Eric Lenze, M.D.

Everyone occasionally feels down or blue. The occasional blues are a normal part of life. However, feeling down without relief may be a sign of what doctors call clinical depression. Depression can happen to anyone.

Depression affects the lives of up to 15 percent of older adults, but it is not a normal part of aging. Some medical problems more common in late-life can cause or make depression worse. These include chronic medical conditions like diabetes, high blood pressure, heart disease, cancer, painful arthritis, and experiencing changes in memory. In addition, stressors such as death of a loved one, retirement from a job, or suddenly having to raise grandchildren may contribute to feelings of stress, anxiety, and ultimately depression.

When these emotions persist and start to negatively affect relationships and daily functioning, they may be a sign of clinical depression.

Symptoms of depression in late-life may include persistent sadness, difficulty enjoying previously pleasurable activities (like spending time with grandchildren or going to church), irritability, low energy, changes in sleep or appetite, feeling slowed down, and having trouble concentrating or remembering. Many older adults with depression have excessive worry and describe that it is difficult to turn off their worries. People with depression cannot “just snap out of it.”

These feelings and behaviors can be overwhelming for family and friends who find their loved one’s “moodiness” confusing, and this can cause difficulty in the relationship.

When depression is severe, older adults may think that life is not worth living or that they would be better off dead. Depression can cause people to feel like a burden to their family, and they may think that their family would be better off if they were no longer around. When people lose hope that they will get better, they may even consider taking their own lives. Suicide is the most tragic outcome of severe and untreated depression.

For some older adults, seeking help for depression may be stressful or embarrassing. Some people can’t find the words to describe how they feel, which can make them feel even more alone.

Primary care physicians are usually the first health care provider older adults speak with about their stress, mood, anxiety, loneliness, and concerns about their future. Primary care physicians are usually educated about depression and anxiety in older patients, and they want their patients to talk to them about these feelings. They know how to evaluate patients for symptoms of depression and excessive stress and anxiety. Then they can work with the patient to develop a personalized treatment plan.

Both counseling and antidepressant medications are effective treatments for depression in older adults. Many people get better with counseling or antidepressant medication alone. Some people with more difficult-to-treat depression may require both counseling and antidepressant medication offered together.

Other effective treatments include exercise (in particular aerobic activity), increasing socialization and taking steps to reduce isolation and loneliness (which may be accomplished by joining social clubs or attending senior centers), and working to promote healthy, more restful sleep.

Depression makes everything else worse. It magnifies stress and problems, and it makes other medical problems like diabetes and heart disease more difficult to treat. Encourage older adults to talk about their mood, worries, and stress level with their Primary care physicians, in order to optimize not only their mental health but their physical health too.

If you or a loved one is suffering from depression, please talk to your doctor.

You can also learn about participating in depression research studies for adults 60 years and older at Washington University School of Medicine by calling (314) 273-7034 or visiting https://healthymind.wustl.edu/.

Dr. Eric Lenze, a geriatric psychiatrist and professor of psychiatry at Washington University School of Medicine.

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