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Aging-Related Depression

Older adults face unique challenges that increase their risk of depression, but it is not a normal part of aging. It is important to be vigilant of the symptoms, like isolation and suicidal ideation, and seek out care as soon as possible.

Depression and Aging

Older adults make up a significant percentage of adults suffering from depression worldwide. Based on a 2022 meta-analysis out of Hubei University, the combined global prevalence of depression in older adults is estimated to be 28%.

Older adults are less likely to receive treatment for their depression because they tend to present with more physical symptoms, such as more frequent headaches and stomachaches, poor memory, sleeping too much, and having little energy. Older adults are less likely to bring these symptoms to a doctor’s attention due to embarrassment and attributing them to the aging process.

How Do I Know if It’s Depression?

An easy way to remember the symptoms of depression is using the mnemonic “SIGECAPS.” The letters in the mnemonic stand for:

  • Sleep
  • Interest
  • Guilty feelings
  • Energy (low)
  • Concentration difficulties
  • Appetite change
  • Psychomotor slowing or agitation (moving so slowly that other people notice or being restless)
  • Suicidal thoughts

In older adults, the phrasing of questions is important to increase the likelihood of detecting depression because they experience it differently than younger adults. The Geriatric Depression scale is a free screening tool designed specifically to detect symptoms of depression in older adults. The following are the questions from that scale:

  • Are you basically satisfied with your life?
  • Have you dropped many of your activities and interests?
  • Do you feel that your life is empty?
  • Do you often feel bored?
  • Are you in good spirits most of the time?
  • Are you afraid that something bad is going to happen to you?
  • Do you feel happy most of the time?
  • Do you often feel helpless?
  • Do you prefer to stay at home, rather than going out and doing things?
  • Do you feel that you have more problems with memory than most?
  • Do you think it is wonderful to be alive now?
  • Do you feel worthless the way you are now?
  • Do you feel full of energy?
  • Do you feel that your situation is hopeless?
  • Do you think that most people are better off than you are?

The tool has 15 questions, and of the 15 items, 10 indicate the presence of depression when answered with a “yes,” while the other 5 are indicative of depression when answered with a “no.” A score of 5 or higher suggests possible depression.

How Is Depression Different for Older Adults?

Depression in older adults does not present the same way it does for younger adults with depression.

Older adults are less likely to say they feel depressed and more likely to experience physical symptoms, especially changes in memory, getting sick more often, and feeling extremely tired. People often mistake depression for dementia in this population, leading to its underdiagnosis.

What Are the Risk Factors of Depression in Older Adults?

Older adults face unique challenges that put them at risk for developing depression. Risk factors of depression related to age include:

  • Presence of chronic and new medical conditions
  • Loneliness and isolation
  • Loss of loved ones
  • Decreased mobility
  • Loss of independence
  • Loss of ability to drive
  • Financial instability
  • Poor support system

Risk factors that are not unique to older adults also apply, such as a previous history of depression, family history of depression, and history of adverse events in childhood, to name a few.

What Are the Signs and Symptoms of Depression?

Depression can impact an individual’s sleep, appetite, and ability to think clearly. Common signs and symptoms of depression include:

  • Difficulty falling or staying asleep, waking up too early, or sleeping too much
  • Feeling depressed most days out of the week
  • Getting easily angered
  • Losing interest in previously enjoyed activities
  • Feeling guilty, worthless, or hopeless
  • Having low energy
  • Difficulty concentrating and being more forgetful than usual
  • Poor appetite leading to weight loss or increased appetite leading to weight gain
  • Moving and talking noticeably slower
  • Feeling restless and unable to relax
  • Thoughts of suicide

Not all symptoms have to be present to diagnose depression, and some symptoms may be a little more difficult to identify in an older adult. For example, older adults are less likely to report feeling depressed but may have more mood changes and be more easily angered.

Aging-Related Depression and Suicide

Since depression is a leading risk factor for suicidal ideation and suicide, this age group has the highest rate of suicide when compared to other age groups.

