Older Adults with Depression: How to Spot it and How to Help

Getting older comes with many life changes, some of which are easier to handle than others. The aging process can also impact a person's mental health, physical limitations, lifestyle choices, and more. Whether or not these changes are positive or negative depends upon many things, such as present risk factors and other aspects of a person's life.

Sometimes, older adults face challenges, such as difficult medical conditions, social isolation, stress, and trouble adapting to various changes. While younger adults may try to be there for their relatives, show support, and let older adults know they're not alone, sometimes this, alone, won't be enough.

It is sadly not uncommon for older adults to struggle with a mental illness, such as depression. Understanding older adults with depression, what they're going through, and the appropriate treatment requires a step-by-step breakdown.

It's so important to shine a light on how depression affects our older loved ones. This condition doesn't just touch their mood; it weaves through various aspects of their lives, impacting their health, social connections, and even their enjoyment of everyday moments.

• Physical health: Depression can exacerbate pre-existing health conditions like heart disease or diabetes by affecting individuals' motivation to manage these conditions through medication adherence, diet, and exercise.
• Increased risk of mortality: Studies have shown that depression in older adults is associated with an increased risk of death, partly due to its relationship with other health problems and the potential for suicide.
• Social isolation: Older adults experiencing depression may withdraw from social interactions, which can lead to a cycle of increased loneliness and worsening depressive symptoms.
• Cognitive decline: There is evidence to suggest that depression in older adults can be linked to an increased risk of cognitive decline, including memory issues and slower processing speeds, which can affect their ability to live independently.
• Reduced quality of life: Depression can significantly impact the quality of life for older adults, affecting their daily functioning, enjoyment of life, and overall satisfaction with life stages.Warning signs of depression in older adults

Getting a diagnosis of depression

If you or an older adult in your life is struggling with mental health, getting an official diagnosis from a medical professional may be a good idea. In order to get a diagnosis of depression, you'll first need to meet with a doctor. Typically, they'll first perform a physical exam and ask about the symptoms you're experiencing. Medical professionals may also inquire about your family history, previous health complications, or another medical condition you may have experienced in the past.

For older patients, a doctor may perform various tests to find out if other health complications - such as calcium channel blockers - could be causing symptoms of depression. If not, a psychological evaluation typically comes next. It's during this time that medical professionals ask about your emotions, life experiences, and other factors that impact your mental health. Once all of this information has been assessed, older adults will then receive a diagnosis from the doctor, along with recommended treatment options.

Certain medications commonly prescribed to older adults can have side effects that may contribute to or worsen depression. It's important to manage these conditions carefully, especially in older adults who may be more sensitive to medication side effects. Here are some common types of medications that might have depression as a side effect:

• Beta-Blockers: Used to treat hypertension, heart conditions, and migraines, beta-blockers like propranolol (Inderal) and metoprolol (Lopressor) can sometimes lead to depression.
• Corticosteroids: Also known as steroids, they are often prescribed for conditions like asthma, arthritis, and lupus, corticosteroids like prednisone can have mood-altering effects, including increased risk of depression.
• Statins: These cholesterol-lowering medications, such as atorvastatin (Lipitor) and simvastatin (Zocor), have been linked in some cases to mood changes, including depression.
• Proton Pump Inhibitors (PPIs): Used to treat gastroesophageal reflux disease (GERD) and peptic ulcers, medications like omeprazole (Prilosec) and esomeprazole (Nexium) have been associated with an increased risk of depression in some studies.
• Calcium Channel Blockers: Medications like amlodipine (Norvasc) and diltiazem (Cardizem), used for high blood pressure and heart conditions, have been reported to affect mood in some individuals.
• Hormonal Medications: This includes treatments for prostate cancer (such as androgen deprivation therapy) and hormone replacement therapy (HRT) for menopause symptoms, which can impact mood and contribute to depression.

Getting a diagnosis of depression

If you or an older adult in your life is struggling with mental health, getting an official diagnosis from a medical professional may be a good idea. In order to get a diagnosis of depression, you'll first need to meet with a doctor. Typically, they'll first perform a physical exam and ask about the symptoms you're experiencing. Medical professionals may also inquire about your family history, previous health complications, or another medical condition you may have experienced in the past.

