Depression is a medical disorder— just like diabetes, high blood pressure, or heart disease — that requires attention. Day after day depression affects thoughts, feelings, physical health, and behaviors. Depression is not just “feeling blue” or “down in the dumps.” It is not just being sad after a loss. It is not an ordinary part of aging.
Why is it important?
Major depression affects up to 15% to 20% of people older than 65 years of age.
10% to 20% of patients develop chronic depressive symptoms despite treatment
25% to 30% of patients fail to respond to initial therapy. (1)
90% will NOT seek out the help or their depression will be missed or ignored, denying them beneficial treatment for mental health problems.(1)
Health problems: frailty, illness and disability; chronic or severe pain; cognitive decline; damage to body image due to surgery or disease.
Loneliness and isolation: Living alone; a dwindling social circle due to deaths or relocation; decreased mobility due to illness or loss of driving privileges.
Reduced sense of purpose: Feelings of purposelessness or loss of identity due to retirement or physical limitations on activities.
Fears – Fear of death or dying; anxiety over financial problems or health issues.
Recent bereavements –death of friends, family members, and pets; the loss of a spouse or partner. (3)
Depression red flags include:
abandoning or losing interest in hobbies or other pleasurable pastimes,
social withdrawal and isolation (reluctance to be with friends, engage in activities, or leave home)
weight loss or loss of appetite
sleep disturbances (difficulty falling asleep or staying asleep, oversleeping, or daytime sleepiness)
loss of self-worth (worries about being a burden, feelings of worthlessness, self-loathing)
increased use of alcohol or other drugs
fixation on death; suicidal thoughts or attempts
Often presents atypically which may include:
non-specific features of irritability
calling out and restlessness
may co-exist with dementia
Factors suggestive of higher risk of suicide include:
Evidence of Plan/intent
Significant loss of support
Goal of treatment is remission: assess treatment using Patient Health Questionnaire–9 (2)
Treatment can be pharmaceutical (antidepressants) or non-pharmaceutical. Factors to guideantidepressant choice can include previous response, concurrent conditions, type of depression, other medications, and risk of overdose.(1)ECT can be particularly effective in treating depression in elderly.
1. Frank, C. (2014) Pharmacologic treatment of depression in the elderly. Canadian Family Physician (CFP) vol. 60 no. 2, 121-126, February 2014. Retrieved Feb. 2014 from: http://www.cfp.ca/content/60/2/121.full
2. Dickinson, J., Gorber, S.C., Jaramillo, A., Joffres, M., Lewin, G., Pottie, K., Shaw, E. and Tonelli, M. Canadian Task Force on Preventive Health Care, Recommendations on screening for depression in adults. CMAJ June 11, 2013 vol. 185 no. 9. Retrieved March 2014 from: http://www.cmaj.ca/content/185/9/775.full.pdf+html