all treatment for depression. It could take time to find the right medication, or figure out the best approach in psychotherapy. It may take a few tries to find a good connection with a mental health provider. Stay focused on small, achievable goals and don’t give up hope.
Depression Tests, Quizzes, & Self-Assessment Tools for Older Adults
The best way to learn whether you or your loved one may be affected by depression is to consult with a medical professional, e.g. Primary Care Physician, or a mental health professional. A medical or mental health professional is clinically trained to perform a thorough assessment and make a diagnosis. They are also trained to explore differential diagnosis—this is when the symptoms of one disease or disorder can mimic the symptoms of another.
There are assessments that can help medical and mental health professionals to identify depression in older adults. These are tools which are developed by researchers and scientists to reliably screen for symptoms, assess the severity of symptoms, and monitor the progress of treatment.
There are a few assessments for depression, used by clinicians but available to consumers, that are available for consumers to use without charge, and they are available in a few different languages:
1. Geriatric Depression Scale (GDS)
This is an assessment of symptoms of depression in older adults. It is offered in short (15 questions) and long (30 questions) form, and responses are Yes or No. It is simple to score and is indicative of whether depression is present.10 This assessment can be performed by a clinician or self-administered.
2. Patient Health Questionnaire (PHQ-9)
This is a 9 item depression scale. This is a concise way to diagnose and assess the severity of symptoms of depression. It can also be used to monitor treatment. The assessment can be performed by a clinician or self-administered.11
3. The Beck Depression Inventory II – (BDI-II)
This is a reliable tool for measuring the severity of depression in adults and also in adolescents. There are 21 questions that assess how much or how frequently a person is experiencing a particular symptom. This assessment can be performed by a clinician or self-administered.12
