Everyone feels down or sad sometimes, but these feelings usually pass after a few days. When you have depression, you have trouble with daily life for weeks at a time. Depression is a serious illness that needs treatment. If left untreated, depression can lead to suicide.

Depression is a common problem among older adults, but it is not a normal part of aging. It may be overlooked because for some older adults who have depression, sadness is not their main symptom. They may have other, less obvious symptoms of depression or they may not be willing to talk about their feelings. Therefore, doctors may be less likely to recognize that their patient has depression.

Different forms of Depression?

There are several forms of depression. The most common forms are:

Major depression

—severe symptoms that interfere with your ability to work, sleep, study, eat, and enjoy life. Some people may experience only a single episode within their lifetime, but more often a person may have multiple episodes.

Dysthymic disorder, or dysthymia

—depressive symptoms that last a long time (2 years or longer) but are less severe than those of major depression.

Signs and Symptoms of Depression

Different people have different symptoms. Some symptoms of depression include:

  • Feeling sad or "empty"
  • Feeling hopeless, irritable, anxious, or guilty
  • Loss of interest in favorite activities
  • Feeling very tired
  • Not being able to concentrate or remember details
  • Not being able to sleep, or sleeping too much
  • Overeating, or not wanting to eat at all
  • Thoughts of suicide, suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems.
  • Basic Etiologies of Depression:

    Endogenous Depression
  • Reactionary Depression
  • Traumatization
  • Depression from Excessive Early Life Adversity
  • Depression from illness or brain damage, such as stroke.

    Endogenous Depression

    Endogenous depression relates to the temperament a person is born with and the attitudes within their environment that shape the way a person views life.

    An endogenously depressed person will have spent a large part of their life in a low mood or depressed but they do not have to stay in that frame of mind.

    If a person can think positive thoughts then they can change their mood and everyone is capable of thinking positive thoughts. They need to change their intentional bias from negativity to positivity.

    Reactionary Depression

    Reactionary depression is based on situational stressors.

    A common form of reactionary depression comes from a person setting a goal that is in some way inappropriate. Their low mood is signaling a need to change goals.

    A typical example is when a person says to themselves “If I just work harder, I’ll get ahead of this thing and it will be okay.” But they have to give up too much of what makes life worth living in order to work harder on that one thing, like they stop taking care of themselves, stop having fun and put more energy into the inappropriate goal.

    The Serenity Prayer addresses the basic issue. It is: God, grant me the serenity to accept things I cannot change, Help me change the things I can, And give me the wisdom to know the difference. A person does not have to actually say this prayer. They need to think about the things in their life that they can and cannot change while maintaining a healthy, contented life for themselves.

    What causes depression?

    Several factors, or a combination of factors, may contribute to depression.

    Genes—people with a family history of depression may be more likely to develop it than those whose families do not have the illness. Older adults who had depression when they were younger are more at risk for developing depression in late life than those who did not have the illness earlier in life.

    Brain chemistry—people with depression may have different brain chemistry than those without the illness.

    Stress—loss of a loved one, a difficult relationship, or any stressful situation may trigger depression.

    For older adults who experience depression for the first time later in life, the depression may be related to changes that occur in the brain and body as a person ages. For example, older adults may suffer from restricted blood flow, a condition called ischemia. Over time, blood vessels may stiffen and prevent blood from flowing normally to the body’s organs, including the brain.

    If this happens, an older adult with no family history of depression may develop what is sometimes called “vascular depression.” Those with vascular depression also may be at risk for heart disease, stroke, or other vascular illness.

    Depression can also co-occur with other serious medical illnesses such as diabetes, cancer, heart disease, and Parkinson’s disease. Depression can make these conditions worse, and vice versa. Sometimes, medications taken for these illnesses may cause side effects that contribute to depression. A doctor experienced in treating these complicated illnesses can help work out the best treatment strategy.

    How is depression typically treated?

    The first step to getting appropriate treatment is to visit a doctor. Certain medications or conditions can cause symptoms similar to depression. A doctor can rule out these factors by doing a complete physical exam, interview, and lab tests.

