Older Adults - Depression Sex And Age: Depression

Content provided by the Faculty of the Harvard Medical School

Older adults

Depression is not a normal part of aging, although many older people and their caregivers think the two go hand in hand. As people age, they do often encounter many familiar sources of depression, including losing loved ones and facing health problems. Still, depression can and should be treated in people of all ages.

About 15% of adults over age 65 have significant depressive symptoms, and about 3% have major depression. But, as noted earlier, the risk of suicide increases with age: The National Institute of Mental Health reports that older Americans are disproportionately likely to die by suicide, and that white men over age 85 have the highest suicide rates in the United States. Two studies further underscore why older people with even minor depressive symptoms need treatment: One, published in the Journal of Abnormal Psychology in 2002, found that older adults with signs of depression had diminished immune responses, which may affect their ability to fight off infections or disease. Another, published in the American Journal of Psychiatry in 2004, found that more depressive symptoms in older adults meant more limitations on daily activity and a greater need for care. People with no depressive symptoms received three hours a week of care on average, those with one to three depressive symptoms had about four hours of care a week, and those with four to eight depressive symptoms needed six hours of care a week.

Research has also linked depression to cancer and Alzheimer's disease in older people. A long-term study of more than 4,800 men and women over age 70, reported in the Journal of the National Cancer Institute, found that those who suffered from chronic depression lasting at least six years had an 88% higher risk of developing cancer. In another study, Dutch researchers followed several thousand seniors over the course of three years. They noted that the risk of developing Alzheimer's or experiencing a decline in mental powers was higher among those who were depressed.

Treating depression in the elderly

Although roadblocks to treatment exist for most individuals with depression (see "Overcoming barriers to treatment"), an older adult's road to recovery can seem especially difficult. For example, in older people, depression is sometimes mistaken for dementia (see "Is it dementia or depression?"). Or it may occur in conjunction with dementia or other illnesses that mask the depressive symptoms. Health care professionals may treat the medical illness and overlook the depression. In addition, many in this older generation mistakenly regard depression as a weakness or a shameful family secret. In fact, older people are least likely to seek help for depression. Those who do seek help may need to pay for it out of pocket or bridge a wide gap between the costs and what Medicare will cover.

Once an older person seeks treatment, other problems may arise. For example, older adults are sometimes more sensitive to side effects of antidepressants. These drugs also may not mix well with medication they take for other illnesses. For these reasons, as many as 40% of older people taking antidepressants quit or repeatedly miss doses because of side effects, memory problems, or difficulty keeping track of complicated drug regimens. Although older patients with severe depression appear to respond to antidepressant drugs about as well as younger people, they sometimes improve more slowly and relapse sooner. However, a knowledgeable doctor can help see you through these kinds of concerns.

Psychotherapy alone may help older patients with milder depression, while combining psychotherapy with medication may be helpful for those with more severe depression. Older adults in good physical and cognitive health may respond well to cognitive behavioral therapy or interpersonal therapy (see "Psychotherapy for depression and bipolar disorder"). Cognitive behavioral therapy has also shown promise among the cognitively impaired and physically ill.

The path to treatment and recovery can be difficult for older adults, but a knowledgeable doctor or therapist can help you find a treatment that's right for you.

Last updated:	January 23, 2007