Depression in Seniors: Causes & Treatment
Major depressive disorder (MDD) is incredibly common among seniors. Unfortunately, it’s often untreated. That could be because it’s misdiagnosed, or the person suffering with depression struggles to find quality treatment with tolerable side effects.
Fortunately, there’s an abundance of research on depression among the aging population. This has led to better outcomes for the many seniors who suffer from the mental illness.
How Many Seniors Have Depression?
Roughly 6 million Americans aged 65 and older suffer from major depressive disorder. It can be more difficult to detect than depression among younger people, in part because physical illnesses can mask mental health issues. That means an even higher number of elderly Americans could be suffering from MDD without realizing it. Only 10% of seniors with depression receive treatment.
Depression is a dangerous condition, but it may be even more so for the elderly. MDD makes recovering from a physical illness more difficult, and depression has even been shown to increase the risk of death following a heart attack.
What causes depression in Seniors?
Depression is often caused by significant life challenges or changes. Events that commonly trigger depression include:
- A break-up
- Everyday stress
But seniors face some risk factors that other age groups are less likely to experience:
- The death of a spouse
- Leaving work and entering retirement
- Decreased physical ability
- Social isolation
- Physical conditions like heart disease, stroke, and cancer
- Medications that cause depressive side effects or side effects that can lead to depression, like insomnia
- Changes in brain chemistry that occur as people age
What Causes Depression?
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Signs & Symptoms of Depression in the Elderly
Depression in seniors can look very different from depression in other age groups. Some warning signs may resemble other conditions or even the normal effects of aging. This is why it’s important to know the difference between what’s normal and what isn’t.
Symptoms of depression in later life:
- Feelings of hopelessness, helplessness, guilt, or worthlessness
- Fatigue or decreased energy
- Moving or talking more slowly
- Insomnia or oversleeping
- Physical aches and pains without a physical cause
- Cramps or digestive problems
- Poor memory
- Difficulty concentrating and making decisions
- Loss of interest in activities once enjoyed
To indicate clinical depression, any of the above symptoms should persist for more than two weeks.
If you notice these signs and symptoms in yourself or a loved one, reach out for help. Suicide is prevalent among the elderly: 20.1% of all suicides occur in people 85 and older, and 51 of every 100,000 white men aged 85 and older die by suicide.
Treatment for Depression in Seniors
If you’re suffering from depression, you have hope. There are a variety of effective treatment options available for seniors. The first thing to do is reach out to your doctor or mental health professional. They’ll be able to best screen for depression based on their knowledge of your health and family history. They can prescribe treatment based on other medical conditions you may have and medications you’re taking.
It’s important to remember that what works for one person may not work for another. More than one treatment is often needed before finding the route to relief, and sometimes the best way forward is a combination of treatments.
Antidepressants are generally just as effective for seniors as they are for any other age group. Your doctor will likely prescribe an SSRI first, like citalopram (Celexa®), sertraline (Zoloft®), or fluoxetine (Prozac®). Your doctor will consider potential drug interactions when prescribing an antidepressant.
Certain side effects of SSRIs can be more pronounced and dangerous in the elderly. SSRIs can cause hypotension and sedation. They can also cause hyponatremia, a condition resulting from low sodium levels. SSRIs can contribute to upper GI tract bleeding among seniors. The level of risk for these conditions can vary from person to person.
If SSRIs aren’t effective, other options include:
- SNRIs (Effexor®, Cymbalta®)
- Atypical antidepressants (Remeron)
- Tricyclics (Gamanil®)
Many of the side effects of SSRIs can occur to a greater degree with these other types of antidepressants. Increased risk of falls is a common side effect. The risks versus benefits should be weighed carefully by you and your doctor.
Antidepressant Side Effects
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Psychotherapy or Talk Therapy
Clinical talk therapies like cognitive-behavioral therapy can be effective for geriatric depression. This is especially true if you’re undergoing major life changes or stressors. Talk therapy is also a good option if you can’t safely take medications due to drug interactions or side effects.
Talk therapy can take many forms:
- One-on-one meetings with a licensed therapist
- Support groups, such as bereavement groups
- Self-help, such as meditation
- Support from family and friends
These can go a long way toward relieving your depression symptoms.
Transcranial Magnetic Stimulation (TMS)
Transcranial magnetic stimulation, or TMS, is a drug-free depression treatment that’s also virtually free of side effects. It works by stimulating cells in your prefrontal cortex through electromagnetic pulses. These pulses are delivered painlessly by an electromagnetic coil placed gently against your head.
Treatment sessions are short (18 to 19 minutes), non-invasive, and don’t require any anesthetic or preparation. You can get back to your day as soon as you’ve finished one.
Clinical trials have shown TMS to work quickly to combat depression and that these results are long-lasting.
TMS is an especially great option for seniors because:
- It’s medication-free.
- It causes few, if any, side effects – You may feel slight discomfort during treatment, but this usually goes away after the first week.
- It’s FDA-approved and covered by many insurance companies.
TMS has been shown to be effective specifically in the aging population. In one study among senior recipients of TMS, 42% of senior patients’ mental health symptoms were tracked over a 6-week period. Sixty-four percent were diagnosed with severe depression. After TMS treatment, 69% showed significant reduction in symptoms of depression, and 59.5% achieved remission.