    If these other factors can be ruled out, the doctor may refer you to a mental health professional, such as a psychologist, counselor, social worker, or psychiatrist. Some doctors are specially trained to treat depression and other mental illnesses in older adults.

    The doctor or mental health professional will ask about the history of your symptoms, such as when they started, how long they have lasted, their severity, whether they have occurred before, and if so, whether they were treated and how. He or she will then diagnose the depression and work with you to choose the most appropriate treatment.

    It is important to remember that a person with depression cannot simply "snap out of it." Treatment choices differ for each person, and sometimes different treatments must be tried until you find one that works.

    Medications called antidepressants can treat depression but they can take several weeks to work. Antidepressants can have side effects including:

  • Headache
  • Nausea—feeling sick to your stomach
  • Difficulty sleeping or nervousness
  • Agitation or restlessness
  • Sexual problems.
  • The side effects may lessen over time. Talk to your doctor about any side effects you have.

    Older adults often respond well to stimulant medications including bupropion and methylphenidate. These medicines counter the fatigue, sleepiness, low energy, and poor concentration associated with depression. They also have the benefit of working fairly quickly. Particularly methylphenidate works immediately and it's benefits can be more accurately evaluated.

    Psychotherapy can also treat depression. Psychotherapy helps by teaching new ways of thinking and behaving, and changing habits that may be contributing to the depression. Therapy can help you understand and work through difficult relationships or situations that may be causing your depression or making it worse.

    For a person to really overcome depression they have to recognize that their depressive feelings are not going to lead them out of depression. They need to realize that they will have to make an effort to do things that they know intellectually, are good for them even though emotionally they "don't feel like it."

    Psychotherapists encourage their patients to:

  • Exercise - exercise affects the same neurotransmitters in the brain as antidepressant medicines and with as much potency but without the negative side effects.
  • Maintain a healthy diet
  • Learn to regulate a negative mood by introducing positive thoughts.
  • Make a plan to have fun.
  • Learn to focus on the present, that is, you don’t have to worry about something if it hasn’t happened yet.
  • Practice visualizing coping. For example, consider a fearful thought such as “Oh no what if ______ happens.” Then visualize the bad thing happens and you coping with it, resourcefully, in the best way possible, that is, visualize what you can do to make it work out the right way.
  • Practice helping other people give you what you need. For example, remind them when your birthday is coming, so that they will not forget.
  • How can I help a loved one who is depressed?

    If you know someone who has depression, first help them see a doctor or mental health professional.

  • Offer support, understanding, patience, and encouragement.
  • Talk to them, and listen carefully.
  • Never ignore comments about suicide, and report them to your loved one’s therapist or doctor.
  • Invite them out for walks, outings, and other activities.
  • Remind them that with time and effort, the depression will lift.
  • How can I help myself if I am depressed?

    As you continue treatment, gradually you will start to feel better. Remember that if you are taking an antidepressant, it may take several weeks for it to start working. If a first antidepressant does not work, be open to trying another. You may need to try a few different medications before finding one that works for you.

    Try to do things that you used to enjoy before you had depression. Studies have shown that doing these things, even when you don’t expect to enjoy them, can help lift your spirits. Go easy on yourself. Other things that may help include:

  • Breaking up large tasks into small ones, and doing what you can as you can. Don’t do too many things at once.
  • Spending time with other people and talking to a friend or relative about your feelings.
  • Once you have a treatment plan, stick to it. It will take time for treatment to work.
  • Avoid making important life decisions while under the cloud of depression. Ask yourself what would you do if you weren't depressed. If there is any doubt, discuss decisions with others who know you well.
  • If you are in a crisis

    Older adults with depression are at risk for suicide. In fact, men age 85 and older have the highest suicide rate in the United States.

    If you are thinking about harming yourself or attempting suicide, tell someone who can help immediately.

  • Call your doctor.
  • Call 911 for emergency services.
  • Go to the nearest hospital emergency room.
  • Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); to be connected to a trained counselor at a suicide crisis center nearest you.
  • References: The U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES National Institutes of Health NIH Publication No. QF 11-7697