What to Know About Depression in Older Adults

Ahmed Sherif Abdel Meguid, MD, FRCPC, (pronouns: he/him) is a board-certified consultation-liaison psychiatrist and neuropsychiatrist at Inova Behavioral Health Services.

Note: Depression is not a normal part of aging. It is a treatable medical condition, and older adults are at increased risk of developing symptoms of depression (also called major depressive disorder, or MDD).

If one or more of the people you love are older than 65, here’s a quick guide to depression in older adults including what to watch out for, why it happens and how to help.

Signs and symptoms of depression in older adults

The presentation of depression symptoms varies by culture and gender. Many older adults, particularly men, won’t say they’re depressed, even if they meet the criteria for MDD diagnosis.

Signs and symptoms to watch for include:

• Feelings of sadness most of the time
• Decreased motivation to participate in activities they loved before
• Agitation or irritability
• Feelings of worthlessness, guilt, helplessness or hopelessness
• Fatigue, decreased energy
• Difficulty with memory and concentration
• Sleeping problems (not sleeping well or sleeping too much)
• Appetite problems – usually loss of appetite, although overeating can also happen
• Wishing to die or having suicidal thoughts

Risk factors for depression in older adults

• Older age
• Multiple medical conditions – about 80 percent of people 65 or older have at least one chronic medical condition, and about half have two or more
• Multiple medications for treatment of medical conditions
• Social isolation with limited social support
• Loneliness
• History of depression or psychiatric conditions in themselves or family members
• Any kind of dementia
• Lack of exercise and physical activity
• Use of alcohol and drugs

Many older adults go undiagnosed and untreated for their depression. Not only does this cause unnecessary suffering, but if depressed older adults are not taking care of themselves, it can negatively affect their other medical conditions as well.

How you can help

The good news is that most elderly people with depression improve with treatment. Here is how you can help depressed older adults in your life get help.

• Recognize the signs and symptoms of depression.
  • Typically, the people around depressed older adults are the first to notice it.

• Encourage them to seek help, understanding that you may have to overcome resistance.
  • Start the conversation by asking them how they’re feeling – they’re feeling bad right now, and you want to help them feel better.
  • You may not even want to use the word “depression.”

• Suggest starting with a visit to their primary care provider.
  • Although many older adults may not have a regular psychiatrist, chances are they do have a trusted relationship with their primary care doctor.
  • Primary care providers can screen for depression and can prescribe medications.

• Help them get to their appointments.
  • Treatment may involve counseling.
  • A lot of older adults may not be able to easily access new technology for a virtual visit, or even get to an in-person appointment easily. Help get them there and be supportive while they’re there.

• Make sure they continue treatment
  • Treatment for depression usually involves medications, and older adults need to take their medicines every day to see a benefit from them. If they have dementia or memory problems, however, this can be a challenge.
  • Monitor their medication compliance to make sure they’re taking the right doses at the right times.

Tips for older adults to help prevent depression or reduce risk

There is a lot older adults can do to prevent depression or reduce the risk of depression:

• Keep chronic medical conditions under control.
• Stay active, both physically and mentally, with regular social interaction or day programs as well as activities like crossword puzzles, sudoku or Jeopardy.
• Have a balanced and healthy diet.
• Get enough sleep, especially at night.
• Stay in touch with family and friends, both of which can give older adults a great sense of purpose and joy.
• Try to keep doing favorite activities, including hobbies and meeting with friends.

By keeping in mind the signs and symptoms of depression in older adults, as well as treatment and prevention tips, you can help the older adults in your life make the most of their golden years.

If you or someone you know is experiencing a mental health crisis, please call 911 or go to the nearest emergency room. Learn more about Inova Behavioral Health Services or about Inova’s adult mental health inpatient services specifically.