Depression is not part of normal aging and is one of the most common, treatable problems in older adults. Depression in older adults is under-recognized and undertreated. It may impair independence and make health problems worse.
The symptoms of depression include:
- Depressed mood most of the time
- Loss of interest or pleasure
- Disturbed sleep (too much or too little)
- Weight loss or gain
- Fatigue or loss of energy
- Feelings of worthlessness or guilt
- Difficulty in concentration
- Difficulty in decision making
- Restlessness or agitation
- Frequent thoughts of death or suicide
There are three basic types of depression. Major depressive disorder is characterized by having 5 or more of the above symptoms nearly all the time for at least two weeks. Often those with major depression feel hopeless, anxious, worry, and loss of pleasure. Minor depression is characterized by having 2-4 of the above symptoms nearly all of the time for at least two weeks. Despite calling it “minor” it is not trivial and responds to treatment. Dysthymia is a “minor” depression that is chronic, occurs most of the time for at least two years.
Whereas about 5% of older adults living independently suffer from major depression, as many as 26% experience minor depression or dysthymia. These numbers increase to 15% and 35% for those in skilled nursing homes. Left untreated depressive symptoms are persistent. Estimates suggest that 60-80% of older adults who receive appropriate treatment will become less depressed and have a higher quality of life.
Effective treatment of depression must address issues of health as well as mood. Issues such as diabetes, heart disease, arthritis, and hypertension increase the risk of depression and must also be addressed. Anxiety often co-occurs with depression and adds to the distress. Furthermore, cognitive impairment may accompany depression and complicates treatment. Caregiving for someone with cognitive as well as physical disorders often leads to depression and anxiety and must be addressed.
A large component of treating depression is re-engagement. Treatment works best when it involves a return to meaningful activities. This is often the crux of treatment as those who are depressed don’t want to exercise, be social, or go to activities. Treating depression requires getting moving despite the lack of interest or energy.
Psychotherapy for depression is effective as and may be even more effective than medications for minor depression. Short-term cognitive behavioral treatment or problem-solving therapy may be particularly helpful. If you are someone you care for suffers from depression, don’t go it alone. A course of brief therapy can restore your quality of life.