Depression in healthy older people is less common than it is in healthy younger people, but depression and aging can be a dangerous mix for seniors dealing with chronic illness and loss of independence. Depression is the most important risk factor for suicide in the elderly, and older white men commit suicide more often than any other group.
Although 80 percent of depression in the elderly can be treated, there are special concerns that the combination of aging and depression present.
• Chronic illness. Diseases of aging like dementia may have symptoms that mimic, mask, or make depression worse.
• Denial. Many elderly people, and even some caregivers, may assume that depression is a normal part of aging. Some elderly may think of depression as a weakness and are too ashamed to get help.
• Different response to treatment. Elderly people may be more sensitive to some types of antidepressant medications and may be more likely to experience side effects. On the other hand, they may respond better to simple group therapies that include exercise.
Depression may begin with an evaluation of the person’s medications. Often adjusting or stopping medications may be helpful and discovering other ways to treat mild depression would be valuable
• Psychosocial treatment. Therapy that addresses social interaction is very important for many elderly people. Often a type of intervention that relieves loneliness goes a long way—group fitness can be very effective.
• Talk therapy. This therapy may be resorted to before medications. Studies show that this type works as well as medication for mild depression.
• Social support. In addition to treatment, establishing a support system is particularly important for seniors. This may include group meals, arranging for visiting nurses, and encouraging activities like volunteer work that reestablish purpose and social engagement in elderly.
When social support and talk therapy are not enough, other types of treatment like antidepressants and electroconvulsive therapy (ECT) can be used in addition to psychotherapy and support.
• Antidepressants. Antidepressant medication like selective serotonin reuptake inhibitors (SSRIs) work slowly for elderly.
• ECT. Sometimes called shock therapy, this treatment has been shown to be very helpful for severe depression in the elderly when other treatments are not enough.
• Duration of treatment. For a first episode of depression in the elderly, treatment should continue for six months to one year after symptoms have been relieved.
It is important for elderly persons and their caregivers to understand that symptoms of depression are not a normal part of aging.