Among men aged 55 and older, the rates of death related to suicide increased with increasing age. Men who were 55–64 had a rate of suicide deaths of 26.6 per 100,000 people, those 65–74 had a rate of 26.1 per 100,000, those 75–84 had a rate of 38.2 per 100,000, and those over 85 had a rate of 55.7 suicide deaths per 100,000 people.

Disrupted sleep is a symptom of depression in older adults. Individuals may have trouble falling asleep and may lie awake for hours before getting to sleep. Sleep may become restless, and an individual may wake up multiple times throughout the night and then take a long time to get back to sleep. Individuals may also wake up much earlier than intended and be unable to get back to sleep. Some individuals may have the opposite issue and may constantly feel tired despite getting at least eight hours of sleep a night. They may have difficulty getting out of bed in the morning and need to take multiple naps throughout the day.

A 2021 systematic review out of the United Kingdom showed that the use of sleep medication was found to be a significant risk factor for depression, suggesting the role that sleep plays in the development of depression. Disrupted sleep is one of the signs of depression and poor sleep increases the likelihood of future development of depression.

What Treatments Are Available for Depression in Older Adults?

Age-related depression is often undertreated, with only 12% of adults over 65 reported being treated for depression.

Fortunately, there are many available options for the treatment of depression in older age, including talk therapy, medication, and brain therapies.

Psychotherapy

Psychotherapy is a very effective form of treatment and is recommended first in the treatment of mild depression. Cognitive-behavioral therapy is a popular form of therapy used to treat depression that is effective and works quickly. This form of therapy helps individuals examine negative thoughts, identify how those thoughts can impact behavior, and work on correcting those negative thoughts.

Medication

Medications are another effective form of treatment for depression. There are many different types of antidepressants, with popular ones including:

  • Sertraline (Zoloft)
  • Duloxetine (Cymbalta)
  • Fluoxetine (Prozac)
  • Escitalopram (Lexapro)
  • Paroxetine (Paxil)

Most antidepressants are very safe, widely available, inexpensive, and have few side effects. However, antidepressants do take at least four to six weeks to begin working.

Brain Therapies

There are also some non-medication treatments available for non-responders to standard antidepressants and therapy. These include methods like SAINT Treatment, which uses transcranial magnetic stimulation, a non-invasive treatment that uses magnetic fields to generate electrical impulses in the brain, to target specific areas affected by depression. This form of treatment is usually reserved for individuals who have tried at least 2–3 antidepressants without improvement in their symptoms.

Electroconvulsive therapy is a form of treatment that has been around for a long time. It is used to treat depression that has not responded to multiple different treatments. It involves the use of an electrical current to generate a brief seizure, which changes the brain chemistry to treat depression.

What Problems Affect The Treatment of Depression in Older Adults?

There are special considerations in the treatment of depression in older adults. As we age, medications affect our bodies differently and break down medications more slowly. This means when medications are started in older adults, they should be started at lower doses than usual and increased more slowly to avoid side effects.

Older adults are also more sensitive to side effects; many medications can cause dizziness and increase the risk of falling. Some medications can cause the opposite of the desired effect in an older adult (a paradoxical reaction), which can lead to disorientation and confusion in the older adult. For example, a medication intended to have a calming effect can cause some older adults to feel anxious, “on edge,” and unable to sleep. There is also a higher likelihood that older adults are taking other medications already, so care must be taken to avoid drug interactions.

The Council on Aging has resources specifically for older adults to help patients and caregivers navigate conditions such as depression and dementia. Your local chapter of the National Alliance On Mental Illness also offers peer support and a friendly visitor program for lonely older adults.

Depression is a common mental health condition that presents additional concerns when it occurs in older adults. If you think you or your loved one could be depressed, start by setting up an appointment with a primary care doctor for a thorough evaluation.

If there are concerns about suicide, seek emergency services immediately.

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