Symptoms of depression in the elderly

Generally the pattern of depression is similar in elderly people and younger adults and they suffer the same symptoms. However, certain symptoms are more common and some are less common in the elderly than in others.

• The elderly often do not complain of low mood.
• Elderly people often experience depression as physical symptoms.
• Anxiety is a common feature of depression in the elderly.
• Forgetfulness and confusion occur because of depression in the elderly.

The elderly are less likely to complain of low mood than younger people. When depressed, they may complain of increased aches and pains or other physical symptoms. These can be a way of expressing their depression rather than of the development of any new physical disease.

Many people who are suffering from a depressive illness experience symptoms of anxiety (such as feeling tense, on edge, panicky). The elderly are even more at risk of experiencing these symptoms. The anxiety may be more obvious than a 'low' mood.

Some older people with depression may become confused and forgetful and in severe cases of depression they can appear as if they have dementia. This is obviously very frightening for both the person with depression and others who are looking after them. However, it must be remembered that when the depression is treated these symptoms will go away.

Causes of depression in the elderly

Depression in old age may be triggered by adverse life events including: bereavement; loss of health; threat of bereavement or loss of health in a loved one. Such events are clearly more common experiences for elderly people.

In general, the elderly appear to be better able to cope with these losses than younger people, and so do not develop depression more often. However, as with younger adults, being single and having no close friends makes elderly people more vulnerable to such losses.

More recently, evidence has emerged suggesting that depression occurring for the first time in the elderly can be associated with subtle brain abnormalities, which may be detected by special brain scans. These changes may reflect hidden or undetected vascular (blood vessel) disease in the brain.

Treatment of depression in the elderly

Treatment is broadly similar to treatment in younger adults and the majority of people respond well to the same antidepressant treatments, which need at least two to four weeks to begin to work. These may be supplemented by supportive counseling by your GP.

People with more severe depression, or those who do not respond to such treatment, may need to be referred to a psychiatrist skilled in treating the elderly. They may respond to another antidepressant or to a combination of antidepressants and other drugs. Electroconvulsive therapy (ECT) can also be very effective in elderly people with severe depression and can be life transforming.

Why it is important to recognize depression in the elderly

Too often, depression is dismissed as normal for old people or it is thought it is not severe enough to need antidepressant treatment. Sadly it is often not recognised and so no consideration is given to treatment. This can lead to many months of unnecessary misery and, in some cases, to death from suicide or the physical illnesses, which can be made worse by untreated depression. Since the depression can be expected to respond to treatment, it is tragic if it is not recognized or properly treated.

Recognizing depression in the elderly

As elderly people often have physical illnesses, it can be difficult to know whether some of the symptoms (tiredness, poor sleep, poor appetite, weight loss) are due to the illness or to depression. In addition, elderly people are less likely to complain of feeling sad. However, the following symptoms may suggest a depressive illness:

• persistent sadness that does not lift with happy experiences.
• lack of interest in activities and hobbies that are normally enjoyed.
• a loss of interest in friends and socializing.
• feelings of guilt and self-blame.
• marked pessimism about the future.
• suicidal thoughts and talk of wishing one were dead.

If a few of these have developed over several weeks, then help should be sought, in the first instance from the family doctor. This is extremely important if the person has expressed any suicidal thoughts.