For older patients, a doctor may perform various tests to find out if other health complications - such as calcium channel blockers - could be causing symptoms of depression. If not, a psychological evaluation typically comes next. It's during this time that medical professionals ask about your emotions, life experiences, and other factors that impact your mental health. Once all of this information has been assessed, older adults will then receive a diagnosis from the doctor, along with recommended treatment options.

Despite the medical community's extensive findings on older people who struggle with mental illness, there are still some very common misconceptions about depression. Understanding and tackling this challenge goes beyond just knowing the risk factors, understanding the value of support groups, and implementing healthy lifestyle changes.

Another essential part of helping older adults who face depression is doing away with misinformation as it pertains to this mood disorder.

• Depression is a normal part of aging: Many believe that feeling depressed is just another aspect of growing older. However, depression is not a natural or inevitable part of the aging process but a serious mental health condition that affects people of all ages.
• Depression symptoms are always different in older adults: While it's true that older adults might sometimes express or experience symptoms of depression differently, the core symptoms of depression do not change with age. Older adults can experience the same range of symptoms as younger individuals, including sadness, loss of interest in activities, and changes in appetite and sleep.
• Depression in older adults is primarily due to medical conditions: Another misconception is that depression in older adults is always linked to other medical issues and, therefore, is less about mental health and more about physical health. While physical health problems can contribute to or exacerbate depression, depression itself is a distinct condition that requires specific treatment.
• Older adults are less likely to benefit from treatment: Some believe that depression treatments, such as psychotherapy or medication, are less effective in older adults. However, research shows that older adults can respond well to treatment. Effective management and treatment of depression are possible and can significantly improve quality of life.
• Older adults don't want or need psychotherapy: There's a myth that older people are either too set in their ways for therapy or that they do not see the value in it. On the contrary, many older adults find therapy to be a valuable tool for dealing with depression, especially when it's tailored to their specific needs and life experiences.
• Depression is less serious in older adults: Some may underestimate the severity of depression in older adults, mistakenly thinking that because they are at a later stage in life, the impacts of depression are not as serious. In reality, depression can have profound effects on an older adult's quality of life, physical health, and mortality risk.
• Social isolation and loneliness are just part of getting older: While older adults may face greater risks of social isolation and loneliness, these are not inevitable aspects of aging and can be both a cause and a symptom of depression. Social connections are crucial for mental health at any age.

Navigating the path to wellness for older adults with depression involves a compassionate blend of medical interventions, lifestyle adjustments, and supportive care. Understanding the breadth of treatment options can empower both older adults and their caregivers to make informed decisions that enhance quality of life. Let's explore these options with warmth, understanding, and professionalism:

• Medication management: Antidepressants can be effective in managing symptoms of depression, but it's crucial to find the right medication at the right dose. Older adults may respond differently to these medications, and side effects can vary. Regular consultations with healthcare providers ensure that any prescribed medication supports overall well-being without compromising other aspects of health.
• Psychotherapy: Also known as talk therapy, psychotherapy can be particularly beneficial for older adults. Therapies like cognitive-behavioral therapy (CBT) help individuals change negative thought patterns and develop coping strategies. Sessions can be tailored to address the unique challenges and concerns that come with aging.
• Lifestyle modifications: Simple changes in daily habits can significantly impact mood and mental health. Encouraging a healthy diet, regular physical activity, and sufficient sleep are foundational steps. Activities that promote relaxation and stress reduction, such as mindfulness and yoga, can also be beneficial.
• Social support: Strengthening social connections combats loneliness and isolation, common triggers for depression in older adults. Participation in community groups, senior centers, or hobby clubs can provide meaningful interaction and a sense of belonging.
• Home health services: For older adults who may have difficulty accessing in-person appointments, home health services can bring support directly to them. These services can include nursing care, counseling, and physical therapy, tailored to meet their needs in the comfort of their own home.
• Assistive technology: Tools and devices designed to aid those with mobility or cognitive challenges can improve independence and reduce frustration, contributing to a more positive outlook on life.
• Integrated care: Addressing coexisting medical conditions is vital, as physical health significantly impacts mental health. An integrated care approach ensures that treatment plans for medical conditions are coordinated with depression treatment, optimizing overall health.
• Alternative therapies: While more research is needed, some older adults may find relief from symptoms of depression through acupuncture, massage therapy, or herbal supplements. These should be explored under the guidance of a healthcare professional to avoid interactions with other treatments.

