Seven million Americans over the age of 65 suffer from depression. Unlike with many other groups, depression in the elderly often goes unrecognized or is mistaken for another condition.

While the rates of depression are fairly low for the elderly living on their own—between one and five percent—they rise dramatically with the loss of independence. Twelve percent of hospitalized patients and 14 percent of those receiving home care have depression. Various studies have found that anywhere between 29 and 52 percent of elderly people living in nursing homes suffer from depression.

Up to 90 percent of people who suffer from depression later in life don’t receive adequate care, with 78 percent receiving no treatment at all. Elderly patients diagnosed with major depressive disorder (MDD) spend nearly twice as much on health care as those without the disease. In addition, the suicide rate among people over 75 is higher than that of any other group—more than one and a half times the average.

Depression Risks in the Elderly

As people age, biological changes increase the risk of depression. Brain scans of elderly people often show atrophy of the cerebral cortex, enlargement of the ventricles, and damaged blood vessels. Brain injuries such as a stroke or as the result of coronary artery disease, diabetes, or hypertension may also lead to depression.

Neurotransmitters linked to well-being and happiness—such as serotonin, dopamine, and norepinephrine—become less abundant as people age. Many medications taken by the elderly, including steroids, benzodiazepines, and beta blockers may cause depressive symptoms. So too can life changes such as loss of independence, social isolation, and bereavement. 

Ten to 20 percent of those who have lost a spouse will develop significant depression within the first year after the loss. Left untreated, depression increases the likelihood that a person will become disabled or placed in a nursing home. It also increases the risk of death from all causes. For instance, depressed patients are at five times the risk of dying from a heart attack than those who aren’t depressed.

Recognizing Depression in the Elderly

As a group, elderly people typically respond better to treatment for depression than others do. The trick is recognizing the disease in seniors.

Older people are far more likely than others to consult general medical practitioners for symptoms of depression than turning to mental health professionals. Often, family doctors are ill-equipped to diagnose and treat mood disorders such as depression. In fact, fewer than half of those who could benefit from antidepressants receive a prescription from their doctors.

Don’t Blame the Doctor

It’s easy to overlook depression in the elderly. Often, the disease coincides with other ailments such as arthritis, pulmonary disease, or dementia. Many elderly patients take multiple medications that have side effects which can mask an underlying depression. Seniors themselves may also attempt to cover up their symptoms due to social stigmas against mental illness.

Symptoms & Diagnosis

Symptoms of depression often manifest differently in older people than they do in younger people. For instance, while frequent crying may be sign of depression in a younger person, elderly people are often more stoic, sometimes to the point of not admitting to any sadness at all. 

One way to recognize depression in the elderly is to look for significant mood changes related to life changes such as retirement, loss of independence, or the death of a spouse. Normal sadness will always accompany bereavement, but if grief is accompanied by insomnia, a change in eating habits, or a loss of enjoyment in a hobby, it may be a sign of depression.

Other symptoms to look out for are frequent anxiety, irritability and suicidal ideation. 

Suicide and the Elderly

Sadly, suicide among the elderly is common. In the U.S., people over the age of 65 make up 12 percent of the population. However, they account for 16 percent of all suicides—or 14 per 100,000 individuals—according to the Centers for Disease Control and Prevention (CDC).

White men over 85 have the highest suicide rate in the nation—nearly six times that of the general population. It’s estimated that between 20 and 40 percent of seniors who commit suicide don’t show any signs of major depression or bipolar disorder.

Often, suicide coincides with a doctor visit—20 percent on the same day, 40 percent within a week, and 70 percent within one month. Suicide triggers may include the diagnosis of a life-threatening illness, severe or chronic pain, or a loss of physical or financial independence.

The most common cause of death by suicide in the elderly is by gunshot wound (71 percent). The presence of a handgun in the home doubles the chances that a depressed elderly person would take? their own life.

Treatments for Depression in the Elderly

Selective serotonin reuptake inhibitor (SSRI) antidepressants such as paroxetine (Paxil) tend to be more effective than other treatments in elderly patients over 70.

Talk therapies have been found to be less effective among the aged than other groups due to a general unwillingness of many elderly people to discuss their feelings.

Exercise may be the best bet, as it lacks the side effects associated with antidepressants and may contribute to better overall health and well-being. Patients or their caregivers should discuss fitness options with a physician to design an exercise plan that’s age appropriate and safe.