Depression is a medical illness characterized by persistent sadness, discouragement, and loss of self-worth. These feelings are accompanied by reduced energy and concentration, sleep problems (insomnia), decreased appetite and weight loss. In the elderly, it also frequently presents with excessive concerns about bodily aches and pains.

Causes, incidence, and risk factors
Detecting depression in the elderly may be complicated by several factors. Often the symptoms of depression such as fatigue, loss of appetite, and sleeping difficulties are associated with the aging process or a medical condition rather than with major depressive disorder.

Contributing factors include the loss of a spouse or close friends, chronic pain and illness, difficulty with mobility, frustration with memory loss, difficulty adapting to changing circumstances such as moving from a home to a retirement facility, or changes within the family.

Depression can also be a sign of a medical problem. It may be complicated by brain disorders associated with the aging process such as Alzheimer’s disease.

Depression in the elderly is a widespread problem that is often not diagnosed and frequently undertreated. Many older individuals will not admit to signs and symptoms of depression for fear of being seen as weak or crazy.

Symptoms

 
• depressed or irritable mood  
• feelings of worthlessness or sadness  
• loss of interest or pleasure in daily activities  
• temper, agitation  
• change in appetite, usually a loss of appetite  
• change in weight
  • unintentional weight loss (most frequent)      
  • weight gain

   

• difficulty sleeping
       

  • daytime sleepiness      
  • difficulty falling asleep (initial insomnia)      
  • multiple awakenings through the night (middle insomnia)      
  • early morning awakening (terminal insomnia)

   

• fatigue (tiredness or weariness)
   

• difficulty concentrating
   

• memory loss
   

• abnormal thoughts, excessive or inappropriate guilt
   

• excessively irresponsible behavior pattern
   

• abnormal thoughts about death
   

• thoughts about suicide
   

• plans to commit suicide or actual suicide attempts

If these symptoms are present every day for more than 2 weeks, then depression is likely present.

Signs and tests

 
• a physical examination will help determine if there is a medical illness causing the depression  
• psychological evaluation  
• blood tests: CBC or blood differential, thyroid function tests, liver or kidney function tests  
• a variety of other tests may be indicated

Treatment
Sometimes depression can be alleviated by social interventions to help with isolation or loneliness such as group outings, volunteer work for the healthy elderly, or regular visits from concerned people.

Treatment of underlying medical conditions or the discontinuation of certain medications may alleviate symptoms.

Antidepressant drug therapy has been shown to increase quality of life in depressed elderly patients. These medications are carefully monitored for side effects, and doses are usually lower and increased slower than in adults. Neuroleptic medications may help treat agitation in some individuals. Electroconvulsive therapy (ECT) may be indicated in the severely depressed if other measures are unsuccessful.

Expectations (prognosis)
If detected, depression may respond to medical treatment. Undetected, it may lead to complications. The outcome is usually worse for those who have limited access to social services, or family or friends who can help promote an interest in activities.

Complications
Depression may be complicated by Alzheimer’s disease or other forms of dementia. It may also complicate other medical conditions in the elderly. Untreated depression in the elderly is associated with a high rate of suicide.

Calling your health care provider
Call your health care provider if you are feeling worthless or hopeless or if you are crying frequently. Also call if you feel that you are having difficulty coping with stresses in your life and want a referral for counseling.

Go to the nearest emergency room or call your local emergency number (such as 911) if you are having thoughts of suicide or of taking your own life.

If you are caring for an aging family member and think they might be suffering from depression, contact their health care provider. Often, older patients will not admit to signs and symptoms of depression out of pride.

Prevention
Prevention is related to the contributing factors. Social supports that help deal with losses, mobility changes, and so on can be helpful. In many cases, there is no effective prevention.