A note about the positive impact of senior living on mental health

Moving into a senior living community can significantly uplift the mental health of older adults, particularly those grappling with depression. These communities are not just about providing care; they're about fostering a supportive environment that nurtures emotional well-being:

• Social connections: Senior living communities actively combat loneliness by creating a vibrant social atmosphere. Regularly scheduled activities and communal spaces encourage interactions, helping residents build friendships and a sense of belonging, which are vital for mental health.
• Structured activities: Engaging in a variety of planned activities can bring joy and a sense of purpose. Whether it's through art, fitness, or learning, these activities stimulate the mind and body, contributing to improved mood and well-being.
• Professional support: Access to mental health services within the community means that help is always close at hand. Whether it's counseling or therapy sessions, these services are designed to address the unique challenges faced by older adults.
• Safety and security: The peace of mind that comes from living in a safe environment with easy access to medical care can alleviate anxiety and stress, making it easier for residents to focus on their mental health and happiness.
• Reduces stress of daily living: By taking care of household chores and maintenance, senior living communities allow residents to focus on what truly matters to them, reducing daily stressors that can impact mental health.

While self help, antidepressants, and therapy can go a long way for older adults who face mental health challenges, so does support from other people. Unfortunately, the people who love depressed older adults may be unsure of how to help. In many cases, there's a fear of saying or doing the wrong things that can worsen an already delicate mental health condition.

• Consult with a primary care doctor: First up, if they haven't already done so, encourage them to talk with their primary care doctor to rule out any medication side effects or undiagnosed medical issues that could be contributing to their depression. This step can help ensure that their treatment plan is comprehensive and tailored to their specific needs.Just listen: Offering a safe space for older adults with depression to share their feelings is incredibly valuable. Sometimes, they just need someone to listen, which can significantly contribute to their sense of being understood and supported.
• Avoid judgment: It's important to keep an open mind and avoid passing judgment. Each person's experience with depression is unique, and showing understanding without judgment encourages more open conversations.
• Support positive changes: If their therapist recommends lifestyle changes, such as getting more fresh air or engaging in social activities, offering your support can make a big difference. Whether it's a walk in the park or a coffee date, your involvement shows you care.
• Encourage professional help: Many older adults may not be aware of the treatment options available for depression. Gently suggesting the possibility of therapy or support groups can be a turning point for them.
• Assist with daily tasks: Helping with everyday chores like grocery store runs or cooking can alleviate stress and provide them with more time to focus on recovery and self-care, showing your support in a very practical way. If your loved one is ok with receiving the help, this can take a huge load off their plate, giving them more time to practice therapy, adjust to taking antidepressants, or simply just rest after a long day.
• Respect boundaries: It's crucial to respect their need for space or alone time. Honoring their boundaries, even if it means stepping back, can be an important part of supporting their mental health journey.
• Suggest or plan outings: Helping them find reasons to leave the house can be a great boost to their mood and overall mental health. Planning simple outings, like a trip to a favorite museum, a movie, or even a nature walk, can provide something to look forward to and an opportunity for gentle exercise and social interaction.

Educate yourself

Depression is defined by the National Institute of Mental Health (NIMH) as a mood disorder that impacts how individuals think, feel, and handle day-to-day tasks, such as eating, resting, and going to work.

Sometimes, depression can be more readily apparent in certain individuals than others; nevertheless, this doesn't take away from the gravity of this mental disorder or the importance of getting treatment for it.

In order for younger adults or older adults to be diagnosed as depressed, they have to face depression symptoms for at least two weeks. Depression can influence people from all walks of life, regardless of their gender, race, age, or ethnicity.

