Depression in Older Adults

My mother’s only brother was 15 years older than her. When his wife of 45 years died of cancer, he had a very difficult time adjusting to “single life” again. Despite being surrounded by family and friends, he committed suicide a few years after his wife passed away. He must have had depression, but was never diagnosed; no one in the family even thought he was depressed. My father recently passed away and my mother is the same age my uncle was when he committed suicide. I am worried that my mother might develop depression or try to commit suicide. What signs should I look for? How can I prevent this from happening?

Dealing with Depression

Dear Dealing with Depression,

Depression is often underdiagnosed, especially in the older population. Fifteen percent of older adults living in the community have depression and greater than 50% of nursing home residents have depression. Caucasian men over the age of 85 have one of the highest suicide rates in our country.

Depression presents very differently in the geriatric population. Older adults with depression will often complain of vague symptoms such as insomnia, lethargy, fatigue, increased aches and pains, slowed functioning, decreased appetite, apathy, memory impairment or just not wanting to or being able to do the things they used to do. Often times patients (and their families) attribute these symptoms to normal aging and do not discuss these findings with a doctor. If you notice any of these symptoms in your mother or she just feels down, you should take her to a geriatrician or a psychiatrist who is trained in diagnosing depression in the older population.

Your doctor should first screen for depression. However, if the patient states that they are depressed, a screening test is not required; older people rarely say they are depressed when they are not. The physician may also get lab tests to make sure that there is not another cause for depressive symptoms, such as thyroid hormone imbalances or vitamin deficiencies. The physician should also perform a thorough review of all the medications your mother takes to make sure that her symptoms are not a side effect of one of her medications.

There are many medications that can be used to successfully treat depression in the older adult; some of the SSRIs have a low side effect profile as well as a low potential to interact with other medications. Occasionally more than one medication may be needed to treat the depression adequately. Depression medications take a while to take effect, so please be patient as your doctor starts a treatment program. A first episode of depression is usually treated for at least one year. Additionally, counseling and daily exercise is highly beneficial in treating depression and should be started at the same time as the medication.

Please keep in mind that if a person ever tells you that they would like to harm themselves or others, they should be taken to the emergency department or an inpatient psychiatric facility immediately.

The Doctor

Depression in Older Adults