Health and Wellness

Depression: A Problem for Older Adults and Elderly

By Greg Newlin, LCSW

Have you lost interest in the activities you used to enjoy? Do you struggle with feelings of helplessness and hopelessness? Are you finding it harder and harder to get through the day? If so, you’re not alone.

Depression is a common problem in older adults. The symptoms of depression affect every aspect of your life, including your energy, appetite, sleep, and interest in work, hobbies, and relationships.

Unfortunately, all too many depressed seniors fail to recognize the symptoms of depression, or don’t take the steps to get the help they need. There are many reasons depression in older adults and the elderly is so often overlooked:

  • You may assume you have good reason to be down or that depression is just part of aging.
  • You may be isolated—which in itself can lead to depression—with few around to notice your distress.
  • You may not realize that your physical complaints are signs of depression.
  • You may be reluctant to talk about your feelings or ask for help.

Feeling good as you age

Depression isn’t a sign of weakness or a character flaw. It can happen to anyone, at any age, no matter your background or your previous accomplishments in life. Similarly, physical illness, loss, and the challenges of aging don’t have to keep you down. Whether you’re 18 or 80, you don’t have to live with depression. Senior depression can be treated, and with the right support, treatment, and self-help strategies you can feel better and live a happy and vibrant life.

Causes of depression in older adults and the elderly

As you grow older, you face significant life changes that can put you at risk for depression. Causes and risk factors that contribute to depression in older adults and the elderly include:

  • Health problems – Illness and disability; chronic or severe pain; cognitive decline; damage to body image due to surgery or disease.
  • Loneliness and isolation – Living alone; a dwindling social circle due to deaths or relocation; decreased mobility due to illness or loss of driving privileges.
  • Reduced sense of purpose – Feelings of purposelessness or loss of identity due to retirement or physical limitations on activities.
  • Fears – Fear of death or dying; anxiety over financial problems or health issues.
  • Recent bereavement – The death of friends, family members, and pets; the loss of a spouse or partner.

Bereavement, loss, and depression in the elderly

As you age, you experience many losses. Loss is painful—whether it’s a loss of independence, mobility, health, your long-time career, or someone you love. Grieving over these losses is normal and healthy, even if the feelings of sadness last for a long time. Losing all hope and joy, however, is not common.

Is it grief or depression?

Distinguishing between grief and clinical depression isn’t always easy, since they share many symptoms. However, there are ways to tell the difference. Remember, grief is a roller coaster. It involves a wide variety of emotions and a mix of good and bad days. Even when you’re in the middle of the grieving process, you will have moments of pleasure or happiness. With depression, on the other hand, the feelings of emptiness and despair are constant.

While there’s no set timetable for grieving, if it doesn’t let up over time or extinguishes all signs of joy—laughing at a good joke, brightening in response to a hug, appreciating a beautiful sunset—it may be depression.

Other symptoms that suggest depression, not just grief:

  • Intense, pervasive sense of guilt.
  • Thoughts of suicide or a preoccupation with dying.
  • Feelings of hopelessness or worthlessness.
  • Slow speech and body movements.
  • Inability to function at work, home, and/or school.
  • Seeing or hearing things that aren’t there.

Depression and illness in older adults and the elderly

Depression in older adults and the elderly is often linked to physical illness, which can increase the risk for depression. Chronic pain and physical disability can understandably get you down. Symptoms of depression can also occur as part of medical problems such as dementia or as a side effect of prescription drugs.

Medical conditions can cause depression in the elderly

It’s important to be aware that medical problems can cause depression in older adults and the elderly, either directly or as a psychological reaction to the illness. Any chronic medical condition, particularly if it is painful, disabling, or life-threatening, can lead to depression or make depression symptoms worse.
These include:

  • Parkinson’s disease
  • stroke
  • heart disease
  • cancer
  • diabetes
  • thyroid disorders
  • Vitamin B12 deficiency
  • dementia and Alzheimer’s disease
  • lupus
  • multiple sclerosis

Prescription medications and depression in the elderly

Symptoms of depression are a side effect of many commonly prescribed drugs. You’re particularly at risk if you’re taking multiple medications. While the mood-related side effects of prescription medication can affect anyone, older adults are more sensitive because, as we age, our bodies become less efficient at metabolizing and processing drugs.

Medications that can cause or worsen depression include:

  • Blood pressure medication (clonidine)
  • Beta-blockers (e.g. Lopressor, Inderal)
  • Sleeping pills
  • Tranquilizers (e.g. Valium, Xanax, Halcion)
  • Calcium-channel blockers
  • Medication for Parkinson’s disease
  • Ulcer medication (e.g. Zantac, Tagamet)
  • Heart drugs containing reserpine
  • Steroids (e.g. cortisone and prednisone)
  • High-cholesterol drugs (e.g. Lipitor, Mevacor, Zocor)
  • Painkillers and arthritis drugs
  • Estrogens (e.g. Premarin, Prempro)

If you feel depressed after starting a new medication, talk to your doctor. You may be able to lower your dose or switch to another medication that doesn’t impact your mood.

Alcohol and depression in the elderly

It can be tempting to use alcohol to deal with physical and emotional pain as you get older. It may help you take your mind off an illness or make you feel less lonely. Or maybe you drink at night to help you get to sleep.

While alcohol may make you feel better in the short term, it can cause problems over time. Alcohol makes symptoms of depression, irritability, and anxiety worse and impairs your brain function. Alcohol also interacts in negative ways with numerous medications, including antidepressants. And while drinking may help you nod off, it can impair the quality of your sleep.

Signs and symptoms of depression in the elderly

Recognizing depression in the elderly starts with knowing the signs and symptoms. Depression red flags include:

  • Sadness
  • Fatigue
  • Abandoning or losing interest in hobbies or other pleasurable pastimes
  • Social withdrawal and isolation (reluctance to be with friends, engage in activities, or leave home)
  • Weight loss or loss of appetite
  • Sleep disturbances (difficulty falling asleep or staying asleep, oversleeping, or daytime sleepiness)
  • Loss of self-worth (worries about being a burden, feelings of worthlessness, self-loathing)
  • Increased use of alcohol or other drugs
  • Fixation on death; suicidal thoughts or attempts

Depression in the elderly without sadness

While depression and sadness might seem to go hand and hand, many depressed seniors claim not to feel sad at all. They may complain, instead, of low motivation, a lack of energy, or physical problems. In fact, physical complaints, such as arthritis pain or worsening headaches, are often the predominant symptom of depression in the elderly.

Depression clues in older adults

Older adults who deny feeling sad or depressed may still have major depression. Here are the clues to look for:

  • Unexplained or aggravated aches and pains
  • Feelings of hopelessness or helplessness
  • Anxiety and worries
  • Memory problems
  • Lack of motivation and energy
  • Slowed movement and speech
  • Irritability