In the case of older adults, depression may materialize more easily if there are other risk factors present in their lives. Sometimes, older adults with depression aren't even aware they're facing mental health problems. This is partially due to certain stigmas that have surrounded the topic of mental health for quite some time.

Unfortunately, it is not uncommon for people to dismiss depressive symptoms as simply feeling sad or under the weather. Unlike sadness, however, clinical depression does not simply fade away; in fact, without support, treatment, and intervention, older adults who develop depression can see their symptoms worsen.

If you or someone you know is facing depression or another mental health condition, seeking help is absolutely imperative. Many available resources, such as support groups and talk therapy, exist to help individuals who may be facing mental disorders like depression.

What are depression symptoms?

Depression in older adults is best detected via an understanding of depressive symptoms. Many people acutely grasp that helplessness, irritability, and loneliness are common symptoms of depression. However, this mood disorder goes far beyond these three emotions.

In fact, depression can adversely impact a person's ability to think, function, and get through their day.

Having a concrete understanding of depression symptoms is the very first step to helping older adults with this mood disorder seek help. To date, depressive symptoms materialize on emotional, behavioral, and physical levels.

Emotional symptoms

On an emotional level, an older person who has depression may feel empty, numb, and apathetic to people and hobbies they once enjoyed. Emotions of despair, anxiety, and hopelessness are common, as is lacking energy on a regular basis or feeling as though you're just going through the motions each day.

Isolation is also commonly associated with depression. Depressed older adults may face challenges with human connection or relating to other people around them. Restlessness, anger over seemingly minor things, and a lack of self-esteem are other emotional tolls that come along with depression.

Behavioral symptoms

Symptoms of depression show up not just in a person's emotions, but also in their behavior towards themselves and others. Severe depression can cause an older adult to physically harm themselves or attempt to commit suicide.

A depressed elderly person may likewise have trouble with thinking clearly, articulating their feelings, or making choices. Loss of interest in intimacy, concentration problems, and either sleeping too much or too little all fall under the umbrella of behavioral depressive symptoms.

In other cases, older adults who experience depression turn to excessive amounts of drugs, alcohol, or other risky substances in order to cope. These can be used to numb feelings of pain, isolate from others, or otherwise disassociate.

Physical symptoms

When facing depression, physical health problems in an elderly person are not uncommon. Older adults with depression may therefore experience throbbing pains or aches in the body. These physical problems often include discomfort in the back, limbs, and chronic joints.

Among other physical symptoms of depression are gastrointestinal issues, sleep interruptions, significant psychomotor shifts, and even excessive hunger. Sometimes, this mood disorder can even make a person appear to others in a physically drained or tired state. Appearing lifeless behind the eyes also makes the list of depressive symptoms.

A depressed mood is no joke

As you can imagine from the emotional, behavioral, and physical symptoms associated with major depression, this form of mental illness is no joke. Younger people and older adults who face depression can benefit from getting help as quickly as possible.

If any of the above symptoms resonate with you, reaching out for emotional support and assistance from others is highly recommended. This can provide a necessary lifeline in real time, while also putting you on track to see major improvements in your mental health.

If you know an older person who is showing depressive symptoms, reaching out to them, offering a helping hand, and letting them know you're there can make a huge difference. Many people who experience depression want to seek help, yet may not know how to do so.

Combating depressive symptoms - along with depression itself - is also much easier for people who know they have loved ones in their corner.

Most common types of depression

Just as the symptoms of depression often vary, so do the different forms of this mood disorder. Depression in older adults doesn't always look the same, but it's critical to pinpoint the differences and understand how they can impact people in old age.

The following forms of depression are most common amongst people facing this mood disorder in older age:

Major depressive disorder

Older adults can be clinically diagnosed as having major depressive disorder once they've had one serious episode of depression within 14 days. This form of depression can be recurring on a monthly or yearly basis. It can also emerge on and off throughout a person's life.

Major depressive disorder is also sometimes referred to as clinical depression, owing to the regular emergence of "low" moods.

Bipolar depression

A mental health condition like bipolar disorder comes with high and low mood swings. During the low periods, depression is a common psychological reaction. Someone who experiences depression as a result of bipolar disorder may come with a loss of interest in daily activities and depleted energy. Research suggests that irritability, hopelessness, and immense sadness are also a normal part of bipolar depression.

Persistent depressive disorder

Older adults with persistent depressive disorder often face chronic and ongoing depressed moods. While the medical community acknowledges this as less severe than major depression, the impacts are still quite debilitating.

Some folks who face persistent depressive disorder are able to navigate life and go to work every day; however, they also face regular feelings of irritability, stress, and fatigue. It's also not uncommon for someone facing this mental health challenge to believe the emotional symptoms are simply a part of their personality.

Because of this misconception, they may be more likely to dismiss someone who reaches out to offer help and less likely to seek support on their own. Diagnoses for persistent depressive disorder typically come after someone's faced these symptoms for more than two years without a consecutive, two-month lapse.

Seasonal affective disorder (SAD)

Some older adults with a depressed mood may only experience symptoms during certain times of the year, such as during the late fall and/or early winter. Most cases of seasonal affective disorder generally go away by the time spring and summer emerge.

Due to the sporadic nature of this mental health challenge, affected individuals may not recognize a need to seek help. Nevertheless, seasonal affective disorder is tied to major changes in appetite, weight gain, social withdrawal, and fatigue. Older adults with SAD are also known to struggle with concentration and experience intense cravings for foods with carbohydrates.

The medical community has theorized that seasonal affective disorder may emerge as a result of disruptions to circadian rhythms, a decrease in serotonin levels, and changes to melatonin production during certain times of the year.

Ongoing efforts to understand the underlying causes and reasons behind this form of depression remain ongoing.

Psychotic depression

An older person with psychotic depression often experiences extreme delusions and hallucinations in the middle of a depressive episode.

The common symptoms of this disorder are quite extreme. Psychotically depressed individuals can become paranoid or immediately distrustful of others. They may believe the people in their immediate environments are working to get them or otherwise up to something nefarious.

Because of the hallucinations and delusions that accompany psychotic depression, these episodes are often quite dangerous to both the depressed older adult and those around them. There's also an increased risk of physical harm, seeing as psychosis can lead to seeing and hearing things that don't actually exist.

Depression in older adults doesn't have to be permanent

Depression symptoms are notoriously difficult, overwhelmingly, and oftentimes persistent. Despite the challenges posed by this mental disorder, overcoming depression, getting treatment, and enjoying a great life afterward is very much possible.

Each of these steps can be facilitated by people knowing the warnings signs of depression, understanding how to seek help, and recognizing the risk factors associated with depressive symptoms. It's also important for people to realize that vices like substance abuse, social isolation, and toxic relationships can worsen depressive symptoms.

Every older adult's story is different and no two people will have the exact same runs with this mood disorder. Some may experience depression as a result of a tragedy or other lifestyle change. Others could have a higher predisposition to the illness as a result of family history or other factors.

At the end of the day, depression never has to be a final destination. Whether through therapy or medication, older people can get treatment for depression, make healthy lifestyle medications, and begin a new lease on life.

Anyone who faces depression can benefit from having loved ones in their corner. Whether this means having people remind them to take certain medications, running certain errands, or simply hopping on the phone with them a few times per week, a strong support system can work miracles.

In batting mental health challenges, knowing you have people to rely upon is a great reminder than you're not alone. Older adults especially need to know this and feel the presences of loved ones in their lives.

The time it takes to recover from depression can vary. Some people who receive treatment have noticed positive signs of improvement in a matter of weeks. However, a variety of individual factors can impact each person's recovery journey.

Older adults who are working to bounce back from depression should remember to take things one step at a time and not feel like they need to rush. Taking medication as prescribed, attending therapy on a regular basis, and embracing healthy lifestyle habits are each conducive to recovery.

If you know an older adult who you believe may be experiencing depression or symptoms of depression, passing this information along to them could be life-changing. It is never to late to seek help, improve mental health, and enjoy an amazing life.

Get Help

If you or a loved one is concerned about mental health or depression, the following resources are available:

• National Mental Health Hotline
• Veterans Crisis Line
• Crisis text line